Despite advances in preventive dentistry, dental caries is increasing in children. In addition, the prevalence of developmental defects of tooth structure (enamel hypomineralisation and hypoplasia) in young children is increasing in general dental practice. Management of the pulpally involved or severely compromised primary tooth poses considerable challenges for clinicians providing care of the child patient. Vital pulp therapy and stainless steel crowns are proven, dependable and efficient treatment options in the primary dentition as a means of maintaining the tooth and space for the permanent successor, whilst minimising the need for re-treatment. Case selection through appropriate diagnosis is essential to the long-term success of the procedures. In some cases, it may be appropriate to extract a primary tooth. We will discuss the reasons it may be preferable to extract a tooth and the options for space management. These options will include practical demonstrations and hands-on experience with the construction of a chairside space maintainer. 

Stainless steel crowns may be indicated in permanent molars when there has been enamel hypomineralisation, significant breakdown of the crown and pulpal sensitivity. The procedure is more complex than for primary crowns but the results are again reliable and predictable. Restoration with stainless steel crowns can provide an effective interim restoration with a view to considering planned extractions at the appropriate developmental stage.