The Hall Technique; a randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice: acceptability of the technique and outcomes at 23 months

<p>Abstract</p> <p>Background</p> <p>Scotland has high levels of untreated dental caries in primary teeth. The Hall Technique is a simplified method of managing carious primary molars using preformed metal crowns (PMCs) cemented with no local anaesthesia, caries removal or tooth preparation. This study compared the acceptability of the Hall Technique for children, their carers, and dentists, and clinical outcomes for the technique, with conventional restorations.</p> <p>Methods</p> <p>General dental practice based, split mouth, randomized controlled trial (132 children, aged 3–10). General dental practitioners (GDPs, n = 17) in Tayside, Scotland (dmft 2.7) placed conventional (Control) restorations in carious primary molars, and Hall Technique PMCs on the contralateral molar (matched clinically and radiographically). Dentists ranked the degree of discomfort they felt the child experienced for each procedure; then children, their carers and dentists stated which technique they preferred. The teeth were followed up clinically and radiographically.</p> <p>Results</p> <p>128 conventional restorations were placed on 132 control teeth, and 128 PMCs on 132 intervention teeth. Using a 5 point scale, 118 Hall PMCs (89%) were rated as no apparent discomfort up to mild, not significant; for Control restorations the figure was 103 (78%). Significant, unacceptable discomfort was recorded for two Hall PMCs (1.5%) and six Control restorations (4.5%). 77% of children, 83% of carers and 81% of dentists who expressed a preference, preferred the Hall technique, and this was significant (Chi square, p < 0.0001). There were 124 children (94% of the initial sample) with a minimum follow-up of 23 months. The Hall PMCs outperformed the Control restorations:</p> <p>a) 'Major' failures (signs and symptoms of irreversible pulpal disease): 19 Control restorations (15%); three Hall PMCs (2%) (P < 0.000);</p> <p>b) 'Minor' failures (loss of restoration, caries progression): 57 Control restorations (46%); six Hall PMCs (5%) (P < 0.000)</p> <p>c) Pain: 13 Control restorations (11%); two Hall PMCs (2%) (P = 0.003).</p> <p>Conclusion</p> <p>The Hall Technique was preferred to conventional restorations by the majority of children, carers and GDPs. After two years, Hall PMCs showed more favourable outcomes for pulpal health and restoration longevity than conventional restorations. The Hall Technique appears to offer an effective treatment option for carious primary molar teeth.</p> <p>Trial registration number</p> <p>Current Controlled Trials ISRCTN47267892 – A randomized controlled trial in primary care of a novel method of using preformed metal crowns to manage decay in primary molar teeth: the Hall technique.</p

Managing dental caries in children:improving acceptability and outcomes through changing priorities and understanding the disease

This new approach to dentistry for children with dental caries provides a deliverable treatment philosophy for practitioners. It centres around leading children into adulthood with a caries-free permanent dentition, with responsibility and ability to care for their mouth and teeth, and without fear of dental treatment. There are three parts: changing attitudes and priorities; redressing the balance of prevention; and taking advantage of new understanding around caries and the biofilm, applying it to less invasive dental treatments which are easier for children to cope with. While dentistry for children should be of as high a standard as for adults, it is not the same as dentistry for adults

The Hall Technique

The contemporary view of caries management focuses on treating carious lesions using less invasive treatment options. The Hall Technique is an innovative, less invasive, operative management option, in which preformed metal crowns (PMCs) are used to seal carious lesions with dentin involvement in primary molars using a glass ionomer luting cement. Thus, removal of carious tissue, tooth preparation, or the use of local anesthesia are not required for the Hall Technique. The PMCs are simply pushed over the tooth, to isolate and seal the carious lesions from the oral cavity, resulting in reduction of the nutrient supply and consequently carious lesion arrest. This makes the Hall Technique a technically simple procedure to perform, in terms of clinical skills, and is well accepted by dentists, children, and their parents. However, it should not be considered as a quick solution to the problem of treating all carious primary molars in children who are unable to cooperate with more invasive treatment. For success, the Hall Technique requires careful case selection, precise carious lesion and pulpal diagnosis, good patient management, and parental cooperation. The Hall Technique is an effective treatment option for management of asymptomatic dentin carious lesions in primary molars with long-term high success rates and is, with a strong evidence base, recommended as part of our armamentarium for everyday use in pediatric dentistry

Modern approaches to caries management of the primary dentition

When prevention of dental caries fails, and a child is exposed to the risk of pain and infection, the disease must be managed to reduce this risk. There is growing evidence supporting more 'biological' and fewer 'surgical' approaches to managing dental caries in primary teeth. These biological methods include partial and stepwise caries removal procedures, as well as techniques where no caries is removed. An overview of clinical trials comparing these biological methods to complete caries removal shows that they perform as well as traditional methods and have the advantage of reducing the incidence of iatrogenic pulpal exposures. The Hall Technique is one biological approach to managing caries in primary molars which involves sealing caries beneath preformed metal (stainless steel) crowns. The crown is cemented over the tooth without caries removal, tooth preparation or use of local anaesthesia. The clinical steps for the Hall Technique are straightforward but, as with all dental care provision, appropriate treatment planning for the procedure requires skill. The Hall Technique offers another method of managing early to moderately advanced, active carious lesions in primary molars, with good evidence of effectiveness and acceptability. This evidence aligns with the positive findings of other studies on biological strategies for managing caries in primary teeth