THE HALL TECHNIQUE IN PAEDIATRIC DENTISTRY : A REVIEW OF THE LITERATURE AND AN “ ALL HALL ” CASE REPORT WITH A-24 MONTH FOLLOW UP
Table 1 . Indications and contra-indications of the Hall technique ( adopted from Innes et al ., 2009 ). 11
Indications include
Contra-indications include
United Kingdom ( UK ) as a child friendly treatment approach . 11
2 . Conventional management of the carious primary molar It is well known that primary tooth decay management represents a challenge for those who dentally care for children , whether they are general dental practitioners ( GDPs ) or specialists in paediatric dentistry . For the past five decades , the dental literature in the United States of America ( USA ) and Europe had advocated treating the deep carious primary molar in using the conventional “ drill and fill ” philosophy . That is , give LA to the child by injection to anaesthetise the tooth , drill the carious tissue out ( often after placing a rubber dam ) using a high and slow speed drill , restore the primary tooth with a restorative material ( often a preformed stainless steel crown or SSC ) after carrying out pulp therapy . Although aesthetic crowns are available for primary teeth ( made from Zirconia ), they are very expensive and require protracted tooth preparation ; thus the SSC remains the crown of choice for the
12 , 13 carious primary molar .
Class I lesion , non-cavitated , if patient unable to accept fissure sealant , or conventional restoration Class I lesion , cavitated , if patient unable to accept partial caries removal technique , or conventional restoration Class II lesions , cavitated or non-cavitated Teeth with signs or symptoms of irreversible pulpitis , or dental sepsis ( pulpal pathosis ) Teeth with clinical or radiographic signs of pulpal exposure , or periradicular pathology
Teeth with crowns so broken down with caries , they would normally be considered as unrestorable with conventional techniques Patients at risk of infective endocarditis
molar but not as a replacement for conventional methods . 3.2 . Clinical Steps of the HT The HT involves the following simple steps that are usually carried out over a couple of five minute appointments . A . Hall technique : Appointment One 1 ) Case selection : It involves diagnosing asymptomatic early enamel and dentine caries in a primary molar ; clinically and radiographically ( using bitewings usually or a periapical ). Bitewings or periapicials ( See Fig . 1 ) may typically show approximal lesions that are not visible clinically but are diagnosed radiographically . There should be a clear radiolucent band between the carious lesion and the pulp of the tooth intended to be restored with the HT . There should be no signs or symptoms of pulpal pathosis ; the lesion should be detected prior to the development of symptoms ( See Table 1 ). 2 ) Fitting orthodontic separators : It involves the placement of two elastic orthodontic separators , mesially and distally , on tooth intended for restoration with a HT ( see Fig . 2 ).
Case Reports
3 . The Hall technique : “ Sealing in ” caries The HT concept 9 recommended a simple way in managing early enamel and dentinal decay in the primary molar using a SSC ; this technique involved no LA , no rubber dam , no drilling and took place in a child friendly play manner . In essence there was no dental caries removal at all from the carious lesion . The technique relied on sealing the carious lesion in situ cutting off its supply of sugary substrate , thus altering the bacterial plaque of the lesion ultimately leading to the arrest of the caries process in the tooth . 3.1 . Indications for the HT SSCs placed using the HT are not suitable for all child patients with caries . There are selection criteria 11 that should be assessed before considering this technique . These are summarized in Table 1 . The dentist should consider the HT as one of the available clinical methods for treating the carious primary
Figure 1 . A periapical radiograph showing caries DO to 84 . The tooth was asymptomatic and the caries was not visible clinically . Radiographically there is a band of dentine separating the lesion from the pulp . This tooth is suitable for the HT . ( Image courtesy of Dr Amal Mahmoud )
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