STOMATOLOGY EDU JOURNAL 2017, Volume 4, Issue 3 SEJ_3-2017_Online - Page 59

Table 1. Indications and contra-indications of the Hall technique (adopted from Innes et al., 2009). 11 Indications include 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 Contra-indications include 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 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 carious primary molar. 12,13 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 Stomatology Edu Journal 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). THE HALL TECHNIQUE IN PAEDIATRIC DENTISTRY: A REVIEW OF THE LITERATURE AND AN “ALL HALL” CASE REPORT WITH A-24 MONTH FOLLOW UP 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 VB#