STOMATOLOGY EDU JOURNAL 2017, Volume 4, Issue 3 SEJ_3-2017_Online - Page 60

THE HALL TECHNIQUE IN PAEDIATRIC DENTISTRY: A REVIEW OF THE LITERATURE AND AN “ALL HALL” CASE REPORT WITH A-24 MONTH FOLLOW UP 210 a b Figure 2. The Hall Technique: tooth 84 with orthodontic separators mesially and distally. They are left in situ for 3-5 days. Figure 3. The Hall technique: tooth 84 before (a) and after (b) orthodontic separator removal. Notice the space thus created. Figure 4. The SSC is tried on tooth 84 using adhesive tape and patient in the supine position. Figure 5. The patient bites down on the crown using a cotton roll. The patient bites on a cotton wool roll to allow the SSC to “snap” on tooth number 84. A click is occasionally heard. B. Hall Technique: Appointment 2 1) Removal of separators: 3-7 days after the first appointment, the patient returns for the removal of the orthodontic separators. Space is created mesially and distally that will negate the need for crown preparation (see Figs. 3 a & b). 2) SSC selection and placement: The patient is sat up in the supine position and the operator selects the correct SSC in terms of tooth number and size. After selecting the correct SSC, it is tried passively on the tooth to make sure that it fits with gentle pressure applied to the SSC over the contact points but not completely through. For safety purposes the crown is stuck to the operator’s finger (See Fig. 4), while trying out the size, using an adhesive tape/elastoplast. The SSC should be neither too loose nor too tight. The crown should “spring back” from the contact points while trying it on the tooth at this stage. After crown selection, the crown should then be filled with a self- curing glass ionomer cement and positioned over and on the tooth. The operator then digitally presses the crown through the contact points so that the crown flexibly “clicks” on the tooth and fits snugly. The patient is then asked to bite on a cotton wool roll to finish off its correct positioning (see Fig. 5). The excess of the glass ionomer cement is wiped off. The crown should be level with the occlusal plane and blanching of the gingivae will be noticed buccally and lingually indicating an adequate seal (see Fig. 6). The patient may feel a little tightness; however that and the gingival blanching disappear within an hour if not less. Equated to the tightness of a brand new pair of shoes around feet, it resolves spontaneously after a while. Occasionally the bite may be raised by a millimeter. Multiple SSCs using the HT could be placed in one patient over several appointments without any LA or drilling; however it is possible to place two SSC using the HT in one appointment. 11 This is possible in: a) contra-lateral primary molars in the same arch, for example placement of two SSC on upper Es (teeth 55 and 65) or lower Ds (74, 84). b) diagonal teeth in opposing arches, for example, placement of SSCs on tooth 55 and 75, or placement of SSCs on 65 and 85. C. Hall Technique: Follow-up appointments All teeth treated with the HT should be followed up clinically and radiographically following the same protocols as conventional treatments. 9 The tooth should be assessed for pain, sinuses, swelling and radiographically for signs of interradicular radiolucency or root resorption. The bite usually resolves spontaneously due to dento-alveolar compensation within a week or two (see below). 4. Can the Hall technique be used to restore all Ds and Es in one patient? Restoring multi surface carious primary molars using conventional SSCs (i.e.; all Ds and Es in one child) after preparing them with a high speed drill has been the standard for many years. However, this is not the Stoma Edu J. 2017;4(3): 208-217