STOMATOLOGY EDU JOURNAL 2017, Volume 4, Issue 3 SEJ_3-2017_Online - Page 62

THE HALL TECHNIQUE IN PAEDIATRIC DENTISTRY: A REVIEW OF THE LITERATURE AND AN “ALL HALL” CASE REPORT WITH A-24 MONTH FOLLOW UP Pre-op Immediate post-op 9 months post-op 24 months post-op Figure 7. Shows clinically pre-op, immediate, 9 months and 24 months post-treatment SSCs HT. No clinical pathology related to the SSC was noted on any of the molars (no sinuses or swellings). 5.2. Treatment A treatment plan was arranged on our postgraduate clinic (See Table 2). An extensive preventive programme was instigated to improve the patient’s very poor oral hygiene in addition to diet assessment, analysis and advice. Over a period of two months and following the HT protocol, 9 the child had all his eight primary molars fitted with SSCs and cemented with GIC. No LA was used. The molars were fitted with elasticated orthodontic separators in order to create space to prepare the teeth to receive the SSC a week later. Two molars were treated per appointment (see Table 3). As per the standard Hall manual, 9 the following principles were adhered to during treatment: 1) Compliance with the indications and contra indications and selection criteria 9 for the HT (See Table 1). Assurance of the absence of any symptoms or signs of pulpal pathosis or sepsis (clinical or radiographic assessments); 2) Blue elasticated orthodontic separators were used and left in situ for one week to create interdental spaces where required; 3) Two SSCs placed in a single appointment were never: a. In the same arch adjacent to each other (i.e. never in the same quadrant); b. On the same side in opposing arches. 4) When two crowns were placed in a single appointment they were diagonally in opposing arches (for example 64 and 84); 5) Appointments were at least one to two weeks apart to allow the occlusion to settle. The 212 appointments were short; no longer than 15-20 minutes. The SSCs crowns were placed as per the schedule in Table 3. The patient also had simple restorations placed (with no LA) on his upper anterior primary incisors and canines, using simple excavation and GIC with a view to eventually receiving composite strip crowns. Figure 7 shows the mouth immediately after completion of treatment. The bite appeared open and was initially raised by approximately 1-1.5 mm. The patient was followed up six, nine, 12, 15, 18 and 24 months later. Neither he nor his parents had any complaints whatsoever. There were no i ssues with the occlusion, symptoms or signs of pulpal pathosis or sepsis affecting the molars. The bite had completely recovered (see Fig. 7). The parents’ satisfaction in reaching a positive outcome, without resorting to the use of GA, was very high. Post op radiographs (Fig. 8) showed satisfactory clown placement and no recurrent caries. The only noticeable development was that tooth 26 became impacted against the SSC of 65. This was also noted on the other first permanent molars (16, 46, and 26); however, they disengaged spontaneously without intervention. The 26 impaction was corrected within a week by removing the SSC of 65. The long term treatment plan was the following: 1) Continue follow-up at 3 months intervals of all Es and Ds clinically; 2) Close monitoring of tooth 51 for any sign of infection. Pulpectomy or extract if symptoms; 3) Bitewing radiographs every 6 months to monitor all Es and Ds. Interval to increase if caries risk status changed; Stoma Edu J. 2017;4(3): 208-217