STOMATOLOGY EDU JOURNAL 2017, Volume 4, Issue 3 SEJ_3-2017_Online - Page 64

THE HALL TECHNIQUE IN PAEDIATRIC DENTISTRY: A REVIEW OF THE LITERATURE AND AN “ALL HALL” CASE REPORT WITH A-24 MONTH FOLLOW UP 214 Table 3. Sequence of appointments. Appointment 1 Assessment, radiographs, explain treatment options, OHI, diet sheet, orthodontic separator 64 (as parents opted for HT) Appointment 2 (one week later) 2 SSCs placed Diet advice, remove separator 64. Place and cemented SSC using HT on 64 and 84 (spaced already), place new separators on 55 and 75 Appointment 3 (one week later) 2 SSCs placed OHI reinforced, remove separators, cement SSC HT on 55 and 75 Appointment 4 (one week later) Place new separators on 65 and 85 Appointment 5 (one week later) 2 SSCs placed Remove separators and cement SSCs HT on 65 and 85 Appointment 6 (one week later) Place separators, 54 and 74 Coincidently 51 noted to be discoloured, no known history of trauma. X-ray taken. Opted to manage this tooth conservatively although pulpectomy or extraction of 51 not ruled out Appointment 5 (One week later) 2 SSCs placed Reinforce OH. Placed SSCs HT on 54 and 74. Restore Upper anterior teeth using GIC restorations as interim restorations Appointment 6 (One week later) Check occlusion. Reinforce OHI and polish upper anterior teeth Recall 3 months No complaints. Check occlusion and OH Recall 6 months later All Es and Ds SSCs in situ. No symptoms. Bitewings taken. No clinical or radiographic signs of pathology. Occlusion had settled (No open bite). Good gingival health Recall 9, 12, 15, 18 months later No complaints. OH excellent. Occlusion normal. Good gingival health. Radiographs taken. Fluoride. Consider if cooperation improves, anterior strip crowns with composite (in addition to pulp therapy for 51) Review at 24 months No complaints. Bitewings taken show no pathology. 26 noted to be impacted against 65 SSC. Dissimpacted 26 by removing SCC. 26 erupted . Replaced SSC 65 young age, anxiety, the number of molars involved, pre-cooperation, the limited financial capacity of the parents to afford general anaesthesia. However, the parents’ dedication to attend to multiple appointments, motivation and great support to their child made it successful. Modelling techniques had worked successfully to reduce the patient’s dental anxiety, where he observed and learned appropriate behaviour from his parents and sister. Separation anxiety is very common at this age and having the parent or his sister around was helpful. He had a high risk dental caries status, so his primary molars were treated using SSCs, although other options such as complete caries removal and composite restorations, partial caries removal or even non restorative caries treatment (NRCT) were possible. 7 The patient was a good candidate for the HT, as his molars were carious, asymptomatic, had no signs of irreversible pulpitis or sepsis, no clinical or radiographic signs of pulpal involvement or inter-radicular pathology and had a good amount of tooth structure for crown retention. In other words, the molar lesions were “captured” before they became pulpally involved. The HT was effective as it sealed the caries under the crown without LA, tooth preparation or caries removal. Priority was given to tooth 84 as it had the deepest lesion compared to the rest. The patient accepted the minute occlusal changes after cementation of each HT crown. The occlusion clinically appeared to have re-established itself in a very short time (see Fig. 7 using the primary canines as indices) and this was always checked before proceeding with the next phase. Managing the upper anterior cavities with permanent restorations would have been impossible in this case due to the child’s lack of cooperation. Therefore, temporization of open cavities with GIC Stoma Edu J. 2017;4(3): 208-217