THE HALL TECHNIQUE IN PAEDIATRIC DENTISTRY : A REVIEW OF THE LITERATURE AND AN “ ALL HALL ” CASE REPORT WITH A-24 MONTH FOLLOW UP
was a straightforward way to introduce the child to dental procedures . It was also advantageous in terms of preventing the progression of caries , reducing the chance of sepsis and pain , reducing the oral load of plaque and a good source for fluoride . Composite strip crowns will be considered as an alternative if cooperation allowed . Coincidently the patient ’ s 51 became discoloured , albeit asymptomatic . Although no history of trauma was elicited in this case , it was assumed to be the case . Persistent dark discolouration in the patient ’ s 51 may be associated with pulp necrosis . Since the tooth is asymptomatic clinically and in the absence of radiographic pathological signs , it was decided to keep under close review . Parents were aware that this tooth may require future treatment ; a pulpectomy or extraction . As for the Es and Ds , the patient was followed up for 24 months after treatment was completed . He remained clinically free of symptoms and became a patient who enjoyed attending our clinic . They will remain under observation in the long term . Plans are in place to manage his upper anterior teeth as outlined above . As for the 26 impacted tooth , it was corrected within a week of removing and replacing the 65 SSC . No LA was used .
6 . HT Discussion and literature review The Hall technique was named after Dr Norna Hall , a Scottish dentist who worked as a salaried GDP in a remote high dental caries risk area in the North East of the UK . As she faced a high proportion of children with dental caries ( dmft of Scotland was around 2.54 at the time ), and was not a specialist in paediatric dentistry , she thought “ outside the box ” and used SSCs to seal in dental caries with no preparation and no LA . This technique caught the attention of the team of paediatric dentists / clinical researchers at Dundee Dental School in Scotland . 17 They took an interest in Dr Hall ’ s novel work ( which she had audited ) as they were facing very high levels of dental caries themselves . Subsequently a pilot trial by Evans et al . was published online in 2000 . 17 This prospective case series study assessed 49 patients who were fitted with SSC crowns using the HT from the patient , caregiver and dentist point of view . It was deemed a success as the study reported very high levels of satisfaction . In addition , the team of Dundee Dental School researchers shared their findings with The British Society of Paediatric Dentistry ( BSPD ) UK national conference meeting in Edinburgh ( UK ) in the same year ( 2000 ) to the astonishment of its audience ( the second author of this paper was present that day and recollects the response !). Because the initial reaction to this technique by other paediatric dentists in the UK was profound , 18 the team of Dundee University researchers ( Innes et al .) undertook it upon themselves to investigate this technique by employing the most robust methods of evidence- based dentistry ; namely a prospective randomized controlled clinical trial and first published their results in 2007 . 10 This study formed the pivotal event that made this technique a “ school of thought ” in paediatric dentistry in its own right . It was a prospective split mouth randomized control study that showed very high success rates of the HT after two years . 10 The 2007 study was a prospective split mouth randomized control study that recruited 132 child patients aged between 3-10 years all of whom had two matched dental carious lesions . 10 Each child acted as his / her own control . One lesion was randomly treated using the HT and the other was randomly treated conventionally ( mostly by glass ionomer cements ). Seventeen GDPs treated these patients under the auspices of the paediatric dentistry team at Dundee University . The results were an outstanding success rate of 98 % for the Hall SSC when compared to the control restorations 85 % ( in terms of major failures : pain due to pulptitis ). Authors concluded that “ The HT was preferred to conventional restorations by the majority of children , carers and GDPs . After two years , Hall SSCs showed more favourable outcomes for pulpal health and restoration longevity than conventional restorations . The HT appears to offer an effective treatment option for carious primary molar teeth ”. In 2011 , Innes et al . published similar high success rates in the five year follow-up the same study . 19 Despite the fact that the HT is now considered the “ Gold Standard ” in managing the multisurface carious primary molar in the UK 20 there was a mixed international reaction to its development in paediatric dentistry circles , with many advocating such a treatment method 21 , 22 , 23 while others opposing it completely . 24 , 25 , 26 It is important to note that there is no disagreement about the fact that SSCs are the restorative materials of choice in multi-surface caries affecting primary molars . 13 , 27 The disagreement lies in the method used to apply them . Interestingly this debate came to a head during a joint meeting between the American Academy of Pediatric Dentistry ( AAPD ) and the Royal College Surgeons of Edinburgh ( UK ) in 2011 , where clinical methods employed in the USA and UK were compared . The discrepancy between advocates of the HT and the conventional school of thought became apparent . The president of the AAPD stated that “ while we may not have agreed with our British and Scottish colleagues on every approach we all agreed that we benefitted by seeing how others practice ” 28 and “ Can we imagine informing our parents that we are placing a crown over an untreated , decayed tooth "? 29 In this sense , the success of the HT and its 2007 study design were questioned . 24 Criticism centered on the control restorations used in the main 2007 study . They were not considered the gold standard restorations which paediatric dentists use in the USA ; namely the conventional treatment modality . In addition , in vitro laboratory studies showed that SSC cemented using the HT exhibited micro-leakage when using glass ionomer cements , 25 however the latter study lacked clinical relevance as what actually occurs in the mouth was not demonstrated . There had also been concerns that Hall SSCs props open the bite after placement by 1 mm on average , but there is clinical evidence that the bite resolves itself with dento-alveolar compensation taking place . The bite returns to normal levels within a week . 9 , 14 A recent abstract submission to the International Association of Dental Research ( IADR ) highlighted that mild intrusion of the crowned tooth takes place , 15
Case Reports
Stomatology Edu Journal
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