Hall Technique

The Hall Technique is a non-invasive treatment for decayed baby back (molar) teeth. Decay is sealed under preformed (stainless steel) crowns, avoiding injections and drilling. It is one of a number of biologically orientated strategies for managing dental decay.

The technique has an evidence-base showing that it is acceptable to children, parents and dentists and it is preferred over standard filling techniques. Preformed metal crowns are now recommended as the optimum restoration for managing carious primary molars, however a potential problem with sealing caries opposed to caries removal is that the caries process might only be slowed, rather than arrested. [1][2]

Crowns placed using the Hall Technique have good long term outcomes (pain/infection and need for replacement) compared with standard fillings.[3][4][5]

History

Preformed metal crowns have been used for restoring primary molars since the 1950’s. Literature suggests preformed crowns placed on carious primary molar teeth reduce risk of major failure or pain in the long term compared to fillings. There is also evidence to suggest that fitting crowns using the Hall Technique can reduce patient discomfort at the time of treatment in comparison to conventional fillings. [6] The Hall Technique is named after Norna Hall, a dentist working in Scotland, who has developed a simplified technique where the crown is simply cemented over the carious primary molar, with no local anaesthesia, caries removal, or tooth preparation of any kind.[7]

The Hall Technique has been included in a guideline of the Scottish Dental Clinical Effectiveness Programme (SDCEP)[8] and has helped to drive change in how dentists manage decay in primary teeth from the traditional invasive surgical approach to the less-invasive biological management of decay.[9][10][11][12][13] The traditional method for management of dental caries has evolved form the exclusive domain of techniques based on complete caries removal prior to tooth restoration. Dr. Norna Hall used pre-formed crowns and cemented over carious primary molars using a glass-ionomer luting cement, with no caries removal, tooth preparation, or local anaesthesia.

Clinical trials have shown the Hall Technique to be effective, however it is not an easy quick fix solution to the problem of carious primary molars. The technique is not suited to every tooth, child or clinician, however it can be an effective method of managing carious primary molars. Hall technique should not be used when there are clinical or radiographic signs and symptoms of irreversible pulpitis or dental abscess. Radiographically there should be a clear band of dentine between the carious lesion and pulp for a Hall Technique to be suitable.

Baby teeth

Biologically orientated strategies for managing dental caries are considered by their proponents to have advantages for child patients receiving dental care as the techniques are less invasive and often avoid use of local anaesthesia and drilling as well as being less destructive and potentially damaging for primary teeth. A number of clinical trials have been carried out looking at incomplete, or no caries removal, in primary teeth and how the outcomes for these techniques compare to complete caries removal. These "minimal intervention" approaches reduce some of the adverse consequences associated with carrying out restorative treatment: conservation of tooth structure and integrity, maintenance of maximum pulpal floor dentinal thickness, which reduces the impact on pulpal health;[14] reduced pulp exposure, and less need for local anaesthesia if no vital dentine is being removed, which has been shown to reduce children’s reported discomfort.[15][16]

A recently updated Cochrane systematic review [17] has compared biologically orientated strategies (stepwise, partial and no-caries removal), with complete caries removal for managing decay in both primary and permanent teeth. Eight trials of 934 patients (1372 teeth) with outcomes reported for 1191 teeth were included in the analyses. The conclusion of the review was that for symptomless and vital teeth, biologically orientated strategies had clinical advantages over complete caries removal in the management of dentinal caries. Not only were there no differences in restoration longevity or in the numbers of teeth (or patients) experiencing pulpal pathology (pain or infection), but there were significantly less pulp exposures. For partial caries removal in primary teeth, this was a risk ratio of 0.24 [0.06,0.90], when caries was not completely removed.

Further reading

File:HallTechGuide V4.pdf

References

  1. ↑ Innes NPT, Evans DJP, Stirrups DR. The Hall Technique: a randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice; acceptability of the technique and outcomes at 23 months BMC Oral Health 2007 7:18. http://www.biomedcentral.com/1472-6831/7/18
  2. ↑ Innes, N. P. T., Evans, D. J. P., & Stirrups, D. R. (2011). Sealing caries in primary molars randomized control trial, 5-year results. Journal of dental research, 90(12), 1405-1410.
  3. ↑ Innes NPT, Evans DJP, Stirrups DR. Sealing Caries in Primary Molars; Randomized Control Trial, 5-year Results. J Dent Res 2011 90(12) 1405-10. http://jdr.sagepub.com/content/90/12/1405.abstract
  4. ↑ Innes NPT, Marshman Z, Vendan R. A Group of General Dental Practitioners’ Views of Preformed Metal Crowns after Participation in the Hall Technique Clinical Trial; A Mixed-Method Evaluation. Primary Dental Care 2010 Jan; 17(1):33-7 http://www.ingentaconnect.com/content/fgdp/pdc/2010/00000017/00000001/art00017?crawler=true
  5. ↑ Gilchrist F, Howell J, Gavern D, North S, Innes NPT, Rodd HD. Clinical outcomes for preformed metal crowns placed by dental undergraduates. Int J Paediatr Dent 2011, 21 (Suppl. 2): 1
  6. ↑ Innes, N. P. T., Ricketts, D., Chong, L. Y., Keightley, A. J., Lamont, T., & Santamaria, R. M. (2015). Preformed crowns for decayed primary molar teeth (Review).
  7. ↑ Innes NPT, Stirrups DR, Evans DJP, Hall N. A Novel Technique Using Preformed Metal Crowns for Managing Carious Primary Molars in General Practice – a retrospective analysis Brit Dent J 2006; 200(8):451-4 & 444 http://www.nature.com/bdj/journal/v200/n8/abs/4813466a.html
  8. ↑ Scottish Dental Clinical Effectiveness Programme “Prevention and management of dental caries in children”. Published April 2010. http://www.sdcep.org.uk/index.aspx?o=2858
  9. ↑ Morgan AG, Gilchrist F, Cowlam J, Rodd HD. Comparative outcomes for Hall vs conventionally placed preformed metal crowns. Int J Paediatr Dent 2012; 22(Suppl. 2):17-18.
  10. ↑ McKinney A, Britton, KFM, Innes NPT, Cairns A. The success of Hall Technique crowns on a student outreach clinic. Int J Paediatr Dent 2011; 21(Suppl. 2): 8-9.
  11. ↑ Foley JI. Short communication: a pan-European comparison of the management of carious primary molar teeth by postgraduates in paediatric dentistry. Eur J Paediatr Dent 2012; 13(1):41-6.
  12. ↑ Innes NPT, Evans DJP. Modern approaches to caries management of the primary dentition. Brit Dent J. 2013, 214(11) 559-566.
  13. ↑ Bark JE, Dean AA, Cairns AM. Opinion and usage of the “Hall Technique” amongst paediatric dental specialists in Scotland. Int J Paediatr Dent 2009; 19(Suppl. 2):11
  14. ↑ Murray, P.E., et al., Remaining dentine thickness and human pulp responses. International Endodontic Journal, 2003. 36(1): p. 33-43.
  15. ↑ Rahimtoola, S., et al., Pain related to different ways of minimal intervention in the treatment of small caries lesions. Journal of Dentistry for Children, 2000. 67(2): p. 123-7.
  16. ↑ van Bochove, J.A. and W.E. Amerongen, The influence of restorative treatment approaches and the use of local analgesia on children's discomfort. European Archives of Paediatric Dentistry, 2006. 7(1): p. 11-16
  17. ↑ Ricketts D, Lamont T, Innes NPT, Kidd E, Clarkson JE. Operative caries management in adults and children. Cochrane Database of Systematic Reviews 2013; Issue 3. Art. No.: CD003808. DOI: 10.1002/14651858.CD003808.pub3. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003808.pub3/abstract
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