Evaluation of Success of Stainless Steel Crowns Placed Using the Hall Technique in Children with High Caries Risk

Abstract

Objective: This study aimed to compare the clinical efficacy and survival rates of the hall technique (HT), and conventional restoration (CR) for the management of occlusoproximal carious lesions in primary molars. Materials and Methods: This clinical study observed 35 children (aged 4–8 years). Exclusion criteria included symptoms of pulpal or periradicular pathology or systemic conditions requiring special dental considerations. For each child, at least one tooth was treated with HT and one with CR. The primary outcome measures were minor and major clinical failure rates. Plaque and gingival scores of the teeth were also evaluated. Friedman test and Wilcoxon signed ranks test were used to compare the plaque and gingival index scores for each arm. Chi-square tests were used for comparisons of clinical outcomes, plaque-gingival index, and distribution of ICDAS categories among treatment arms (P < 0.05). Results: Thirty-three of 35 (94.2%) participants returned for 1-year follow-up. HT showed statistically significantly higher treatment survival rate and fewer minor failures than CR (P = 0.040). The rate of major failures was minimal (2 of 84 teeth) and did not differ between treatments (P = 0.092). In both treatment groups, the gingival score and plaque score were significantly decreased at the 1-year follow-up (P < 0.05). Conclusion: HT was a more successful method for managing caries in primary molars than CR, both for symptoms of pulpal disease and longevity of the restorations. HT is a simplified method of managing carious primary molars using SSCs cemented with no local anesthesia, caries removal, or tooth preparation.

Hall technique for primary teeth: A systematic review and meta-analysis

“…( Fig. 3 B) This was supported by the other studies not included in the meta-analysis [22] , [23] . However, when compared only against conventional PMCs [18] , [21] , HT showed similar success rates (RR 1.02 [95 % CI: 0.90–1.15], I 2 =52.3 %, p = 0.148).…”

“…Four of the studies included were judged to be of low risk of bias overall [17] , [18] , [19] , [20] , with the rest judged to be of high risk of bias [21] , [22] , [23] , [24] . The largest contribution of bias occurs with the randomisation process, with some studies randomising at subject level but reporting results at tooth level, introducing significant bias to the results.…”

“…Three of the studies randomised and analysed one tooth per subject [17] , [18] , [20] . Two studies randomised at subject level and included one or more teeth per subject [23] , [24] , while the other three studies were split mouth studies with two including two teeth (control and intervention) per subject [19] , [21] and the other including two or more teeth per subject [22] . Due to these differences in the unit of randomisation and the unit of analysis reported, only five studies were included in meta-analyses, the three studies with unit of randomization at tooth level with one included tooth per subject [17] , [18] , [20] and the two spilt mouth studies with only two teeth per subject [19] , [21] .…”

“…This may be the result of the higher failure rate of ART in multi-surface restorations. For the studies not included in the meta-analysis, [22] , [23] , [24] HT had a success rate ranging from 85 % to 93 %.

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Vital Pulp Therapy in Primary Dentition: Pulpotomy—A 100-Year Challenge

“…Actually, recent evidence suggests that IPT (selective removal to soft dentin) is preferred over the traditional pulpotomy [4], with reported success rates of 90% and above [84,85]. On the other hand, there is increasing evidence that the long-disputed Hall technique (a simplified method of managing carious primary molars using preformed metal crowns, cemented with no local anaesthesia, caries removal or tooth preparation) is effective in the long-term, showing more favourable outcomes for pulpal health and restoration longevity than conventional restorations [86] and is even more cost effective compared to the pulpotomy procedure [87]. A 2020 report [88] identified that although the Hall technique is recognised, it is not being used, by an outright majority of paediatric dentists across the globe; barriers such as lack of training, perception as substandard dentistry and perceived lack of evidence reduced its use.…”