Hall technique crowns and children's masseter muscle activity: A surface electromyography pilot study

Longitudinal observational digital analysis of occlusion in Hall Technique

OBJECTIVE

To evaluate volumetric changes over time in teeth treated with the Hall Technique (HT) and their opposing teeth. Secondary aims included assessing occluso-vertical dimension (OVD), temporomandibular joint (TMJ) function, and children's treatment perceptions.

METHODS

Twenty-eight children (5-9 years-old) requiring HT treatment for one first primary molar were recruited. Dental impressions were taken. Mean volume differences were digitally calculated from scanned models (Rapidform2006) between HT-treated and opposing teeth over time. Canine overlap (to measure OVD) was assessed with digital calipers. TMJ function was evaluated using Helkimo Clinical Dysfunction Index and AAPD Temporomandibular Disorders guidance. Data were collected pre-treatment (T0), immediately post-treatment (T1), at one-month (T2), and three-months (T3) after. Children's perceptions were assessed at T3.

RESULTS

The mean volume differences (mm³)±Standard error of the mean(SEM),(min-max) for HT teeth were:T0-T1:71.0 ± 3.2, (43.18 to 113.3mm³); T1-T2:10.1 ± 1.2 (0.02 to 23.52mm³); T2-T3:4.3 ± 1.0 (-4.11 to 15.43mm³) and for opposing teeth: T1-T2:6.8 ± 1.1 (-4.30 to 21.51mm³); T2-T3:0.5 ± 0.9 (-11.12 to 15.24mm³). Crowns and canine overlap measurements resolved within one month (p < 000.1), reflecting occlusion re-establishment. TMJ assessments showed mild-dysfunction in two children (8 %), resolved by T3, Children's perceptions: 26 children (93 %) "strongly agreed" or "agreed" they were happy with their crowned-tooth; one child preferred not to show it, and 26 (93 %) reported no discomfort or pain.

CONCLUSION

The volumetric changes in HT-treated and opposing teeth, along with canine overlap, indicate gradual occlusion re-establishment, primarily within one month. OVD changes resolved, there was minimal TMJ dysfunction and high patient satisfaction.

CLINICAL SIGNIFICANCE

This study demonstrates that occlusal adjustments in Hall Technique-treated teeth mainly occur within one month of crown placement, with minimal effects on TMJ function and occlusion. Results support the Hall-Technique as a child-friendly option for managing carious primary molars with high acceptance and limited clinical adverse effects.

Questionnaire survey on the clinical application of Hall technique preformed metal crowns in caries of primary molars in China

Objective

To analyze the clinical application and limiting factors of the Hall technique (HT) preformed metal crowns in caries of primary molars and to provide reference for its clinical application based on a questionnaire survey.

Materials and methods

From June to December 2022, a questionnaire was distributed to pediatric dentists through the WeChat platform using "Questionnaire Star" to analyze the clinical application and influencing factors of the HT preformed metal crowns in caries of primary molars.

Results

A total of 700 survey questionnaires were distributed, and 650 valid questionnaires were recovered, with a effectiveness rate of 92.86%. In terms of the awareness level of the HT, only 11.08% of pediatric dentists fully understood, while 19.85% of those were completely unaware; In terms of the understanding methods, classes study accounted for 47.60%, and 28.79% of pediatric dentists understood through literature; In terms of the application of the HT, 46.15% of pediatric dentists had applied it, only 11.23% had frequently applied it, and 53.85% had never applied it; In terms of the usage time, the highest proportion was between 1 and 3 years, accounting for 40.33%, and only 9.67% were over 5 years; In terms of the choosing of indications, only 26.62% of pediatric dentists could select indications correctly; Regarding the choice of treatment methods for children who do not cooperate, only 19.54% of pediatric dentists chose the HT. The education background and nature of the workplace had a statistically significant difference in the application of the HT, the number of years of application, the selection of indications, and the choice of treatment methods for children who do not cooperate.

Conclusions

The survey showed that the awareness level and application frequency of the HT were relatively low in China. The understanding methods mainly learned through classes study.

Clinical relevance

It is necessary to further promote the development of continuing education projects with the theme of clinical application of the HT and the guidance of clinical operation standards, in order to promote the clinical popularization of it in China.

Assessment of masticatory performance in pediatric patients receiving preformed crowns by Hall technique: a controlled clinical trial

PURPOSE

The purpose of the study was to assess and compare the masticatory performance in children receiving preformed metal crown by Hall technique and conventional technique.

METHODS

Children having teeth indicated for restorative/endodontic therapy and belonging to the age group of six to ten years were invited to participate in the study. Eighteen children received preformed metal crowns (PMCs) by Hall technique. Meanwhile, nineteen children received preformed metal crowns by the conventional technique. Their masticatory performance (MP) was assessed at T0 (pre-intervention), T1 (day 1 post-intervention), T2 (1 week), T3 (2 weeks), T4 (1 month) and T5 (3 months) using Hue-check Gum® (University of Bern, Switzerland). The chewing gum samples were scanned within 24 h of their collection and processed in the ViewGum Software©. The software calculated the hue value (VOH) which indicated the masticatory performance of the individual. A questionnaire was given to the parents at T4 and T5 to assess any discomfort or pain associated with PMCs placed in both groups.

RESULTS

The evaluation of masticatory performance using the two-color chewing method revealed reduction in MP on day 1 post-intervention (p < 0.001) for both groups. However, the MP values recorded at T5 were comparable to the baseline values at T0 (p = 0.009). No significant discomfort or pain was reported in both groups.

CONCLUSION

The findings of the current clinical study indicate that placement of PMCs by both conventional and Hall technique in children deteriorates their MP which equilibrates within 1 month.

CLINICAL TRIAL REGISTRY OF INDIA NUMBER

CTRI/2021/02/031532 [Registered on: 25/02/2021]-Trial Registered Prospectively.

Do Hall Technique Crowns Affect Intra-arch Dimensions? A Split-mouth Quasi-experimental Non-randomized Feasibility Pilot Study

Aim and background

The Hall technique preformed metal crowns (HT-PMCs) are allegedly oversized, temporarily altering inter-arch relationships. Intra-arch dimensions and leeway space (LWS) HT effects are unknown.

Aim

To study single HT-PMC intra-arch effects and treated tooth dimensional changes.

Materials and methods

Split-mouth, quasi-experimental, non-randomized feasibility pilot study. Intraoral scans (iTero II®) were taken preorthodontic separator placement (scan1), immediately post single HT-PMCs (scan2) in 13 children, and 1 month later (scan3) in eight children. Control and study quadrants' lengths ("arcs") and HT-PMCs/control tooth dimensions [mesiodistal (MD), buccopalatal/lingual (BP/L), diagonal (Diag1/Diag2)] were recorded in mm (OrthoCAD® software). Paired t-test, repeated analysis of variance (ANOVA) post hoc analysis statistics (p < 0.05).

Results

Compared to scan1, the mean study arc increased by 0.7 mm (±0.5) (n = 13, t-test, p < 0.001) at scan2, while at scan3, it increased by 0.8 mm (±0.34) (n = 8, repeated ANOVA, p = 0.008). The HT-PMCs-treated tooth mean dimensions increased at scan2 by 0.9 mm (MD), 0.8 mm (BP/L), 0.5 mm (Diag1), and 0.7 mm (Diag2) (t-test, p < 0.001) with similar observations at scan3. There were no significant changes in the control arc or the control tooth measurements.

Conclusion

One single HT-PMC increased the intra-arch quadrant length by approximately up to <1 mm. The HT-PMC-treated tooth was marginally oversized. This pilot study paves the way for a more robust study with a larger sample size.

How to cite this article

AlRamzi B, AlHalabi M, Kowash M, et al. Do Hall Technique Crowns Affect Intra-arch Dimensions? A Split-mouth Quasi-experimental Non-randomized Feasibility Pilot Study. Int J Clin Pediatr Dent 2024;17(6):673-682.

A quantitative and qualitative investigation into the management of carious primary molars by foundation dentists in primary care in the South East of England

Introduction Dental caries is the most common reason for hospital admission of children aged 5-9 in the UK. Better management of caries in primary molars would reduce the number of children requiring treatment in hospitals; however, little research has been done into why primary care clinicians do not use an evidence-based approach to caries management for deciduous molars.Aims The aim of this paper is to identify the rationale behind caries management techniques used in primary care, as well as the choice of materials and long-term success of restorations placed.Materials and methods Use of a retrospective audit and a focus group with primary care clinicians to provide an insight into the management of carious primary molars and the barriers to achieving gold standard care.Results Glass ionomer cements (GICs) were the restoration of choice in primary care. Lack of time, equipment availability and clinician inexperience were cited as to why Hall crowns were not commonly placed.Conclusions The barriers to gold standard management of carious primary molars in practice are wide-ranging but tend to focus on the limitations of NHS care under the units of dental activity system. Lack of time and cost of materials encouraged clinicians to adopt a 'quick fix' approach in GIC.

Hall technique versus conventional preformed metal crowns: can paediatric dentists tell the difference on radiographs?

PURPOSE

Hall technique (HT) preformed metal crowns (PMCs) are allegedly oversized compared to conventional (C) PMCs. To investigate paediatric dentists' (PDs) perception of HT-PMCs and perception/ability to identify HT or C-PMCs on bitewings radiographs.

METHODS

An online cross-sectional questionnaire including ten bitewings (five of each of HT/CPMCs) was sent to PDs across the globe. A PMC type score (from '10') was calculated. T test, Pearson's and Fischer's Chi-square, and Odd Ratios (OR) (p < 0.05).

RESULTS

A total of 476 PDs from around the world responded. Most (97%) used PMCs in their practice. Most (98.7%) knew of, and 79% used HT-PMCs. A clear opinion shift, towards supporting HT, over time was noted (OR 11.154 [95% confidence interval (CI) 6.006-20.715]. A majority (67%) thought that HT/C-PMCs were similar radiographically. Only five PMCs were identified correctly [mean score 4.9 (± 1.73)]. A minority who thought that HT/C-PMCs were dissimilar scored higher than those who thought they were similar (5.31 ± 1.22; 4.68 ± 1.9, respectively, p < 0.00001). Nobody identified all ten PMCs. HT-PMCs were 4.63 times more identifiable than C-PMCs [(OR 24.857 CI 15.059-41.028) and (OR 5.361 CI 3.089-9.304)] for HT-PMCs and CP-MCs, respectively (p < 0.0001).

CONCLUSIONS

PDs identified the PMC type in half of the bitewings. They perceived no clear radiographic difference between HT-PMCs and C-PMCs, but their chance of recognizing HT-PMCs was five times higher than C-PMCs. HT-PMC support was high.

Outcomes of preformed metal crowns placed with the conventional and Hall techniques: A systematic review and meta-analysis

BACKGROUND

Preformed metal crowns (PMCs) have been used to restore carious primary molars and have a high success and survival rate. There are two methods currently employed for PMC placement - the conventional technique (CT) and Hall technique (HT).

AIM

This systematic review aims to compare the outcomes of PMCs placed using the CT and HT.

DESIGN

This systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. A literature search of five databases was performed up to 23 August 2022. Clinical studies comparing carious primary molars restored with PMCs using either technique with a minimum 12-month follow-up were included. Risk of bias (RoB) assessment was performed using the National Institutes of Health Quality Assessment tool.

RESULTS

Five articles met the inclusion criteria, and four were included for meta-analysis. The 12- and 24-month success and survival rates were above 85% for both groups, with no significant differences shown at 12 and 24 months. The HT requires a shorter treatment duration, is more cost-effective and has a high level of acceptability among parents when compared to the CT. Four articles were rated fair, and one article was rated good in the RoB assessment.

CONCLUSION

Greater consideration may be given towards using the HT as part of standard treatment procedures in managing carious primary molars. Future studies should standardise reporting of outcomes to facilitate a more homogeneous pool of data for future meta-analysis.

Impact of COVID-19 Pandemic on Dental Treatment in Children: A Retrospective Cross-Sectional Analysis in Jeddah City

Background/Purpose

The novel coronavirus disease (COVID-19) outbreak has affected individuals worldwide. Considering the nature of dental treatments and direct exposure to saliva, blood, aerosols, or droplets from infected individuals, dentists are at significant risk of COVID-19 infection. Therefore, to decrease aerosol-generating procedures, minimally invasive dentistry (MID) is recommended during this pandemic. The goal of this research was to compare the flow of patients during a pandemic at a single university hospital in Jeddah City, Saudi Arabia, and to retrospectively assess the impact of the COVID-19 pandemic on pediatric dental treatments including MID.

Materials and Methods

This study was a retrospective cross-sectional analysis of pediatric patient records, dental procedures performed, and minimally invasive techniques using the database of the King Abdul-Aziz University Dental Hospital (R4) system during the period of COVID 19 pandemic compared to the same period in the previous year.

Results

During the COVID-19 pandemic, pediatric dental patient flow included only 699 patients compared to 1151 patients during the same period in the previous year. The most common pediatric dental procedures performed during the pandemic period were simple restorative treatments, including fissure sealants, followed by dental extractions, and fluoride varnish applications. During the pandemic period, more minimally invasive treatments were performed, including the Hall technique, silver diamine fluoride, resin infiltration, and atraumatic restorative techniques.

Conclusion

Based on this data, the COVID-19 pandemic had an impact on dental patient flow and the type of dental procedures performed on children. Minimally invasive treatments that minimize air generation are recommended; however, to establish the long-term effectiveness of minimally invasive treatments in pediatric dentistry, more follow-up studies with bigger sample sizes are required. More recommendations regarding conservative pediatric dental management after the COVID-19 era are suggested.

A 24-month retrospective study of preformed metal crowns: the Hall technique versus the conventional preparation method

PURPOSE

Conventional and Hall Technique (HT) Preformed Metal Crowns (PMCs) are used for treatment of carious primary molars. The aim was to evaluate the clinical and radiographic success of conventional and HT PMCs in a postgraduate dental setting.

METHODS

A retrospective study using patients' electronic case-notes and radiographic images of carious primary molars treated with either conventional or HT PMCs was conducted to assess clinical and radiographic success/failure. A Kaplan-Meier curve was used to assess PMC survival.

RESULTS

187 PMCs (110 HT and 77 conventional) in 65 children (34 females and 31 males) at 6, 12, 18 and 24 months were assessed. At 24 months, the success rates of conventional and HT PMCs were 97.6% and 93.5%, respectively. Two HT (perforated/abscessed) and four conventional (abscessed) PMCs failures occurred. There was no significant difference in success/failure (p = 0.362) at 12 months, but the HT was more successful at 24 months (p = 0.002) with similar survival times for both methods.

CONCLUSION

HT and conventionally placed PMCs, when placed in a postgraduate paediatric dentistry setting, were clinically and radiographically very successful at 6, 12, 18 and 24 months post operatively with a slightly higher success of the HT at 24 months.

Stomathognatic system function in indigenous people from Brazilian Xingu villages: An electromyographic analysis

The maintenance of postural balance can be influenced by the lifestyle of a population. This study aimed to determine the electromyographic activity of the masseter and temporalis muscles during mandibular tasks and habitual and non-habitual chewing in indigenous individuals to reveal the differences among white Brazilian individuals. Sixty Brazilians (18 and 28 years) were divided into two groups: 30 Xingu indigenous individuals and 30 white Brazilian individuals, with 20 men and 10 women in each group. The individuals were assessed using the normalized electromyographic activity of mandibular tasks (rest, protrusion, right and left laterality) and electromyographic activity of masticatory cycles in habitual (peanuts and raisins) and non-habitual (Parafilm M) chewing. Data were analyzed using Student's t-test (p < .05). Comparisons between the groups demonstrated significant differences. Indigenous individuals group presented a decrease in the normalized electromyographic activity of the masticatory muscles during mandibular rest [right masseter (p = .002) and left masseter (p = .004) muscles]. There was increase in the normalized electromyographic activity during protrusion [left temporal (p = .03) muscle]. There was increase in the electromyographic activity during chewing: peanuts [right masseter (p = .001), left masseter (p = .001) and right temporal (p = .01) muscles], raisins [right masseter (p = .001), left masseter (p = .002), right temporal (p = .008), left temporal (p = .01) muscles] and Parafilm M [left masseter muscle (p = .05)]. From the findings of this study, we concluded that in the comparison between indigenous and white individuals, positive changes were observed in the electromyographic pattern of the masticatory muscles in the mandibular postural conditions, with greater masticatory efficiency in the indigenous group.

Pediatric Stainless-Steel Crown Cementation Finite Element Study

Objective  To study the effect of using different cement types under pediatric stainless-steel crown (SSC) around mandibular second primary molar using three-dimensional (3D) finite element analysis.

Materials and Methods  A 3D finite element model was built for pediatric mandibular molar by laser scanning of natural extracted tooth. Four types of cement (zinc phosphate, glass ionomer, resin-modified glass ionomer, and resin) of 200 μm layers thickness were tested under a stainless-steel crown of 130-μm thickness. Twelve case studies were reported within this research, as the applied load of 330 N was tested with three angulations: vertical, oblique at 45°, and laterally.

Results  Linear static stress analysis was performed. The resultant stresses and deformations' distribution patterns did not change with cement type, while the values were altered. All deformations and stresses were found within the normal range.

Conclusions  Analysis results indicated that using stiffer cement material increases tooth structure stresses and reduces crown body stresses and deformations, while bone was nearly insensitive to cement type.

Assessment of paediatric dental guidelines and caries management alternatives in the post COVID-19 period. A critical review and clinical recommendations

PURPOSE

The first aim of this paper is to provide dental professionals caring for children and adolescents during and after the COVID-19 pandemic with a reference to international dental guidelines. The second aim is to suggest minimally invasive treatment alternatives for caries management, minimising the risk of viral cross-infection and offering a safer clinical environment.

METHODS

An evidence-based pertinent literature search of different electronic databases was performed in addition to leading global dental authorities, royal colleges, and programmes.

RESULTS

All guidelines released in response to COVID-19 centred around minimising Aerosol Generating Procedures (AGP) impacting the provision of regular dental treatment of paediatric patients. There was an emphasis on triaging and only treating emergency and urgent cases. Special attention was given to medically compromised children in the guidelines. Detailed guidelines for the dental environment and equipment were given. This paper also summarised the relevant evidence-based guidelines for the use of non-invasive and minimally invasive caries management techniques.

CONCLUSION

 Specific recommendations for dental management of paediatric patients during and in the post-COVID-19 era are suggested. Minimisation of AGP procedures, and case-based selection of biological, non-invasive or minimally invasive methods are recommended.