Hall Technique for Carious Primary Molars: A Review of the Literature

Knowledge and attitudes of dental students and interns on minimally invasive dentistry for pediatric dentistry at King Saud University

BACKGROUND

Minimally invasive dentistry (MID) is a conservative approach focusing on early diagnosis and minimally invasive procedures to prevent the progression of carious lesions.The aim of the study was to assess the knowledge of minimally invasive dentistry among dental students and interns and encourage them to improve their attitudes towards minimally invasive pediatric dentistry (MIPD).

METHODS

A validated questionnaire used to test the knowledge level of 4th, 5th years dental students and interns was distributed prior to an interventional lecture, followed by an educational lecture on the minimally invasive techniques used in pediatric dentistry and later a post-intervention questionnaire distributed to the dental students and interns.

RESULTS

Almost 74% from the 183 study participants reported that they were aware of the term MIPD,73.8% of them had responded positively, and a higher proportion 65.6% of them knew about this through lectures.The study subject's knowledge about MIPD was assessed before they attended the lecture on this topic and after the lecture in multiple responses, where the proportion for different procedures had increased from pre-intervention to post-intervention.

CONCLUSION

It can be concluded that the dental students and interns have an acceptable amount of knowledge on MIPD. However, there is a lack of knowledge on when to use these techniques and how to apply them.

Comparison of three management approaches for dental caries in primary molars: A two-year randomized clinical trial

AIM

to compare two-year clinical success rates of caries management in children (Hall Technique HT, Nonrestorative caries treatment NRCT, Conventional restorations CR), and to evaluate pain perception, behaviour, technique acceptability by patients, parents and dentists.

METHODS

122, 3-8-year-olds were enrolled in 2-year parallel group randomised controlled trial (CR, n = 52, HT, n = 35, NRCT, n = 35). Caries was recorded using Nyvad criteria to measure clinical success/ failure rates. Child's pain perception (Visual Analogue Scale of Faces), child behaviour (Frankl scale), parents' and dentists' treatment opinions (5-point Likert scale) were assessed. Statistical analysis included Chi-square, non-parametric Kruskal-Wallis, Bonferroni-corrected Mann-Whitney U tests (p < 0.05), absolute risk reduction (ARR) and number needed to treat (NNT).

RESULTS

After two years, with 116 participants, clinical success rates were: CR=60.8 % (n = 31), HT=93.8 % (n = 30), NRCT=42.5 % (n = 14) (p < 0.001). Major/minor failure rates differed: CR=17.6 % (n = 9) / 21.6 % (n = 11); HT=6.2 % (n = 2)/ 0 %, NRCT=33.3 % (n = 11)/ 24.2 % (n = 8), (p < 0.05). When comparing HT to CR, ARR = 0.33; NNT= 3 (95 % CI 0.02 -0.58); NRCT to CR, - no observed benefit from NRCT. More than 70 % of children demonstrated "positive/definitely positive" behaviour during treatment. Pain intensity was "very low/low" in 92.3 % of cases for CR, 88.6 % for HT, and 77.1 % for NRCT . NRCT was "very easy" to perform for 82.9 % of participants, compared to 42.3 % for CR and 17.1 % for HT (p < 0.05). CR were reported to take longer than NRCT and HT (p < 0.05).

CONCLUSION

Clinical success rates of HT were superior to CR and NRCT. All treatment techniques were well tolerated by children, CR was more time-consuming and HT - technically more difficult to perform.

CLINICAL SIGNIFICANCE

caries management in primary molars can be successfully performed using minimal intervention, particularly, sealing in caries lesions with Hall technique. NRCT can prevent caries progression when adequate access to mechanical plaque disruption and fluoride is provided. However, occasional fluoride application, and uncontrolled toothbrushing with fluoride toothpaste cannot replace restorative procedures.

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.

Combination of Silver Diamine Fluoride and Hall Technique for Caries Management in Primary Molars: A Randomized Controlled Trial

Aims and background

Combination of different noninvasive caries arresting approaches may improve the effectiveness and success rate of individual procedures for caries management. The purpose of this study was to evaluate clinical and radiographic success rate of a combination of 38% silver diamine fluoride (SDF) application and Hall technique (HT) for the management of dentinal caries in primary molars and compare it with conventional stainless steel crown (SSC) restoration.

Materials and methods

Children aged 4-8 years, having carious primary molars with the International Caries Detection and Assessment System (ICDAS) score of 5 or 6, were randomly assigned to treatment group A or B. Treatment group A (n = 25) received 38% SDF application and Hall crown, while group B (n = 25) received conventional SSC restoration. Follow-up was done at 1 month, 3, 6, 12, 24, and 30 months intervals.

Results

There was one case of major failure in group A (93.5% successful) while no case of major failure in group B (100% successful) and the difference was not statistically significant (p > 0.05). For minor failure (loss of SSC), the success rate was 91.3% in group B and 84.2% in group A, wherein the difference was not statistically significant (p > 0.05).

Conclusion

Conservative management of dentinal carious lesions with SDF and HT showed a similar success rate as compared to conventional operative procedures.

Clinical significance

This protocol can help reduce the clinical chair time and the need for deep sedation/general anesthesia in young children suffering from deep carious lesions with reversible pulpitis.

Trial registration number

CTRI/2020/07/026877, Clinical Trial Registry-India.

How to cite this article

Mittal M, Chopra R, Kumar A, et al. Combination of Silver Diamine Fluoride and Hall Technique for Caries Management in Primary Molars: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2024;17(10):1114-1120.

Beyond Tradition: Non-surgical Endodontics and Vital Pulp Therapy as a Dynamic Combination

Symptomatic irreversible pulpitis and apical periodontitis in mature permanent teeth present challenges in their management. Traditional treatment approaches, such as root canal therapy or tooth extraction, may compromise tooth structure and oral function. This review article explores the combination of non-surgical endodontic treatment and vital pulp therapy as an alternative approach for these conditions. The purpose is to examine this combined approach's effectiveness, benefits, challenges, and limitations. The objectives include reviewing the literature, evaluating clinical outcomes, discussing potential benefits, and providing recommendations for clinical practice. The combination approach aims to preserve tooth structure, promote healing, and reduce postoperative complications. The article discusses the rationale for combining the two techniques, presents evidence supporting their efficacy, and outlines the techniques and protocols involved. Clinical outcomes, case studies, potential challenges, and comparative analysis with traditional approaches are also explored. Future directions and research recommendations highlight areas for further investigation, innovations, and the development of clinical guidelines. In conclusion, the combination of non-surgical endodontic treatment and vital pulp therapy offers a valuable strategy for managing mature permanent mandibular molars with symptomatic irreversible pulpitis and apical periodontitis. Further research and advancements are needed to refine the treatment protocol and expand the evidence base, and clinicians should stay updated to provide optimal care and improve patient outcomes.

Evidence-based clinical practice guideline on restorative treatments for caries lesions: A report from the American Dental Association

BACKGROUND

An expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs together with the ADA Science and Research Institute's program for Clinical and Translational Research conducted a systematic review and developed recommendations for the treatment of moderate and advanced cavitated caries lesions in patients with vital, nonendodontically treated primary and permanent teeth.

TYPES OF STUDIES REVIEWED

The authors searched for systematic reviews comparing carious tissue removal (CTR) approaches in Ovid MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Trip Medical Database. The authors also conducted a systematic search for randomized controlled trials comparing direct restorative materials in Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. The authors used the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the certainty of the evidence and formulate recommendations.

RESULTS

The panel formulated 16 recommendations and good practice statements: 4 on CTR approaches specific to lesion depth and 12 on direct restorative materials specific to tooth location and surfaces involved. The panel conditionally recommended for the use of conservative CTR approaches, especially for advanced lesions. Although the panel conditionally recommended for the use of all direct restorative materials, they prioritized some materials over the use of others for certain clinical scenarios.

PRACTICAL IMPLICATIONS

The evidence suggests that more conservative CTR approaches may decrease the risk of adverse effects. All included direct restorative materials may be effective in treating moderate and advanced caries lesions on vital, nonendodontically treated primary and permanent teeth.

The clinical success of ART restorations and Hall technique in primary molars: a randomized 18-month follow-up study

Objectives

The aim of the study was to evaluate the clinical and radiographic success of the Hall technique (HT) and atraumatic restorative treatment (ART) restorations using high-viscosity glass-ionomer cement for the management of occlusal carious lesions in primary molars.

Materials and Methods

This randomized clinical study observed 40 children (aged 5-6 years). For each child, one tooth was treated with HT and one with ART. The primary outcome measures for HT restorations were successful, minor, and major failure rates. Clinical evaluations of ART restorations were performed according to the modified United States Public Health Service criteria during 18-month follow-up. McNemar test was used for statistical analysis.

Results

Thirty of 40 (75%) participants returned for 18 months of follow-up. In the clinical evaluations of teeth that were treated with HT, the patients did not have complaints of pain or other symptoms, all crowns remained in the oral cavity, the gums were healthy, and the teeth were functional in all evaluations. At the end of the 18-month follow-up, the surface texture and marginal integrity criteria of ART restorations were recorded as 26.7% and 33.3%, respectively. In the radiographic evaluation of 30 patients treated with ART and HT, all restorations were considered successful.

Conclusions

The 18-month clinical and radiographic results after treatments applied to single-surface cavities in anxious children showed that both treatment methods were successful.

Exploring Parent's Satisfaction and the Effectiveness of Preformed Metal Crowns Fitting by Hall Technique for Carious Primary Molars in Jeddah Region, Saudi Arabia: Findings of a Prospective Cohort Study

PURPOSE

The Hall technique (HT) is a non-invasive approach to treating carious primary teeth. Its acceptability by parents and effectiveness is not widely known in the Middle East. Therefore, we aimed to conduct this study to explore the effectiveness of preformed metal crowns (PMCs) fitting by HT and to what extent the parent's satisfaction for their children in Jeddah region.

MATERIALS AND METHODS

A prospective cohort study was conducted in the outpatient pediatric dental clinic at Jeddah Specialty Dental Center, in 2018. The cohort of children was exposed to the HT and was recalled 3 months to two years later to examine present or absence of: crown loss, open margin, signs or symptoms of reversible or irreversible pulpitis, and if the tooth exfoliated naturally. Parents who agreed to undergo the HT for their children completed a 5-point Likert questionnaire after treatment and after three months.

RESULTS

A total of 48 children (72 teeth) were initially enrolled, but only 25 children (49 teeth) completed two years of follow-up. At 2 years follow-up, one PMC was lost (2.04%) while no teeth fitted with the HT required any further intervention. Around 96% of parents were satisfied with this procedure and 92% wanted other carious teeth to be treated similarly. All parents were satisfied with this technique because it did not include local anesthesia and no drilling. It was found that parents of girls were satisfied more than parents of boys and on average their satisfaction score at the time of treatment was 3.04 units higher than parents of boys with a significant p-value of 0.02 and 95% CI for the beta coefficient to be 0.46 to 5.62.

CONCLUSION

The HT is effective as a treatment of dental caries and it was generally accepted by parents initially and during their follow-up visits.

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.

Pediatric Dentistry during Coronavirus Disease-2019 Pandemic: A Paradigm Shift in Treatment Options

Coronavirus disease-2019 (COVID-19) pandemic has affected the world in an aggressive manner and the healthcare fraternity has been at the forefront in this fight. Dental professionals are at a larger risk to get afflicted owing to the proximity to the oral cavity. Along with other verticals of dentistry, pediatric dentistry too has to adapt quickly keeping in mind the newer protocols so as to limit the increase of the global epidemic and the commencement of cross-infections. The purpose of this article is to present different treatment options for a pediatric dentist so as to achieve positive dental outcomes.