A novel technique using preformed metal crowns for managing carious primary molars in general practice — A retrospective analysis

Abstract

BackgroundThere is a high level of untreated dental decay in primary teeth in Scotland. Despite evidence for the efficacy of preformed metal crowns (PMCs) for the restoration of primary molars, few are placed in general practice, possibly due to the interventive nature of the clinical procedure. There is, however, a novel way of placing PMCs involving no local anaesthesia, no caries removal and no preparation of the tooth: the Hall technique. Aim To investigate the survival of carious primary teeth treated with PMCs placed using a novel, simplified method -the Hall technique. Setting General dental practice, in Scotland. Methods A retrospective analysis of practice records from one general practitioner, from 1988 to 2001. The majority of the 978 PMCs fitted on 259 children, using the Hall technique, were placed when there was clinical evidence of approximal caries into dentine. The Kaplan-Meier approach was used to analyse survival times and the Mantel-Haenszel Log rank test for comparison between tooth types. Results For all tooth types, the probability of surviving three years without being extracted or the PMC being lost, was 73.4% (95% confidence interval 70.1% to 76.4%), and for five years was 67.6% (95% confidence interval 63.3% to 71.5%). The probability of surviving without extraction alone for three years was 86.0% (95% confidence interval 83.2% to 88.4%), and for five years was 80.5% (95% confidence interval 76.5% to 83.9%). Conclusion Hall technique restorations placed on primary molars with decay clinically into dentine, by a single operator in general dental practice, have a similar success rate to some other, more conventional, restorative techniques. The technique requires further evaluation through a prospective randomised control clinical trial before its use could be generally recommended.

Undergraduate experience and self-assessed confidence in paediatric dentistry: comparison of three UK dental schools

“…The technique is considerably less demanding than the conventional approach and thus offers an invaluable restorative option for more junior dental students. 16,17 Another interesting finding arising from this study was that in the two centres with a signifi cant outreach component (Manchester and Sheffi eld), students were more likely to have carried out primary molar pulp therapy and extractions in outreach clinics than during hospital sessions. This may be explained by the difference in case-mix presenting to primary care and tertiary services.…”

The success of stainless steel crowns placed with the Hall technique

“…The Hall technique uses SSC to seal over carious lesions on primary molars using glass ionomer cement with no caries removal, no crown preparation, and no local anesthesia. [7] In a randomized, controlled clinical trial, SSC provided using the Hall technique have shown to outperform standard class II restorations provided by general dentists. [8] In addition to comparative restoration success, the Hall technique was preferred over traditional restorative techniques by the child, caregiver, and dentist.…”

Caries Management Strategies for Primary Molars

“…They extend from stepwise caries removal to nonrestorative caries treatment (NRCT), where no caries is removed but the cavity is opened to allow the lesion to be brushed by parent and child; the biofilm is altered through continual disruption/cleaning (Gruythuysen et al, 2011;Kidd, 2012). Additionally, sealing techniques include those with no caries removal, such as the Hall technique (HT; Innes et al, 2006Innes et al, , 2011, partial (Lula et al, 2009) stepwise caries removal (Ricketts et al, 2013), and fissure sealing lesions (Griffin et al, 2008). Although the evidence base supporting biological treatment approaches is growing, the limited comparative evidence for one approach over another leaves clinicians with uncertainty around their efficacy and, therefore, difficulties when planning treatment for children.…”