Outcomes of the Hall Technique and Conventional Pulp Therapy for the Management of Caries in Primary Molars
Condition: Deep Caries; Pulpitis - Reversible
MeSH terms: Pulpitis
Study type: Interventional

Summary: 
      Based on the changing understanding of carious bioﬁlm development and caries progression,
      Sealing carious dentine beneath a restoration deprives the caries bioﬁlm of nutrients and
      alters the environment sufﬁciently to slow or arrest lesion progression. This has the added
      beneﬁt of avoiding pulp exposure and subsequent treatment .The evidence base supporting the
      biological approaches which include Hall technique has been steadily increasing in the last
      few years. This has given rise to a growing trend towards a biological approach by Paediatric
      dentists and has led to an increasing concern about the merits of conventional approach in
      treatment of carious primary molars .
    

Detailed description: 
      In orofacial development of the child, preservation of the primary dentition for as long as
      possible is of great importance. As primary teeth maintain arch length and preserve
      masticatory function. Unfortunately, the occurrence of cavitated caries lesions is still a
      problem in developed and developing countries, with an increasing prevalence, particulary in
      developing communities, conflicting with a general descending trend in prevalence worldwide.

      The management of carious primary molars in children is problematic, additionally, primary
      teeth commonly remain unrestored, especially in the younger children,The high levels of
      dental disease in primary teeth, and its inadequate management, remains a major public health
      issue for children, and one with a significant impact on their lives. In addition many
      children are having to accept toothache as a part of their childhood. Set against this
      background, there would seem to be some scope for the investigation of alternative approaches
      to the management of carious primary teeth. If an alternative technique was found to be
      simpler and more acceptable to children, their parents and general dental practitioners than
      the conventional restorative approach, yet just as effective, then it might be more readily
      applied in the general practice setting.

      A novel, simplified method of using stainless steel crwons, the Hall Technique, has been
      investigated. According to American Academy of Pediatric Dentistry, Hall technique calls for
      cementation of a Stainless steel crown over a caries-affected primary molar without local
      anesthetic, caries removal or tooth preparation, This technique was developed for use when
      delivery of ideal treatment wasn't feasible.

      As the crown is fitted with no occlusal reduction in the Hall technique, it was observed in
      several studies that the occlusion would has been temporarily opened and returned to the
      pretreatment situation within 2 weeks and no child reported Tempromandibular joint pain. This
      goes in accordance with the study of Innes et al., as they stated that after placement of
      stainless steel crowns using the Hall technique, the occlusion returns to the pretreatment
      situation within 15-30 days. Also, Dr. Hall stated that the occlusion tended to equilibrate
      by the next recall appointment and none of her patients reported Tempromandibular joint pain.

      A published data from Dr Hall's practice records has indicated that Hall technique might have
      similar survival rates to other, more conventional, restorative options currently being used
      in Primary Care. In addition, avoiding the use of Local anesthesia and rotary instruments for
      tooth preparation and caries removal might mean that the technique is less demanding of both
      children and their dental team. The technique is therefore minimally invasive and can be
      expected to cause less discomfort than conventional treatment approaches. This aspect could
      be a considerable advantage as the Hall technique is a child centered approach and it is not
      surprising that the first data published on patient perceptions of the hall technique are
      promising. It was reported a clear difference in levels of discomfort, subjectively assessed
      by the operators, between the Hall technique and a conventional treatment approach. The Hall
      stainless steel crowns caused 'no discomfort' to 'mild discomfort' in comparison to the
      conventional restorations. Several conducted studies showed that the majority of the
      children, their caretakers and dentists expressed a preference for the Hall technique to the
      conventional restorations.

      The Hall Technique embraces changing concepts of managing dental caries, moving from the
      dogma requiring its complete surgical excision, even at the expense of cavity size and pulpal
      health, to the understanding that caries in dentine can be slowed, arrested, and possibly
      even reversed, within a meticulously sealed environment. It is known that the microflora in
      sealed carious dentine changes, with the predominating organisms no longer being cariogenic
      having been sealed from the oral environment. This may be important in the apparent arrest of
      caries progression.

      Owing to its non invasive design, acceptance by patients and rate of restoration longevity,
      the Hall technique maybe an improved treatment option to increase access to care, decrease
      rates of untreated caries and provide a restoration that will allow for natural tooth
      exfoliation.

      In the last few years, conventional restorations including complete removal of carious tissue
      with or without pulp therapy for the treatment of carious lesions in primary teeth have been
      challenged and a more biological approach has been suggested. This has given rise to a
      growing trend towards a biological approach by paediatric dentists and has led to an
      increasing concern about the merits of the conventional approach and whether to retain this
      treatment modality as the standard technique in restoring primary teeth or to adopt the
      biological approach as the treatment norm.
    

Intervention name(s): Hall Technique; Formecresol Pulpotomy
Intervention type(s): Other; Other
Intervention description(s): The Hall technique is a simplified method of utilizing stainless steel crowns in treatment of carious primary molars. The SSC is cemented onto the carious tooth using glass ionomer cement. Since there is no need for carious lesion removal, the use of local anesthesia is not mandate; Pulpotomy is a procedure in which the coronal pulp is amputated, and the remaining radicular pulp tissue is treated with a medicament to preserve the pulp's health .This technique involves administration of local analgesia, Isolation of the tooth with rubber dam, Complete caries removal and then access to the pulp chamber using drills
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary purpose: Treatment