Dentaltown March 2020 - 87

The parents of this
5-year-old patient traveled
2,500 miles from the
Northern Territory of Canada
so Dr. Jeanette MacLean could
treat him with the Hall technique in
Arizona, in lieu of general anesthesia.

5. Fill the crown with a high-quality
glass ionomer or resin-modified glass
ionomer cement (Figs. 6a-6c).
6. Seat the crown with firm finger
pressure, or use a bite stick and have
the patient help by biting down
firmly on a cotton roll (Fig. 7).
7. Clean the excess cement with wet
gauze, water spray and flossing the
contacts (Figs. 8a and 8b).
8. The patient's bite may be slightly
opened by approximately 1mm and
will self-adjust over the next one
to two weeks via intrusion of the
crowned tooth and opposing tooth, as
well as supereruption of the adjacent
teeth7-8 (Figs. 9 and 10a-10c).

The controversy
There remains some controversy
regarding this technique in the U.S.,
often stemming from lack of awareness
of the randomized control trial evidence
for Hall crowns or the systematic reviews
and meta-analyses that have demonstrated
that complete caries removal is not necessary for caries management.9-10 Members
of the International Caries Consensus
Collaboration, Drs. Innes, Frencken and
Schwendicke, summed it up best in their
2016 article:

This patient has Hall
crowns on all four first
primary molars.

"The failure to follow new
evidence is not limited to dentists
who are 'out of touch,' do not
undertake continuing professional
development, or have been practicing for many years; in some
countries and some schools, new
dentists are still taught to remove
all infected carious tissue, and
it is actually not possible to pass
professional examinations without
demonstrating this. The reasons
underlying this failure to translate
evidence into clinical practice are
many and complex.
"The ' don't know' could be
due to general ignorance (perhaps
remedied with an appropriate
educational intervention) or the
more problematic willful ignorance, where the subject chooses
not to learn more about a topic
(perhaps because it challenges his
or her current beliefs)." 11

The big picture
While the Hall technique is not for every
patient nor every tooth, it is an evidence-based
procedure that is an extremely advantageous

Because the Hall
technique is usually
performed on molars,
the stainless steel
crowns are not a big deal
aesthetically-this patient has
two in place.

option for managing severe early childhood
caries. This minimally invasive approach
allows the provider to increase access to care
and improve the patient experience while
reducing cost and risk. n
References:
1. Innes NP, et al. The Hall Technique 10 years on: Questions
and answers. Br Dent J. 2017 Mar 24;222(6):478-483.
doi: 10.1038/sj.bdj.2017.273.
2. Innes N P, Evans D J P, Stirrups DR. Sealing caries in
primary molars; randomized control trial, 5 year results. J
Dent Res 2011; 90: 1405-1410.
3. Santamaria R M, Innes N P T, Machiulskiene V, Evans D
J P, Splieth C H. Caries management strategies for primary
molars: 1yr randomized control trial results. J Dent Res
2014; 93: 1062-1069.
4. Narbutaite J, Maciulskiene V, Splieth C H, Innes N P T,
Santamaria R M. Acceptability of three different caries
treatment methods for primary molars among Lithuanian
children. 12th Congress of the European Academy of Paediatric Dentistry 'A passion for Paediatric Dentistry'
5. Araujo MP, Olegario IC, Hesse D, Innes NP, Bonifacio
CC, Raggio DP. ART versus Hall Technique in Primary
Molars: 1-Year Survival and Cost Analysis of a RCT
ORCA Abstract number 86. Caries Res 2017;51:330 DOI:
10.1159/000471777
6. Ludvig KH, Fontana M, Vinson L A, Platt J A, Dean J
A. The success of stainless steel crowns placed with the Hall
Technique. JADA 2014; 145: 1248-1253.
7. Van der Zee V, van Amerongen W E. Influence of preformed
metal crowns (Hall Technique) on the occlusal vertical
dimension in the primary dentition. Eur Arch Pediatr Dent
2010; 11: 225-227.
8. So D, Evans D J P, Borrie F et al, Measurement of Occlusal
Equilibration Following Hall Crown Placement. J Dent
Res 2015; 94 (Spec Iss A). Abstract No 0080; 2015. IADR,
Boston, US.
9. Thompson V., et al. Treatment of deep carious lesions by
complete excavation or partial removal: a critical review. J
Am Dent Assoc. 2008 Jun;139(6):705-12.
10. Ricketts D., et al. Operative caries management in adults and
children. Cochrane Database Syst Rev. 2013 Mar 28;(3).
11. Innes N., et al. Don't Know, Can't Do, Won't Change:
Barriers to Moving Knowledge to Action in Managing the
Carious Lesion. J Dent Res 2016; May;95(5):485-6.

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