THE HALL TECHNIQUE IN PAEDIATRIC DENTISTRY : A REVIEW OF THE LITERATURE AND AN “ ALL HALL ” CASE REPORT WITH A-24 MONTH FOLLOW UP
Figure 6 . The SSC crown on 84 immediately post fit . Note the slight blanching of the gingiva and opening of the bite .
case when using the HT . The 2015 operating manual of the HT stated that “ Hall crowns are not a universal answer to managing all carious primary molars and does not suit every carious primary molar in that child ”. 9 As a result , it became acceptable clinical practice , by those who advocate the use of the HT , to avoid restoring all the primary molars in one child using this approach . To elaborate further , restoring all carious Ds and Es in one single child , using the HT was not standard recommendation . The justification had not been clarified by HT advocates but it may have possibly been due to worries about subsequent long term effects on the occlusion . The sequelae of the HT on the occlusion had been studied in the past . It was found that children ’ s occlusion tended to undergo slight opening of the bite ( 1-2 mm average ) which subsided as a result of dentoalveolar compensation 14 or physical intrusion 15 of the crowned tooth . The aforementioned effects were studied when one or two crowns were placed , however , to date , no study had shown the effect of restoring all Ds and Es in one child , on the occlusion . Keeping the above in mind , we report a case during which the HT was utilised to full capacity , contrary to the usual HT clinical doctrine , to restore all eight primary molars in one single child . There were no known complications and the occlusion was deemed satisfactory . This case has been dubbed the “ All Hall ” case . 16
Table 2 . All Hall case : Treatment plan .
5 . “ All Hall ” 24-month follow-up case report The study protocol was reviewed and approved by the Hamdan College Dental Medicine Institutional Ethical Committee at the Mohammed Bin Rashid University of Medicine and Health Sciences ( MBRU ) in Dubai ( UAE ) and in accordance with the Helsinki Declaration of 1975 , as revised in 2000 . 5.1 . Case details A fit and healthy three-year old male child was brought by his father to the Department of Paediatric Dentistry at the Hamdan College Dental Medicine at the Mohammed Bin Rashid University of Medicine and Health Sciences ( MBRU ) in Dubai ( UAE ). The father reported that his son had tooth decay but had suffered no discomfort . After clinical and radiographic examination , the patient was diagnosed as having numerous asymptomatic carious primary molar and incisor teeth fitting with the diagnosis of Severe Early Childhood Caries ( S-ECC ). The patient ’ s eight carious primary molars ( 55 , 54 , 64 , 65 , 75 , 74 , 84 & 85 ) were symptom free . Clinical and radiographic signs of pulp pathology were absent . See Figure 7 for pre-operative clinical features and Figure 8 for pre-operative radiographic findings . He also had initial caries on 53 , 52 , 51 , 61 , 62 & 63 . There was no known trauma history . His initial cooperation was categorized as “ pre-cooperative ”. The patient ’ s behavioural scale was assessed to be negative initially but improved dramatically to positive behaviour as treatment progressed . The treatment options for the carious primary molars that were discussed and explored with his father were ; prevention only , conventional restorative treatment using LA , the “ Hall Technique ” with no LA ( and restorations of the upper primary incisors ) or full mouth rehabilitation under general anaesthesia ( GA ). The patient ’ s father was keen for his son to receive dental treatment in the dental chair rather than under GA due to many reasons including financial constraints ( children ’ s dental GA is not routinely provided by a free public service - available to everyone - in the UAE as it is in the UK for example ). After sufficient consideration , the father consented for the HT as the child ’ s cooperation for LA was not forthcoming and he was adamant about avoiding GA .
Case Reports
1 . Preventive care phase - Acclimatisation and non - pharmacological behavioural management - Oral hygiene instructions ( OHIs ) - Record plaque score at each visit - Diet analysis and advice - Fluoride application
2 . Restorative treatment plan a . Restore the posterior carious teeth with stainless steel crowns using the Hall Technique ( HT ): 55 , 54 , 64 , 65 , 74 , 75 , 84 , 85 b . Interim therapeutic restorations ( ITR ) using Glass Ionomer Cement ( GIC ) restorations for : 53,52,51,61,62,63 3 . Recall and reviews : regular 3 month recalls , radiographs every 6 months and fluoride varnish application 4 times a year ( 3 , 6 , 9 , 12 , 18 , 24 months thereafter )
4 . Definitive treatment for upper anterior teeth once cooperation allowed .
Stomatology Edu Journal
211