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| Title |
The Hall Technique Has a Similar Rate of Effectiveness as Conventional Restorative Treatments in the Primary Dentition |
| Clinical Question |
For a patient with caries in the primary dentition, in which conventional restorative techniques are not possible or not preferred, is the Hall technique an acceptable alternative? |
| Clinical Bottom Line |
For patients in which factors such as age, cost of treatment, ability to tolerate invasive/extensive procedures, medical conditions, etc. may present significant challenges to conventional restorative treatment, the Hall technique (HT) can be considered as an acceptable alternative. The results of a clinical trial and a cohort study suggest a similar level of clinical success can be achieved with this technique as compared to more conventional treatment modalities. |
| Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| #1) 28691235 | BaniHani/2018 | 246 children with carious lesions in primary dentition | Retrospective Cohort Study | | Key results | The biological treatment approaches of the Hall technique and indirect pulp cap compared very favorably with conventional treatment approaches of complete caries removal and pulpotomy. The survival rates for conventional treatments (95.3%) and biological treatments (95.8%) were not significantly different (p > 0.05). These results are based on the treatment outcomes of 836 teeth from 246 patients. | | #2) 31158253 | Elamin/2019 | 164 children with carious lesions in primary dentition | Randomized Controlled Trial | | Key results | Survival rates of preformed metal crowns (PMCs) placed using the Hall technique (HT) and conventional treatment (CT) approach of complete caries removal with preparation/reduction of tooth structure were comparable. The survival rates for PMCs placed using CT (88.3% ) and those placed using HT (90.8%), were not significantly different (p > 0.05.) Patients in the HT groups experienced increased occlusion following treatment, but 97% returned to normal occlusion by 6 months post-treatment and 100% had normal occlusion by 12 months. Additionally, “no significant relationship between PMC placement method (HT or CT) and periodontal health assessment represented by plaque index, 𝝌2 (3) = 1.12, p > 0.05, and gingival index, 𝝌2 (3) = 3.67, p > 0.05.” These results are based on the treatment outcomes of 212 teeth from 164 patients. | |
| Evidence Search |
MeSH Terms: tooth, deciduous; methods; dental caries (Subheading: methods) |
Comments on
The Evidence |
Validity: These articles reviewed the treatment outcomes for an appropriate number of procedures, which were suitably distributed between the various treatment modalities being studied. Additionally, treatment was provided by dental professionals who were familiar with the treatment techniques being performed. For example, the same provider or group of providers performed either the HT or CT but not both techniques. Presumably these factors could account for the high rate of success and low number of failures. However, as the authors of one paper noted, “the length of follow-up in our study had a wide range and a longer follow-up period could increase the reporting of these failures.” With a similar timeline for follow-up evaluation, the same could be said for both studies.
Perspective: Based on these articles, the Hall technique can be considered as a treatment option when addressing carious lesions in the primary dentition. Both use retention of a given restoration as the measure of success and demonstrate the survivability of treatment performed using either the HT or CT. Additionally, the Elamin study addresses the concerns some practitioners have had of the Hall technique’s effects on occlusion and the periodontium. However, periodontal probing depths and post-treatment radiographs were not included in this study, and additional research may be required to investigate the long-term effects of the HT on occlusion. Until such studies are conducted, providers should be mindful of these unknowns when considering the best course of treatment for their patients. |
| Applicability |
In clinical practice, treating carious lesions with conventional restorative techniques often requires extended treatment times and the use of local anesthetics. In many situations, oral conscious sedation or even general anesthesia may be required as well, due to a patient’s dental anxiety, emotional immaturity, complex medical conditions, etc. For some patients, factors such as access to care, cost of treatment, and health risks may make these treatment options undesirable or even prohibitive. The HT provides an alternative approach for caries in the primary dentition that generally provides immediate treatment, at a lower overall cost, with relatively shorter appointment times and does not involve caries excavation or require anesthesia. The evidence presented in these articles suggests that practitioners who utilize the HT in these types of circumstances can expect commensurate success rates to those experienced with CT modalities. While the overall success rates have been well-documented, and the Elamin study demonstrates no significant negative effects associated with malocclusion and periodontal health in the short term, what remains unclear are the possible long-term complications associated with placing PMCs on unprepared teeth. More research is needed to further investigate these concerns, and, as always, providers should carefully weigh the benefits with the potential risks when determining the best course of action for their patients. |
| Specialty/Discipline |
(Pediatric Dentistry) |
| Keywords |
Caries, primary dentition, Hall technique
|
| ID# |
3399 |
| Date of submission: |
11/26/2019 |
| E-mail |
calamec@livemail.uthscsa.edu |
| Author |
Cody W. Calame, DDS |
| Co-author(s) |
Hunter R. Acord, DDS |
| Co-author(s) e-mail |
acordh@livemail.uthscsa.edu |
| Faculty mentor/Co-author |
Kevin J. Donly, DDS, MS |
| Faculty mentor/Co-author e-mail |
donly@uthscsa.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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