Dentaltown March 2020 - 84

This minimally invasive approach
is particularly advantageous for
young, apprehensive patients,
who may otherwise require sedation
for traditional surgical interventions.

The Hall technique
Dr. Norna Hall was a general practice
dentist working in a region with a high
level of caries in Scotland. In 1997, an audit
discovered she was placing stainless steel
crowns at a higher-than-average rate. Hall
also was placing them in an unconventional
way-without local anesthesia or tooth
preparation, simply sealing the carious
lesions under the crown with a glass ionomer
cement, thereby cutting them off from their
"fuel" (i.e., dietary carbohydrates) and
arresting them.
To her surprise and delight, the clinical
outcomes were similar to conventional
crown placement and well accepted by
her patient population.1 And so the Hall
technique was born. Since that time, four
randomized control trials have been published that demonstrate the efficacy of the
Hall technique for caries management in
pediatric patients.2-5

Presenting to the parent
When introducing the option of the
Hall technique to a parent, I say this: "What
would happen to you if I dropped you in a
tank of cement? Would you live or would
you die?" I usually get a look of wide eyes,
followed by a laugh, then a response, "Die."
To which I reply, "Correct. So, when
I seal the cavities' bugs under a crown in
cement, they're also starved of the fuel
needed to survive, and they arrest and die."
I also explain that the efficacy for the
Hall technique is equivalent to the traditional
surgical, i.e., drill-and-fill approach, each
with a small margin of failure.6 However,

84

the Hall technique has an added benefit
in that it eliminates the need for shots and
drills, which could require sedation for
their child to tolerate the treatment. With
proper informed consent, I have found the
technique is well accepted by parents and
well tolerated by patients.

Contraindications
*	 Clinical symptoms of irreversible
pulpitis or dental abscess.
*	 No clear band of dentin between
the carious lesion and the pulp.
*	 Radiographic evidence of pulpal
exposure or periradicular pathology.
*	 Unrestorable, inadequate tooth
structure for crown retention.
*	 Children whose airway cannot
be managed safely.

Benefits
*	 Patient-centered care.
*	 Quicker to complete.
*	 Proven efficacy by randomized
control trials.
*	 Minimal intervention is favorable
to the pulp.
*	 Reduced anxiety/stress for the child
patient, parent and dentist.
*	 No need for local anesthetic or
tooth preparation.
*	 No soft-tissue damage.
*	 No accidental lip or tongue biting.

Case presentation
A 5-year-old girl presents with extensive
yet asymptomatic caries in her mandibular
left first primary molar (Fig. 1).

Informed consent is reviewed with the
patient's mother and treatment options
were discussed, including no treatment;
silver diamine fluoride; extraction; or a
prefabricated stainless steel crown, placed
with either traditional surgical preparation
or the noninvasive Hall technique.
The patient's mother opted for the Hall
technique because it would involve minimal
tooth preparation and no need for local
anesthetic or sedation.

The technique
1.	 Place orthodontic separators into the
mesial and distal contacts to create
space for the crown. You may use
orthodontic pliers, or thread two
pieces of floss through the separator,
pull them in opposite directions to
stretch the band, and then slide it
into the contact. If the patient has
open contacts or primate space,
it may not be necessary to place
separators (Figs. 2a-2d).
2.	 After approximately two days to one
week, remove the separators and clean
gross debris with plain pumice, then
rinse (Figs. 3a, 3b and 4).
3.	 Protect the patient's airway by
positioning the child slightly upward,
drape a 4x4 gauze across the back of
the throat, and/or use a rolled piece of
adhesive medical tape to adhere the
SSC to your gloved finger.
4.	 Select the crown and crimp or
adjust as needed to have a "snap"
fit and good marginal adaptation
(Figs. 5a-c).

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