DentaltownUK May 2017 - 30

golden nuggets

equilibrium will re-establish within a few weeks.
Despite reviews demonstrating that the Hall
Technique is well-tolerated by children, some
children are still anxious regarding this treatment
modality and therefore behavioural management
and distraction are often required. Cognitive
behavioural therapy techniques like desensitisation
work well. For example, you can demonstrate
the whole process on a tooth model or floss the
separator between two fingers, let them feel the
cement on their hand or squish it between their
fingers-you can even let them taste the cement
before its use so they know what to expect.
Including children in the decision-making
process also helps; ask them to see what friends
have crowns and how they found the treatment.
Let them be interactive throughout the treatment
session by assisting you-holding the cotton wool
roll, guessing the size of the crown, etc. Younger
children may like to name their crown to make
it more personal to them. The use of topical
anaesthetic placed on the surrounding gingivae
of the carious molar allows placement of the PMC
with limited discomfort upon finger pressure or
biting into place. Distraction by a favourite TV
programme or video on a parents' phone whilst
your working produces a cooperative child who
is no longer fixated on the dental treatment but
getting to do something that they enjoy. Finally,
for any dentist trained in hypnosis, the magic
glove technique works exceptionally well.
It is appreciated that many parents are not
keen on the aesthetics of a PMC and the use of
aesthetic white crowns for children's teeth is of

growing interest, but they are not commonly used
yet because they are not available on the NHS.
The Cochrane review6 advises that it is unlikely
for a white crown to be able to be placed using
the noninvasive Hall Technique. This is due to
their rigid properties, with no ability for distortion
upon pushing over the bulbosity of a primary
molar. During current times the only way to
provide an aesthetically pleasing result would be
to carry out a traditional crown preparation with
local anaesthetic to accommodate the thickness
of composite facing material or allow a passive
fit to avoid adjustments.3, 7
As GDPs we are all faced with the technical
demands of children's dentistry-their limited
access with small and challenging morphology
of their primary dentition often coupled with
anxieties. In my opinion, the Hall technique has
revolutionised children's dentistry not only for
children but also for parents and clinicians. It
allows teeth to be restored in a more simplistic,
biological manner with a predictable restoration
which the child readily accepts. Randomised
clinical trials demonstrate that PMCs outperform
other restorative techniques, providing a durable
solution less likely to develop problems or cause
pain in the long term.
I would urge any GDP to try the technique with
a carefully selected number of cases in cooperative
children who require their primary molars to
be restored. As with any new skill, a little bit of
practice will allow you to gain experience in the
correct sizing of PMCs and your technique will
continually refine with each crown placed. n

Appendix Table 1: indications and contraindications for using the Hall Technique

Indications

Contraindications

Proximal lesions: Cavitated/non-cavitated active
caries with no pulpal involvement
Occlusal lesions: Cavitated/non-cavitated active
caries, with no pulpal involvement
Non-cavitated occlusal lesions that the patient is
unable to have restored conventionally or sealed
Developmental defects that are asymptomatic
(for example: hypoplasia, hypomineralisation)

Irreversible pulpal involvement: Clinical signs/symptoms
Radiographic signs of pulpal involvement
+/- periradicular pathology
Extensive multisurface cavities with pulpal involvement
and insufficient tooth tissue to retain a crown
Precooperative child or limited cooperation
preventing safe airway management
Parent or child unhappy with aesthetics

References:
1. Innes NPT, Evans DJP Modern approaches to caries management of the primary dentition. Br Dent J 2013; 214, 559-556
2. Welbury RR, The Hall technique 10 years on: Its effect and influence. Br Dent J 2017; 222, 421-422
3. Innes NPT et al The Hall technique 10 years on: Questions and answers. Br Dent J 2017; 222, 478-483
4. Innes NP, Evans DJ, Stirrups DR Sealing caries in primary molars: a randomised control trial, 5-years results J Dent Res 2011; 90:1405-1410
5. The Hall Technique. A minimal intervention, child centred approach to managing the carious primary molar. A Users Manual. (Edition 3) 11.11.10.
University of Dundee. D.Evans & N.Innes. https://dentistry.dundee.ac.uk/files/3M_93C%20HallTechGuide2191110.pdf (accessed 14/4/17)
6. Innes NPT, et al Preformed crowns for decayed primary molar teeth Cochrane Database Syst Review 2015;12: CD005512
7. A.C. O'Connell, E. Kratunova Prefrabicated crowns for primary molars. http://sdmag.co.uk/2016/02/01/prefabricated-crowns-for-primary-molars
(accessed 14/4/17)

30

MAY 2017 // dentaltownuk.com


https://dentistry.dundee.ac.uk/files/3M_93C%20HallTechGuide2191110.pdf http://sdmag.co.uk/2016/02/01/prefabricated-crowns-for-primary-molars http://www.dentaltownuk.com

Table of Contents for the Digital Edition of DentaltownUK May 2017

On Dentaltown.com
Mike Gow Editorial
Meet the Team
Howard Speaks
Dental Aid Network
Titanium vs. Zirconia Implants
NASDAL Goodwill
Golden Nuggets
Orthodontist Case Study
Poll—Pediatric Dentistry
Technology: The True Foundation of Your Practice
Continuing Education
Timeout: Chris Barrow
Progressive Bites
Walt Disney's Hollywood Smiles
Dental Imaging: Elaine Halley
MANAGING SYSTEMIC DISORDER: STEPHEN HUDSON
The Art of Diagnosis in Endodontics
MESSAGE BOARD: 2nd Distal Root on 36
Social Media Fails
Operation Smile
THROUGH THE KEYHOLE: SURGERY— HOME AND AWAY
Lifestyle Section
History of Dentistry
Student Section
Wish List
DentaltownUK May 2017 - 1
DentaltownUK May 2017 - 2
DentaltownUK May 2017 - 3
DentaltownUK May 2017 - 4
DentaltownUK May 2017 - On Dentaltown.com
DentaltownUK May 2017 - Mike Gow Editorial
DentaltownUK May 2017 - 7
DentaltownUK May 2017 - 8
DentaltownUK May 2017 - 9
DentaltownUK May 2017 - Meet the Team
DentaltownUK May 2017 - 11
DentaltownUK May 2017 - Howard Speaks
DentaltownUK May 2017 - 13
DentaltownUK May 2017 - Dental Aid Network
DentaltownUK May 2017 - 15
DentaltownUK May 2017 - 16
DentaltownUK May 2017 - 17
DentaltownUK May 2017 - 18
DentaltownUK May 2017 - 19
DentaltownUK May 2017 - 20
DentaltownUK May 2017 - 21
DentaltownUK May 2017 - Titanium vs. Zirconia Implants
DentaltownUK May 2017 - 23
DentaltownUK May 2017 - 24
DentaltownUK May 2017 - NASDAL Goodwill
DentaltownUK May 2017 - 26
DentaltownUK May 2017 - Golden Nuggets
DentaltownUK May 2017 - 28
DentaltownUK May 2017 - 29
DentaltownUK May 2017 - 30
DentaltownUK May 2017 - Orthodontist Case Study
DentaltownUK May 2017 - 32
DentaltownUK May 2017 - 33
DentaltownUK May 2017 - Poll—Pediatric Dentistry
DentaltownUK May 2017 - 35
DentaltownUK May 2017 - Technology: The True Foundation of Your Practice
DentaltownUK May 2017 - 37
DentaltownUK May 2017 - 38
DentaltownUK May 2017 - 39
DentaltownUK May 2017 - 40
DentaltownUK May 2017 - 41
DentaltownUK May 2017 - Continuing Education
DentaltownUK May 2017 - 43
DentaltownUK May 2017 - 44
DentaltownUK May 2017 - 45
DentaltownUK May 2017 - Timeout: Chris Barrow
DentaltownUK May 2017 - 47
DentaltownUK May 2017 - Progressive Bites
DentaltownUK May 2017 - 49
DentaltownUK May 2017 - 50
DentaltownUK May 2017 - 51
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DentaltownUK May 2017 - 53
DentaltownUK May 2017 - Walt Disney's Hollywood Smiles
DentaltownUK May 2017 - 55
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DentaltownUK May 2017 - 57
DentaltownUK May 2017 - 58
DentaltownUK May 2017 - 59
DentaltownUK May 2017 - 60
DentaltownUK May 2017 - 61
DentaltownUK May 2017 - Dental Imaging: Elaine Halley
DentaltownUK May 2017 - 63
DentaltownUK May 2017 - 64
DentaltownUK May 2017 - 65
DentaltownUK May 2017 - 66
DentaltownUK May 2017 - 67
DentaltownUK May 2017 - MANAGING SYSTEMIC DISORDER: STEPHEN HUDSON
DentaltownUK May 2017 - 69
DentaltownUK May 2017 - The Art of Diagnosis in Endodontics
DentaltownUK May 2017 - 71
DentaltownUK May 2017 - 72
DentaltownUK May 2017 - 73
DentaltownUK May 2017 - MESSAGE BOARD: 2nd Distal Root on 36
DentaltownUK May 2017 - 75
DentaltownUK May 2017 - Social Media Fails
DentaltownUK May 2017 - 77
DentaltownUK May 2017 - Operation Smile
DentaltownUK May 2017 - 79
DentaltownUK May 2017 - 80
DentaltownUK May 2017 - 81
DentaltownUK May 2017 - THROUGH THE KEYHOLE: SURGERY— HOME AND AWAY
DentaltownUK May 2017 - 83
DentaltownUK May 2017 - Lifestyle Section
DentaltownUK May 2017 - 85
DentaltownUK May 2017 - 86
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DentaltownUK May 2017 - 93
DentaltownUK May 2017 - 94
DentaltownUK May 2017 - History of Dentistry
DentaltownUK May 2017 - Student Section
DentaltownUK May 2017 - 97
DentaltownUK May 2017 - 98
DentaltownUK May 2017 - 99
DentaltownUK May 2017 - 100
DentaltownUK May 2017 - 101
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DentaltownUK May 2017 - Wish List
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