Case study Common Questions from Parents/Guardians A 5-year-old patient was referred to Community Dental Services requiring treatment for multiple carious lesions. Her dentist reported poor cooperation and an abscess on the lower right side. Following an urgent appointment for an emergency nonvital pulpotomy on the lower right first deciduous molar (LRD), assessment and treatment planning was carried out. Fig. 1. Bitewing radiographs showing multiple carious lesions and emergency pulp therapy to the LRD. Note the band of intact dentine visible between the pulp and caries on the LRE, compared with no visible band on the LLD. Extensive preventative advice was completed with a hygiene therapist. The restorative treatment plan included multiple Hall crowns on the restorable carious molars. Extractions were eventually indicated for both lower first primary molars. These were ultimately performed under inhalation sedation. Hall technique to restore LRE The following series of clinical photographs demonstrate the restoration of the lower right second primary molar (LRE) using the Hall technique. Q: How long will the 'loom bands' be in? A: Usually around 3-5 days. (It can be helpful to call separators 'loom bands' because most kids and adults know what loom bands are.) I don't like separators being in for more than one week. I've seen separators that have been in for a few months! Q: What if the 'loom bands' fall out before our next appointment? A: It is possible that they may fall out. If they have fallen out recently, sometimes there is still space to place the SSC. If there isn't, I will either place them again, or I may make some adjustments to the tooth so that the crown can be fitted. Q: Will the crown damage the adult tooth underneath? A: No. (The change in occlusion is thought to be from the intrusion of the primary teeth, but there is no evidence to show it affects the developing dentition.) Q: When will it stop hurting? A: There may be 'tightness' or discomfort for up to a week. Appropriate analgesic relief during this time is recommended. Q: When will the bite get back to normal? A: Many will get used to the small change in occlusion within a few days, but it can take 2-4 months, depending on the individual. Fig. 3a. Placement of separator. Fig. 3b. Removal of separator 3-5 days after placement. Q: Will the crown fall off? A: It should stay on until the tooth exfoliates naturally. (I've had a few cases where a child has ground through the crowns, but this is fairly rare.) dentaltownuk.com \\ MARCH 2018 11http://www.dentaltownuk.com