Hall Technique

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The Hall Technique is a minimally-invasive treatment for decayed baby back (molar) teeth. Decay is sealed under preformed (stainless steel) crowns, avoiding injections and drilling. It is one of a number of biologically orientated strategies for managing dental decay.

Contents

The technique has an evidence-base showing that it is acceptable to children, parents and dentists and it is preferred over standard filling techniques, due to the ease of application and overall patient comfort as young patients don't have to undergo traumatic injections. Preformed metal crowns are now recommended as the optimum restoration for managing carious primary molars. There are now five randomised control trials that have shown the Hall Technique to be superior to other methods for managing decay in baby teeth but there is a lack of evidence to conclude that the Hall Technique is superior to placing preformed metal crowns in a conventional manner. [1] Initial fears over the potential problem with sealing caries into teeth being that the caries process might only be slowed, rather than arrested and that the caries might still progress, leading to pain and infection later. [2] [3] This problem has not been realised with one study showing long-term data beyond five years, to when the baby teeth are lost, with fewer problems from the tooth with the crown.

Crowns placed using the Hall Technique have better long term outcomes (pain/infection and need for replacement) compared with standard fillings. [4] [5] [6]

The technique has been used and found particularly valuable in a developing country with little access to dental services, or resources to support such services. [7] It is also utilized in modern dental practices, as many parents and patients prefer treatment options that are minimally invasive and that help eliminate the need for sedation.

History

Downloadable manual for the Hall technique HallTechGuide V4.pdf
Downloadable manual for the Hall technique

Preformed metal crowns have been used for restoring primary molars since the 1950s. Literature suggests preformed crowns placed on carious primary molar teeth reduce risk of major failure or pain in the long term compared to fillings. There is also evidence to suggest that fitting crowns using the Hall Technique reduces patient discomfort at the time of treatment in comparison to conventional fillings. It can also help reduce the overall time a patient spends in the dental chair due to the relatively simple and quick procedure when compared with traditional method of SSC application. [8]

The Hall Technique is named after Dr. Norna Hall, a dentist working in Scotland, who has developed a simplified technique where the crown is simply cemented over the carious primary molar, with no local anaesthesia, caries removal, or tooth preparation of any kind. [9] The traditional method for management of dental caries has evolved from the exclusive domain of techniques based on complete caries removal prior to tooth restoration. Norna Hall used pre-formed crowns and cemented over carious primary molars using a glass-ionomer luting cement, with no caries removal, tooth preparation, or local anaesthesia.

The Hall Technique has been included in a guideline of the Scottish Dental Clinical Effectiveness Programme (SDCEP) [10] and has helped to drive change in how dentists manage decay in primary teeth from the traditional invasive surgical approach to the less-invasive biological management of decay. [11] [12] [13] [14] [15]

Clinical trials have shown the technique to be effective, however it is not an easy, quick-fix solution to the problem of carious primary molars. The technique is not suited to every tooth, child or clinician, however it can be an effective method of managing carious primary molars. The Hall Technique should not be used when there are clinical or radiographic signs and symptoms of irreversible pulpitis or dental abscess. Radiographically, there should be a clear band of dentine between the carious lesion and pulp for a Hall Technique to be suitable.

Decay in baby teeth

Baby teeth are known as primary teeth or deciduous teeth. Biologically orientated strategies for managing dental decay are considered by their proponents to have advantages for child patients receiving dental care as the techniques are less invasive and often avoid having to use local anaesthesia and drilling. They are also less destructive and potentially damaging for primary teeth. Five randomised control trials with children, on decayed primary teeth, have been carried out looking at incomplete, or no removal of decay. These have looked at how much pain and infection or repeated treatment biological techniques (including the Hall Technique) compare to other treatment techniques including complete caries removal. These "minimal intervention" approaches reduce some of the adverse consequences associated with carrying out restorative treatment: conservation of tooth structure and integrity, maintenance of maximum pulpal floor dentinal thickness, which reduces the impact on pulpal health; [16] reduced pulp exposure, and less need for local anaesthesia if no vital dentine is being removed, which has been shown to reduce children’s reported discomfort. [17] [18]

A Cochrane systematic review [19] has compared biologically orientated strategies (stepwise, partial and no-caries removal), with complete caries removal for managing decay in both primary and permanent teeth. Eight trials of 934 patients (1372 teeth) with outcomes reported for 1191 teeth were included in the analyses. The conclusion of the review was that for symptomless and vital teeth, biologically orientated strategies had clinical advantages over complete caries removal in the management of dentinal caries. Not only were there no differences in restoration longevity or in the numbers of teeth (or patients) experiencing pulpal pathology (pain or infection), but there were significantly less pulp exposures. For partial caries removal in primary teeth, this was a risk ratio of 0.24 [0.06,0.90], when caries were not completely removed.

Use of technique in the permanent dentition

The Hall technique can also be used with permanent first molars in some cases where prognosis is poor, such as where first permanent molars are hypomineralised, carious with poor prognosis but to be maintained until full eruption of second molars, or for cuspal coverage of endodontically treated teeth in minors with compliance issues preventing full coverage crown preparation. [20]

Indications and contraindications

Indications

Hall Technique stainless steel crowns (SSC) are indicated for primary molars in the following situations:

Contraindications

Hall Technique stainless steel crowns are contraindicated in the following instances:

Procedure

A video demonstration is available from Affiliated Children's Dental Specialists

The Hall Technique sometimes requires several appointments to allow separation of the teeth, in order to place the preformed crown to be fitted with no additional tooth removal or anaesthetic. A downloadable manual is available (see Further Reading at the end of this article).

Diagnostics and radiographs will be required initially. Once it has been established that the Hall Technique is indicated the following stages will be likely to occur.

Appointment 1: separator placement

Image 1: Insertion of a separator on a dental model DentalSeperatorPlacement.jpg
Image 1: Insertion of a separator on a dental model

To enable the stainless steel crown to be placed on the tooth, there must be sufficient space between the teeth. If this space is not currently available, orthodontic separators may be placed between the tooth indicated for the Hall Technique and adjacent teeth (see image 1). [25] If the placement is impaired due to interproximal breakdown a temporary restorative material may be used to build up the contact point, to allow the effective placement of separators. [26] However temporary restorative material is not a common practice of the Hall Technique, and case selection appropriateness should be considered. The separators are generally placed 3–5 days prior to the placement of the stainless steel crown to space to be created. [25] The clinician will provide advice on this procedure and how to proceed if these fall out prior to the next appointment.

Appointment 2: Hall Technique

Image 2: Stainless steel crowns PreformSSC.jpg
Image 2: Stainless steel crowns

The stainless steel crowns are selected by tooth type, location and size (see image 2). The tooth will be measured to identify the most suitable size of stainless steel crown. [25] The clinician will try the stainless steel crown prior to its cementation, to ensure that it fits correctly, and establish if an alternative size or contouring of the stainless steel crown is required. When placing the stainless steel crown within the mouth, the airways will generally be protected by placing gauze around the site, or the clinician may secure the stainless steel with tape/Elastoplast. [25] Once a correct size/fit is established, the crown may be adhered to the tooth. The stainless steel crown is secured to the tooth by partially filling the stainless steel crown with a self curing glass ionomer cement and then placing over the tooth. [25] The stainless steel crown should "click" securely into place. [25] The patient is required to bite firmly onto a cotton roll or bite stick to secure it in the correct position whilst it sets. [25] The excess of glass ionomer cement will be wiped off or removed with knotted floss from between the interproximal contact, and a sickle probe from the buccal gingival sulcus on the buccal and lingual/palatal surfaces. [21]

Appointment 3: follow up appointment

Stainless steel crown placed on a dental model HallsTechniqueCrown.jpg
Stainless steel crown placed on a dental model

At follow up appointments the Hall Technique crown will be assessed clinically and radiographically when required. [25] The tooth will still be able to exfoliate naturally, and the tooth should exfoliate with the crown in place. However, if the patient experiences pain/discomfort after the initial few days, consult your dental professional. A dental professional should also be consulted if the crown falls off, as this will prevent the management of the decay.

Materials/instruments

[25]

Advantages and disadvantages of Hall Technique

Advantages

Disadvantages

Patient expectations

Alternative therapies

Related Research Articles

<span class="mw-page-title-main">Human tooth</span> Calcified whitish structure in humans mouths used to break down food

Human teeth function to mechanically break down items of food by cutting and crushing them in preparation for swallowing and digesting. As such, they are considered part of the human digestive system. Humans have four types of teeth: incisors, canines, premolars, and molars, which each have a specific function. The incisors cut the food, the canines tear the food and the molars and premolars crush the food. The roots of teeth are embedded in the maxilla or the mandible and are covered by gums. Teeth are made of multiple tissues of varying density and hardness.

<span class="mw-page-title-main">Tooth decay</span> Deformation of teeth due to acids produced by bacteria

Tooth decay, also known as cavities or caries, is the breakdown of teeth due to acids produced by bacteria. The cavities may be a number of different colors from yellow to black. Symptoms may include pain and difficulty with eating. Complications may include inflammation of the tissue around the tooth, tooth loss and infection or abscess formation.

Dental products are specially fabricated materials, designed for use in dentistry. There are many different types of dental products, and their characteristics vary according to their intended purpose.

Dental restoration, dental fillings, or simply fillings are treatments used to restore the function, integrity, and morphology of missing tooth structure resulting from caries or external trauma as well as to the replacement of such structure supported by dental implants. They are of two broad types—direct and indirect—and are further classified by location and size. A root canal filling, for example, is a restorative technique used to fill the space where the dental pulp normally resides.

<span class="mw-page-title-main">Pulp (tooth)</span> Part in the center of a tooth made up of living connective tissue and cells called odontoblasts

The pulp is the connective tissue, nerves, blood vessels, and odontoblasts that comprise the innermost layer of a tooth. The pulp's activity and signalling processes regulate its behaviour.

Dental sealants are a dental treatment intended to prevent tooth decay. Teeth have recesses on their biting surfaces; the back teeth have fissures (grooves) and some front teeth have cingulum pits. It is these pits and fissures that are most vulnerable to tooth decay because food and bacteria stick in them and because they are hard-to-clean areas. Dental sealants are materials placed in these pits and fissures to fill them in, creating a smooth surface which is easy to clean. Dental sealants are mainly used in children who are at higher risk of tooth decay, and are usually placed as soon as the adult molar teeth come through.

<span class="mw-page-title-main">Crown (dental restoration)</span> Dental prosthetic that recreates the visible portion of a tooth

In dentistry, a crown or a dental cap is a type of dental restoration that completely caps or encircles a tooth or dental implant. A crown may be needed when a large dental cavity threatens the health of a tooth. A crown is typically bonded to the tooth by dental cement. They can be made from various materials, which are usually fabricated using indirect methods. Crowns are used to improve the strength or appearance of teeth and to halt deterioration. While beneficial to dental health, the procedure and materials can be costly.

<span class="mw-page-title-main">Deciduous teeth</span> First set of teeth in diphyodonts

Deciduous teeth or primary teeth, also informally known as baby teeth, milk teeth, or temporary teeth, are the first set of teeth in the growth and development of humans and other diphyodonts, which include most mammals but not elephants, kangaroos, or manatees, which are polyphyodonts. Deciduous teeth develop during the embryonic stage of development and erupt during infancy. They are usually lost and replaced by permanent teeth, but in the absence of their permanent replacements, they can remain functional for many years into adulthood.

<span class="mw-page-title-main">Dental abrasion</span> Medical condition

Abrasion is the non-carious, mechanical wear of tooth from interaction with objects other than tooth-tooth contact. It most commonly affects the premolars and canines, usually along the cervical margins. Based on clinical surveys, studies have shown that abrasion is the most common but not the sole aetiological factor for development of non-carious cervical lesions (NCCL) and is most frequently caused by incorrect toothbrushing technique.

Pulpitis is inflammation of dental pulp tissue. The pulp contains the blood vessels, the nerves, and connective tissue inside a tooth and provides the tooth's blood and nutrients. Pulpitis is mainly caused by bacterial infection which itself is a secondary development of caries. It manifests itself in the form of a toothache.

<span class="mw-page-title-main">Dentinogenesis imperfecta</span> Medical condition

Dentinogenesis imperfecta (DI) is a genetic disorder of tooth development. It is inherited in an autosomal dominant pattern, as a result of mutations on chromosome 4q21, in the dentine sialophosphoprotein gene (DSPP). It is one of the most frequently occurring autosomal dominant features in humans. Dentinogenesis imperfecta affects an estimated 1 in 6,000-8,000 people.

<span class="mw-page-title-main">Early childhood caries</span> Dental disease of young children

Early childhood caries (ECC), formerly known as nursing bottle caries, baby bottle tooth decay, night bottle mouth and night bottle caries, is a disease that affects teeth in children aged between birth and 71 months. ECC is characterized by the presence of 1 or more decayed, missing, or filled tooth surfaces in any primary tooth. ECC has been shown to be a very common, transmissible bacterial infection, usually passed from the primary caregiver to the child. The main bacteria responsible for dental caries are Streptococcus mutans and Lactobacillus. There is also evidence that supports that those who are in lower socioeconomic populations are at greater risk of developing ECC.

<span class="mw-page-title-main">Glass ionomer cement</span> Material used in dentistry as a filling material and luting cement

A glass ionomer cement (GIC) is a dental restorative material used in dentistry as a filling material and luting cement, including for orthodontic bracket attachment. Glass-ionomer cements are based on the reaction of silicate glass-powder and polyacrylic acid, an ionomer. Occasionally water is used instead of an acid, altering the properties of the material and its uses. This reaction produces a powdered cement of glass particles surrounded by matrix of fluoride elements and is known chemically as glass polyalkenoate. There are other forms of similar reactions which can take place, for example, when using an aqueous solution of acrylic/itaconic copolymer with tartaric acid, this results in a glass-ionomer in liquid form. An aqueous solution of maleic acid polymer or maleic/acrylic copolymer with tartaric acid can also be used to form a glass-ionomer in liquid form. Tartaric acid plays a significant part in controlling the setting characteristics of the material. Glass-ionomer based hybrids incorporate another dental material, for example resin-modified glass ionomer cements (RMGIC) and compomers.

<span class="mw-page-title-main">Pulpotomy</span>

Pulpotomy is a minimally invasive procedure performed in children on a primary tooth with extensive caries but without evidence of root pathology. The minimally invasive endodontic techniques of vital pulp therapy (VPT) are based on improved understanding of the capacity of pulp (nerve) tissues to heal and regenerate plus the availability of advanced endodontic materials. During the caries removal, this results in a carious or mechanical pulp exposure (bleeding) from the cavity. During pulpotomy, the inflamed/diseased pulp tissue is removed from the coronal pulp chamber of the tooth leaving healthy pulp tissue which is dressed with a long-term clinically-successful medicament that maintains the survival of the pulp and promotes repair. There are various types of medicament placed above the vital pulp such as Buckley's Solution of formocresol, ferric sulfate, calcium hydroxide or mineral trioxide aggregate (MTA). MTA is a more recent material used for pulpotomies with a high rate of success, better than formocresol or ferric sulfate. It is also recommended to be the preferred pulpotomy agent in the future. After the coronal pulp chamber is filled, the tooth is restored with a filling material that seals the tooth from microleakage, such as a stainless steel crown which is the most effective long-term restoration. However, if there is sufficient remaining supporting tooth structure, other filling materials such as amalgam or composite resin can provide a functional alternative when the primary tooth has a life span of two years or less. The medium- to long-term treatment outcomes of pulpotomy in symptomatic permanent teeth with caries, especially in young people, indicate that pulpotomy can be a potential alternative to root canal therapy (RCT).

Pulp necrosis is a clinical diagnostic category indicating the death of the pulp and nerves of the pulp chamber and root canal of a tooth which may be due to bacterial sequelae, trauma and chemical or mechanical irritation. It is often the end result of many cases of dental trauma, caries and irreversible pulpitis.

<span class="mw-page-title-main">Pulp stone</span>

Pulp stones are nodular, calcified masses appearing in either or both the coronal and root portion of the pulp organ in teeth. Pulp stones are not painful unless they impinge on nerves.

<span class="mw-page-title-main">Pulp capping</span>

Pulp capping is a technique used in dental restorations to prevent the dental pulp from necrosis, after being exposed, or nearly exposed during a cavity preparation, from a traumatic injury, or by a deep cavity that reaches the center of the tooth causing the pulp to die. When dental caries is removed from a tooth, all or most of the infected and softened enamel and dentin are removed. This can lead to the pulp of the tooth either being exposed or nearly exposed which causes pulpitis (inflammation). Pulpitis, in turn, can become irreversible, leading to pain and pulp necrosis, and necessitating either root canal treatment or extraction. The ultimate goal of pulp capping or stepwise caries removal is to protect a healthy dental pulp and avoid the need for root canal therapy.

Silver diammine fluoride (SDF), also known as silver diamine fluoride in most of the dental literature, is a topical medication used to treat and prevent dental caries and relieve dentinal hypersensitivity. It is a colorless or blue-tinted, odourless liquid composed of silver, ammonium and fluoride ions at a pH of 10.4 or 13. Ammonia compounds reduce the oxidative potential of SDF, increase its stability and helps to maintain a constant concentration over a period of time, rendering it safe for use in the mouth. Silver and fluoride ions possess antimicrobial properties and are used in the remineralization of enamel and dentin on teeth for preventing and arresting dental caries.

<span class="mw-page-title-main">Molar incisor hypomineralisation</span> Medical condition

Molar incisor hypomineralisation (MIH) is a type of enamel defect affecting, as the name suggests, the first molars and incisors in the permanent dentition. MIH is considered a worldwide problem and usually occurs in children under 10 years old. This developmental condition is caused by the lack of mineralisation of enamel during its maturation phase, due to interruption to the function of ameloblasts. Many factors have been suggested, such as genetics and medical problems during pregnancy, but only childhood illness, fever in particular, seems to be associated with MIH. However, further studies on the aetiology of MIH are required because it is believed to be multifactorial.

Atraumatic restorative treatment (ART) is a method for cleaning out tooth decay from teeth using only hand instruments and placing a filling. It does not use rotary dental instruments to prepare the tooth and can be performed in settings with no access to dental equipment. No drilling or local anaesthetic injections are required. ART is considered a conservative approach, not only because it removes the decayed tissue with hand instruments, avoiding removing more tissue necessary which preserves as much tooth structure as possible, but also because it avoids pulp irritation and minimises patient discomfort. ART can be used for small, medium and deep cavities caused by dental caries.

References

  1. ↑ Innes, Nicola PT; Ricketts, David; Chong, Lee Yee; Keightley, Alexander J.; Lamont, Thomas; Santamaria, Ruth M. (2015). "Preformed crowns for managing decayed primary molar teeth in children | Cochrane". Cochrane Database of Systematic Reviews (12): CD005512. doi:10.1002/14651858.CD005512.pub3. PMC   7387869 . PMID   26718872.
  2. ↑ Innes NPT, Evans DJP, Stirrups DR. "The Hall Technique: a randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice; acceptability of the technique and outcomes at 23 months" BMC Oral Health 2007 7:18. http://www.biomedcentral.com/1472-6831/7/18
  3. ↑ Innes, N. P. T., Evans, D. J. P., & Stirrups, D. R. (2011). "Sealing caries in primary molars randomized control trial, 5-year results". Journal of Dental Research, 90(12), 1405-1410.
  4. ↑ Innes NPT, Evans DJP, Stirrups DR. "Sealing Caries in Primary Molars; Randomized Control Trial, 5-year Results". J Dent Res 2011 90(12) 1405-10. http://jdr.sagepub.com/content/90/12/1405.abstract
  5. ↑ Innes NPT, Marshman Z, Vendan R. "A Group of General Dental Practitioners' Views of Preformed Metal Crowns after Participation in the Hall Technique Clinical Trial; A Mixed-Method Evaluation". Primary Dental Care 2010 Jan; 17(1):33-7 http://www.ingentaconnect.com/content/fgdp/pdc/2010/00000017/00000001/art00017?crawler=true
  6. ↑ Gilchrist F, Howell J, Gavern D, North S, Innes NPT, Rodd HD. "Clinical outcomes for preformed metal crowns placed by dental undergraduates". Int J Paediatr Dent 2011, 21 (Suppl. 2): 1
  7. ↑ Fadil Elamin. "Saving children’s teeth in Sudan – without anaesthetic or drills"
  8. ↑ Innes, N. P. T., Ricketts, D., Chong, L. Y., Keightley, A. J., Lamont, T., & Santamaria, R. M. (2015). "Preformed crowns for decayed primary molar teeth" (Review).
  9. ↑ Innes NPT, Stirrups DR, Evans DJP, Hall N. "A Novel technique Using Preformed Metal Crowns for Managing Carious Primary Molars in General Practice – a retrospective analysis" Brit Dent J 2006; 200(8):451-4 & 444 http://www.nature.com/bdj/journal/v200/n8/abs/4813466a.html
  10. ↑ "Prevention and management of dental caries in children". Scottish Dental Clinical Effectiveness Programme. 14 September 2012. Archived from the original on 4 October 2013. Retrieved 4 October 2013.
  11. ↑ Morgan AG, Gilchrist F, Cowlam J, Rodd HD. "Comparative outcomes for Hall vs conventionally placed preformed metal crowns". Int J Paediatr Dent 2012; 22(Suppl. 2):17-18.
  12. ↑ McKinney A, Britton, KFM, Innes NPT, Cairns A. "The success of Hall Technique crowns on a student outreach clinic". Int J Paediatr Dent 2011; 21(Suppl. 2): 8-9.
  13. ↑ Foley JI. "Short communication: a pan-European comparison of the management of carious primary molar teeth by postgraduates in paediatric dentistry". Eur J Paediatr Dent 2012; 13(1):41-6.
  14. ↑ Innes NPT, Evans DJP. "Modern approaches to caries management of the primary dentition". Brit Dent J. 2013, 214(11) 559-566.
  15. ↑ Bark JE, Dean AA, Cairns AM. "Opinion and usage of the 'Hall Technique' amongst paediatric dental specialists in Scotland". Int J Paediatr Dent 2009; 19(Suppl. 2):11
  16. ↑ Murray, P.E., et al., "Remaining dentine thickness and human pulp responses". International Endodontic Journal, 2003. 36(1): p. 33-43.
  17. ↑ Rahimtoola, S., et al., "Pain related to different ways of minimal intervention in the treatment of small caries lesions". Journal of Dentistry for Children, 2000. 67(2): p. 123-7.
  18. ↑ van Bochove, J.A. and W.E. Amerongen, "The influence of restorative treatment approaches and the use of local analgesia on children's discomfort". European Archives of Paediatric Dentistry, 2006. 7(1): p. 11-16
  19. ↑ Ricketts D, Lamont T, Innes NPT, Kidd E, Clarkson JE. "Operative caries management in adults and children". Cochrane Database of Systematic Reviews 2013; Issue 3. Art. No.: CD003808. DOI: 10.1002/14651858.CD003808.pub3. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003808.pub3/abstract
  20. ↑ "TOOTH GERM: Hall Crowns: Top 10 Tips".
  21. 1 2 3 4 5 6 7 Kindelan, S. A.; Day, P.; Nichol, R.; Willmott, N.; Fayle, S. A. (2008-11-01). "UK National Clinical Guidelines in Paediatric Dentistry: stainless steel preformed crowns for primary molars". International Journal of Paediatric Dentistry. 18: 20–28. doi:10.1111/j.1365-263X.2008.00935.x. ISSN   1365-263X. PMID   18808544.
  22. 1 2 3 4 5 6 Calache, Hanny; Martin, Rachel (20 April 2016). "The Hall Technique – A Minimally Invasive, Anxiety Reducing Method of Managing Dental Caries in Primary Molars" (PDF). Australian and New Zealand Journal of Dental and Oral Health Therapy. ISSN   2200-3584.
  23. ↑ EA, O'Sullivan; ME, Curzon (1991-07-01). "The efficacy of comprehensive dental care for children under general anesthesia". British Dental Journal. 171 (2): 56–8. doi:10.1038/sj.bdj.4807603. ISSN   0007-0610. PMID   1873095. S2CID   40048498.
  24. ↑ "The Australian and New Zealand journal of dental and oral health therapy / ADOHTA, New Zealand Dental Therapist' Association. - Version details". Trove. Retrieved 2016-05-23.
  25. 1 2 3 4 5 6 7 8 9 "The Hall Technique: The novel method in restoring the carious primary molar that is challenging old concepts. A new tool in the general dentist's toolbox? | Dental Tribune International". dental-tribune.com. Retrieved 2016-05-14.
  26. ↑ University of Dundee. "The Hall technique: A minimal intervention, child centred approach to managing the carious primary molar", 2010. 3. p. 1-40
  27. 1 2 Ludwig K, Fontana M, Vinson L, Platt J, Dean J. "The success of stainless steel crowns placed with the Hall technique". The Journal of the American Dental Association. 2014;145(12):1248-1253.
  28. 1 2 "Crowns in Pediatric Dentistry: A Review". Journal of Advanced Medical and Dental Sciences Research. 2016;4(2).
  29. ↑ Innes N, Evans D, Stirrups D. "The Hall Technique; a randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice: acceptability of the technique and outcomes at 23 months". BMC Oral Health. 2007;7(1):18.
  30. ↑ Foster L. "Acceptability of the Hall Technique to parents and children". The New Zealand Dental Journal [Internet]. 2014 [cited 18 May 2016];. Available from: https://www.researchgate.net/profile/William_Thomson2/publication/261253409_Acceptability_of_the_Hall_Technique_to_parents_and_children/links/0a85e5312d379aa062000000.pdf
  31. ↑ Martin R. "The Hall Technique" [Internet]. 1st ed. Dental Health Services Victoria; 2016 [cited 18 May 2016]. Available from: https://www.dhsv.org.au/__data/assets/pdf_file/0005/3794/21-rachel-martin.pdf
  32. ↑ Levine, R. S., Pitts, N. B., & Nugent, Z. J. (2002). "The fate of 1, 587 unrestored carious deciduous teeth: A retrospective general dental practice based study from northern England". British Dental Journal, 193(2), 99–103. doi:10.1038/sj.bdj.4801495
  33. ↑ "Review of the Clinical Survival of Direct and Indirect Restorations in Posterior Teeth of the Permanent Dentition"

Further reading

File:HallTechGuide V4.pdf

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