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Hall Technique
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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 oriented strategies for managing dental decay.

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 do not have to undergo traumatic injections. Preformed metal crowns are now recommended as the optimum restoration for managing carious primary molars. There are multiple randomised controlled trials that have shown the Hall Technique to be superior to other methods for managing decay in baby teeth,[1] but there is a lack of evidence to conclude that the Hall Technique is superior to placing preformed metal crowns in a conventional manner.[2] Initial fears over the potential problem with sealing caries (cavities) 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.[3][4] 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.[5][6][7]

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.[8] 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

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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 stainless steel crown (SSC) application.[9]

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.[10] 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)[11] 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.[12][13][14][15][16]

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, but 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

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Baby teeth are known as primary teeth or deciduous teeth. Biologically oriented 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;[17] 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.[18][19]

A Cochrane systematic review[20] has compared biologically oriented 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 oriented 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

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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.[21]

Indications and contraindications

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Indications

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

  • There is a proximal carious lesions where two or more surfaces have carious lesions.[22]
    • Radiographically, a clear band of dentine should be able to be seen between the carious lesion and the dental pulp, the carious lesion does not extend beyond the middle third of dentine, and there is a clear dentine bridge between the pulp and the cavity.[23]
  • Restoration of fractured primary molars[22]
  • In primary molars that may be affected by developmental problems both localized or generalized i.e. in cases of enamel hypoplasia, dentinogenesis imperfecta, amelogenesis imperfecta, molar incisor hypomineralisation (MIH).[22]
  • In patients who are at high risk of developing caries i.e. patients who have to undergo general anaesthesia for dental treatment due to rampant caries.[24]
  • To protect and restore teeth that may have extensive tooth tissue loss due to erosion, attrition or abrasion.[22]
  • As a support for some dental appliances e.g. space maintainers[22]
  • In patients with special needs or where regular oral hygiene is impaired leading to likely breakdown of regular direct restorations.
  • In patients with partially submerged primary molars in order to maintain the mesiodistal space.[23]

Contraindications

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

  • The patient is known to be sensitive or allergic to nickel unless approval is given from an allergist or dermatologist first.[22]
  • There is any evidence that the carious lesion has irreversibly damaged the pulp:
    • radiographically there is no obvious clear band of dentine visible between the carious lesion and the dental pulp on the radiograph[25] and/or there is periradicular radiolucency (furcation involvement[23]) indicating infection or
    • clinically – symptoms of irreversible pulpitis or pulpal necrosis[23]
  • More than half of the root has resorbed and the primary tooth is close to exfoliation.[23]
  • Where a tooth is so broken down as to be unrestorable with a preformed metal crown (PMC)[23]

Procedure

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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.

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

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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).[26] 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.[27] 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.[26] 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

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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.[26] 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.[26] Once a correct size and 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.[26] The stainless steel crown should "click" securely into place.[26] The patient is required to bite firmly onto a cotton roll or bite stick to secure it in the correct position whilst it sets.[26] 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.[22]

Appointment 3: follow-up appointment

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Stainless steel crown placed on a dental model

At follow-up appointments the Hall Technique crown will be assessed clinically and radiographically when required.[26] 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, they should consult their 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

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  • Mirror
  • Probe/explorer
  • Separators and pliers or floss for placement
  • Floss – knotted for removing excess cement
  • Gauze for airway protection
  • Stainless steel crown (checked for correct size)
  • Luting cement
  • Glass ionomer cement applicator and amalgamator (if mixing cement hand mixed glass ionomer is recommended as it can be mixed to a less viscous consistency)

[26]

Advantages and disadvantages of Hall Technique

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Advantages

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  • Patients report positive experiences during and after treatment
  • 97% success rate[28]
  • Very low failure rate
  • Does not require local anesthetic or tooth removal (drilling)
  • Lifespan is the same as that of an intact primary tooth/durability
  • Provide protection to the residual tooth structure that may be weakened
  • The technique sensitivity or the risk of making errors during application is low[29]
  • Their long term cost-effectiveness is good
  • Reduce the amount of tooth extraction and extensive treatment
  • Desensitises children to dental procedures, acclimatising them and building their confidence[30]

Disadvantages

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  • Metallic appearance/aesthetics
  • Cannot be used when tooth is only partially erupted.[29]
  • Failure may occur due to periodontal abscess or periradicular abscess if decay has progressed too far into the tooth for it to be arrested before reaching the pulp[28] (failure rate around 3 per 100).
  • When proximal teeth are in tight contact (touching), this technique requires two visits and the use of orthodontic separators, which cause soreness.

Patient expectations

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  • The child and parent should be fully briefed on the procedure.
  • The child should be shown the crown. Some children respond better to the idea of the crown being a "Terminator tooth", "Iron Man tooth", shiny helmet tooth or a princess tiara tooth.[31]
  • It is important that the child knows that during the procedure they may be required to bite down to help seat the crown correctly. They must also know that the cement may not taste nice but will not last long.
  • After the crown is fitted using the Hall Technique is placed the child may find that biting feels unusual. This feeling will return to normal in a few days.
  • The gums may appear blanched and feel tight to the child at first but will settle very quickly.
  • The gum may also appear blue around the crown. This is just the colour of the metal sitting under the gum.[32]
  • Avoid giving the child sticky or chewy foods after the procedure as this may displace the crown.
  • It is important that the child still brushes the tooth to help maintain the crown.

Alternative therapies

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  • No treatment; when dental caries are detected in deciduous teeth some clinicians may choose to leave the tooth to monitor progression and wait for further caries progression until doing an invasive procedure. Alternatively, the clinician may choose to leave caries as the tooth may be likely to exfoliate soon, dependent on the child's age.[33]
  • Conventional stainless steel crown; conventional stainless steel crowns require tooth preparation, usually interproximal and occlusal reductions. Under most circumstances this procedure will require local anesthetic. This procedure is invasive and there is loss of biological dental tissues, which is not required for Hall Technique stainless steel crowns.
  • Dental restoration; this may be a good management option. However, this procedure is invasive and usually requires local anesthetic and tooth preparation (drilling). Indirect fillings such as stainless steel crowns have a higher longevity when compared to direct restorations.[34]
  • Dental extraction; in most situations if a deciduous tooth is indicated for Hall Technique stainless steel crown an extraction would not be a suitable option. Dental extraction is considered invasive and in caries management it is usually the last resort when a tooth cannot be saved.

References

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Further reading

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Revisions and contributorsEdit on WikipediaRead on Wikipedia

Hall Technique

View on Grokipedia
from Grokipedia
The Hall Technique is a minimally invasive dental procedure used to treat carious lesions in primary molars, particularly in children, by cementing a preformed metal crown—typically —over the affected without excavating the decay, administering , or preparing the . This method relies on sealing the caries beneath the crown to arrest its progression by altering the oral environment and promoting remineralization. Developed by Dr. Norna Hall, a general dentist in , the technique emerged from her clinical observations in the late and early 1990s as a child-friendly alternative to traditional restorative approaches that often require drilling and injections, which can be distressing for young patients. Hall first documented and published her method in 2006, drawing on over 15 years of practical application, and it gained wider recognition through subsequent research and guidelines from organizations like the Scottish Intercollegiate Guidelines Network (). The procedure is indicated for primary molars with multi-surface caries that do not involve the pulp or show signs of , provided there is sufficient remaining tooth structure and the child is cooperative enough for placement. Contraindications include active infection, extensive tooth destruction, or conditions like a history of bacterial , where more invasive interventions are necessary. The Hall Technique's procedure is straightforward and typically completed in a single visit: orthodontic separators may be placed a few days prior to create space if needed, followed by selection of the smallest fitting crown, which is then filled with and seated over the tooth using finger pressure or the child's bite until secure. Excess cement is removed, and the crown is checked for proper occlusion. Its advantages include reduced treatment time, lower risk of pulpal exposure, high and acceptability— with studies showing over 90% preference among children—and cost-effectiveness compared to conventional fillings. Clinical supports its , with randomized controlled trials demonstrating rates of 73-97% over 1-3 years, comparable or superior to traditional methods in terms of and caries arrest, while minimizing the need for extractions or repeat visits. Long-term follow-up data indicate that the technique effectively manages decay until natural exfoliation of the primary , making it a valuable option in , especially for anxious or young patients.

History and Development

Origins and Invention

The Hall Technique was developed in the late 1980s by Dr. Norna Hall, a general dental practitioner working in a remote, high dental caries risk area of northern . As a salaried dentist in , Hall sought to address the challenges of treating extensive caries in primary molars among anxious young patients, where traditional methods involving , caries excavation, and tooth preparation often exacerbated fear and discomfort. Her approach emphasized sealing the caries under a preformed metal crown without prior removal or preparation, providing a simpler, less invasive alternative to conventional restorations or extractions. Hall first implemented the technique informally in her daily practice during the late 1980s and early 1990s, refining it based on clinical observations over more than 15 years until her retirement in 2006. Lacking formal publication at the time, the method relied on Hall's practical experience in managing a high volume of pediatric cases, where conventional preformed metal crowns were underutilized due to their complexity (used in less than 1% of children's restorations in the UK). Early anecdotal evidence from her practice suggested the technique's viability, with crowns demonstrating longevity comparable to standard methods and contributing to fewer extractions by preserving tooth structure in carious primary molars. This initial development laid the groundwork for later formal evaluation, culminating in a analysis of Hall's cases published in 2006, which prompted s in the to validate the approach.

Key Studies and Adoption

The landmark (RCT) evaluating the Hall Technique was conducted by Innes et al. in 2007, involving 132 children with carious primary molars treated in general dental practices in . This study compared the Hall Technique—sealing caries under preformed metal crowns without removal or —to conventional restorative methods, finding superior success rates at 23 months, with 93% overall success for Hall Technique crowns (7% failure rate) versus 39% for conventional fillings (61% failure rate), alongside high acceptability among children, parents, and dentists. Subsequent research built on these findings, including a 5-year follow-up of the original cohort published in 2011 by Innes et al., which demonstrated the Hall Technique's superiority, with approximately 92% success in maintaining pulpal and restoration longevity compared to 42% for conventional restorations. A 2019 and meta-analysis by Badar et al. confirmed the technique's superiority, analyzing five studies and reporting individual success rates of 92-97% for Hall Technique crowns over various periods, with a pooled of 5.55 (95% CI: 3.31-9.30) favoring the Hall Technique over conventional approaches in managing multi-surface caries in primary molars. Adoption milestones accelerated following these studies, with the Scottish Dental Clinical Effectiveness Programme (SDCEP) incorporating the Hall Technique into its 2010 guidelines on prevention and management of dental caries in children, recommending it for asymptomatic dentinal caries in primary molars. By 2020, the American Academy of (AAPD) included the Hall Technique in its reference manual on , recognizing it as an effective method for vital pulp therapy in primary teeth with reversible . The technique's global spread has involved widespread training programs, including workshops by the European Academy of Paediatric Dentistry in Europe, continuing education courses through the AAPD in the US, and integration into curricula by the Australian Dental Association.

Principles and Rationale

Caries in Primary Dentition

Dental caries, commonly known as , represents a significant oral issue in primary , affecting a substantial proportion of young children worldwide. Globally, the prevalence of caries in primary teeth among children is approximately 50% (as of 2021), with higher rates observed in disadvantaged populations where it can reach up to 85%. Recent estimates indicate this affects over 500 million children. This condition predominantly manifests as multi-surface decay in primary molars, driven by a combination of dietary factors—such as frequent consumption of fermentable carbohydrates—along with the proliferation of cariogenic bacteria like , which metabolize sugars to produce acids. Additionally, structural differences in primary teeth, including thinner and softer enamel compared to , contribute to increased susceptibility. The of caries in primary involves an initial demineralization where acids from bacterial metabolism lower the oral , leading to the dissolution of crystals in enamel. As the progresses, it penetrates the , resulting in and potential involvement of the pulp. In primary teeth, this progression occurs more rapidly due to the enamel's reduced thickness—approximately 0.5-1 mm versus 1-2 mm in —and lower mineral content, including reduced calcium and levels, which impair remineralization. The proximity of primary roots to developing permanent buds further complicates the condition, as unchecked decay can influence underlying structures. Treating caries in primary teeth traditionally involves mechanical removal of decayed tissue using rotary drills, which often induces and heightens anxiety in children, exacerbating behavioral challenges during procedures. Extensive lesions in these teeth carry a heightened risk of pulp exposure, potentially leading to pulpal or the need for more invasive interventions. An alternative rationale for managing such caries emphasizes arresting the disease process through plaque removal to disrupt cariogenic biofilms, followed by sealing the to create an environment that limits nutrient availability and acid production. Microbiologically, this approach reduces viable cariogenic bacteria, such as S. mutans, by up to 50% within sealed cavities, thereby halting progression without complete excavation.

Minimally Invasive Approach

Minimally invasive (MID) represents a in caries management, emphasizing the preservation of tooth structure by avoiding unnecessary excavation of carious tissue and prioritizing prevention, remineralization, and sealing strategies to control disease progression. This approach focuses on early detection of lesions, , and conservative interventions that maintain the of the dental pulp while minimizing patient discomfort and procedural complexity. In the context of primary , where caries often presents as multi-surface lesions amenable to biological , MID aligns with the goal of sustaining tooth function until natural exfoliation. The Hall Technique exemplifies MID principles through its non-invasive application for carious primary molars, involving the cementation of a preformed metal crown without , caries removal, or mechanical tooth preparation. Orthodontic separators are employed to gently loosen adjacent teeth and create space for crown fitting, after which secures the crown, providing both retention and release to support lesion arrest. This method avoids the trauma associated with drilling, making it particularly suitable for young patients with behavioral challenges. Biologically, the Hall Technique relies on sealing the carious to establish an anaerobic environment beneath the crown, which isolates cariogenic biofilms from oral carbohydrates and oxygen, shifting the microbial ecology from acidogenic to less pathogenic and facilitating remineralization of . This sealing strategy draws support from zonal theories of caries , which recognize distinct layers in carious —infected outer zones, affected inner zones, and remineralizable areas—allowing progression to halt without invasive removal of viable tissue. Unlike conventional techniques that mandate complete caries excavation to firm, hard via rotary instrumentation, potentially risking pulp exposure, , or excessive loss of healthy structure, the Hall Technique eliminates these iatrogenic hazards by forgoing preparation entirely.

Clinical Application

Indications

The Hall Technique is primarily indicated for the management of multi-surface carious lesions in vital primary molars, particularly those involving occlusal or proximal surfaces, where the tooth remains asymptomatic and shows no clinical or radiographic of pulpal involvement. This approach is suitable for children aged 3 to 10 years who exhibit cooperative behavior during dental procedures, allowing for the non-invasive cementation of a preformed metal crown without the need for or caries removal. Lesion criteria emphasize cavitated lesions that extend into but maintain unaffected dentin between the caries and the pulp, confirmed clinically and radiographically, with no evidence of bone loss, periapical radiolucency, or other signs of irreversible . The technique is especially appropriate for young or anxious patients where traditional restorative methods, such as drilling and filling, may be challenging due to non-cooperation or heightened , as it minimizes discomfort and procedure time. Recent evidence from a 2025 umbrella review supports an extension of indications to include cases of mild reversible in primary molars, demonstrating success rates exceeding 85% at 2 years, comparable to conventional techniques, thereby broadening its application while maintaining high clinical outcomes. These criteria inherently exclude scenarios detailed in contraindications, such as irreversible or formation.

Contraindications

The Hall Technique is contraindicated in cases of acute dental , including the presence of , , or swelling, as these indicate potential irreversible or periapical that requires more invasive intervention rather than sealing the caries. Radiographic evidence of periapical radiolucency or other signs of pulp involvement further precludes its use, as the technique relies on the vitality of the pulp and the natural remineralization processes without direct access for treatment. These absolute contraindications ensure that the procedure does not exacerbate underlying in primary molars. Relative contraindications include non-vital teeth, where pulp necrosis is suspected, and extensive crown destruction that leaves insufficient structure to retain the preformed metal , necessitating alternative restorative options like extraction or full-coverage restorations. Severe behavioral challenges in very young children, who cannot comprehend or tolerate the crown seating process without , also represent a relative exclusion to avoid procedural failure or distress. Additionally, excessive , proximity to exfoliation with more than half root resorption on radiograph, or pulp exposure during assessment may warrant avoidance. Hypersensitivity to crowns or used in the procedure constitutes a key due to risks of allergic reactions, particularly in patients vulnerable to sensitivity. Systemic factors such as immunocompromised status or risk of further limit applicability, as the technique's minimally invasive nature does not address potential bacteremia from sealed caries. In patients with high caries risk, the Hall Technique should be avoided without adjunctive to mitigate progression of untreated lesions elsewhere, and it is generally excluded for permanent molars with deep caries due to differing eruption timelines and restorative needs.

Procedure

The Hall Technique is a for managing carious lesions in primary molars, involving the cementation of a preformed metal (PMC) over the affected without caries removal, , or tooth preparation. It is indicated for multi-surface carious lesions where the marginal ridge remains intact, as determined by clinical and radiographic assessment. The procedure typically spans two appointments if orthodontic separators are required to loosen tight proximal contacts, though it can be completed in a single visit in many cases. In the initial appointment, which requires no , elastic or floss-tied separators are placed between the contact points of the carious primary molar and the adjacent to create sufficient space for crown placement; these are left for 3 to 7 days. During the second appointment, the tooth surface is gently cleaned of debris and food particles using a rinse and roll, without excavation of caries. The appropriate PMC size is selected by try-in, ensuring the crown covers the cusps fully and provides a slight "spring-back" resistance at the proximal contacts when pressed. The inner surface of the selected stainless steel crown is filled approximately two-thirds full with , such as Fuji IX, and the crown is seated over the tooth while the child is positioned upright to protect the airway with gauze. The child is instructed to bite down firmly, or the applies finger , to seat the crown evenly through the contacts until the cement sets, typically taking 2 minutes. Excess cement is removed promptly with a scaler or spoon excavator, proximal areas are cleared with , and any high spots on the occlusion are adjusted using articulating paper if necessary. Key materials include preformed stainless steel crowns (PMCs), orthodontic separators (elastic bands or brass wire tied with floss), glass ionomer luting cement, , for airway protection, and articulating paper for bite verification. Instruments such as a crown former or may assist in separator placement and crown handling. The main appointment is time-efficient, averaging 12 to 20 minutes, which reduces overall chair time compared to conventional restorative methods requiring caries excavation and preparation. A follow-up appointment is scheduled at 6 to 12 months to evaluate retention, gingival , and caries through clinical examination and radiographs.

Application in Permanent Teeth

The extension of the Hall Technique to permanent dentition primarily targets young permanent molars affected by early carious lesions or conditions like molar incisor hypomineralization (MIH), offering similar sealing benefits to arrest disease progression while avoiding invasive tooth preparation in adolescents. This minimally invasive strategy preserves vital pulp and tooth structure, which is particularly advantageous for first permanent molars where traditional restorations may lead to higher failure rates due to enamel defects or sensitivity. By cementing preformed crowns over uncut teeth, the technique creates a protective barrier that promotes remineralization beneath the crown, mirroring its established role in primary teeth but adapted for longer-term durability. Modifications for account for larger crown dimensions and increased patient awareness of aesthetics and function. Preformed crowns are selected in appropriate sizes, often with the addition of interproximal spacers placed for about one week to separate teeth and facilitate fitting, followed by cementation using . Unlike the standard protocol for primary teeth, (such as lidocaine with epinephrine) may be used to manage heightened in hypomineralized enamel, and pulp vitality testing is routinely performed to confirm reversible or healthy pulps prior to treatment. While crowns dominate due to their durability, zirconia alternatives are emerging for better esthetics in visible areas, maintaining the core non-preparative approach. Evidence supporting the Hall Technique in permanent teeth remains limited but promising, with case reports demonstrating high clinical success in managing MIH-affected molars by alleviating pain and preventing progression to more severe pathology. For instance, modified applications have shown effective hypersensitivity control and restoration integrity over short-term follow-ups, with no adverse pulpal outcomes reported in treated cases. Ongoing randomized controlled trials, including split-mouth designs comparing the technique to conventional restorations, aim to establish 3-year survival rates, particularly for first permanent molars in children aged 6-12. Challenges include elevated aesthetic concerns from metallic appearances, necessitating patient education, and prolonged retention requirements that heighten risks of gingival inflammation or plaque buildup compared to primary applications.

Evidence and Outcomes

Clinical Efficacy and Success Rates

The clinical efficacy of the Hall Technique is typically assessed through criteria including crown retention, absence of pain or swelling, and radiographic stability without signs of irreversible pulpal or need for extraction. In the foundational 2007 randomized controlled trial (RCT) conducted by Innes et al., the technique achieved a 2-year success rate of 78% (103/132 restorations successful), defined as no major or minor failures requiring intervention, compared to 47% (62/132) for conventional restorations involving caries removal and filling. This trial highlighted the technique's superior outcomes in pulpal health and longevity, with only 2% major failures (e.g., ) in the Hall group versus 14% in the conventional group. Comparative studies indicate the Hall Technique is equivalent or superior to amalgam or composite fillings for multi-surface carious lesions in primary molars. For instance, a 2020 RCT (data collected in 2019) reported similar 1-year success rates of 89% for Hall Technique preformed metal crowns versus 92% for conventional crowns (a proxy for traditional fillings in multi-surface restorations), with no significant differences in failure rates. A 2022 systematic review and further confirmed non-inferiority, showing the Hall Technique 80% more likely to succeed than direct restorations like amalgam or composite ( 1.80, 95% CI: 1.37–2.36), based on pooled data from multiple RCTs. The 2025 systematic review in the Journal of Clinical reinforced this, stating the technique's outcomes are comparable to or better than conventional methods across various lesion types. Long-term outcomes demonstrate sustained viability, with 5-year tooth survival rates around 80% and crown survival at 68%, alongside reduced extraction needs compared to unrestored controls. Factors such as lesion depth influence rates, with shallower cavities (enamel-dentin involvement) yielding higher success (up to 95% at 3 years) than deeper ones approaching the pulp. A retrospective analysis reported 80.5% tooth survival at 5 years, attributing durability to the sealed environment preventing bacterial progression. However, evidence remains predominantly short-term (under 3 years in most RCTs), with calls for larger, more diverse population studies to address variations in socioeconomic and ethnic groups.

Advantages

The Hall Technique offers significant child-centered benefits by eliminating the need for , drilling, or tooth preparation, thereby reducing anxiety and discomfort during the procedure. This minimally invasive approach enhances child cooperation and compliance, as it avoids painful interventions that often lead to fear in pediatric patients. Studies indicate high , with 77% of children, 83% of parents, and 81% of dentists preferring it over conventional methods, fostering a more positive dental experience and encouraging future visits. Clinically, the technique preserves natural tooth structure by sealing carious lesions under a preformed metal without caries removal, effectively arresting decay progression through biological containment. It demonstrates high retention rates due to the 's to the tooth's natural contours, with success rates reaching 97% at 15 months and comparable outcomes to traditional restorations over longer periods. This aligns with atraumatic restorative trends in , promoting pulp vitality and minimizing iatrogenic damage. From a provider perspective, the Hall Technique simplifies treatment by requiring minimal —typically just the , cement, and basic instruments—reducing procedural complexity and chair time to an average of 12 minutes per . It is cost-effective, with direct treatment costs around 24 GBP (approximately $30 USD) per in systems, lower than conventional methods due to fewer visits and reduced material needs. These factors make it particularly advantageous in resource-limited settings or for anxious patients where full might otherwise be necessary.

Disadvantages

The Hall Technique involves the placement of preformed crowns over carious primary molars without caries removal or tooth preparation, which can lead to aesthetic concerns due to the visible metallic appearance of the crowns. Although primarily used on posterior teeth, this visibility may affect children's in social interactions, particularly among older children or those with heightened aesthetic awareness. The technique is not ideal for , where aesthetic demands are higher and preformed crowns are less adaptable. Clinically, a key risk is the potential for undetected pulp to progress if the technique is misapplied, such as in cases with irreversible or periradicular involvement that are not properly diagnosed preoperatively. Non-visualization of the furcation area under the crown can contribute to under-diagnosis of such in up to 37% of cases. Additionally, crown decementation or loss occurs in approximately 1% of cases in the foundational RCT, though higher rates (8-14%) have been reported in studies on preformed crowns generally. Practically, the procedure typically requires an extra appointment to place orthodontic separators, allowing sufficient space for crown fitting, which adds to treatment time and patient visits. It is limited to primary molars and unsuitable for all decay types, particularly those with extensive pulp involvement or where contraindications like mobility or are present. Evidence gaps persist regarding its application in high-caries-risk patients, where challenges such as increased plaque accumulation and potential for higher failure rates arise if selection criteria are ignored, emphasizing the need for strict adherence to indications to mitigate risks.

Patient and Provider Considerations

Patient and Parental Expectations

Patients and parents are typically informed prior to the Hall Technique procedure that it involves a minimally invasive approach without the need for local anesthesia, drilling, or caries removal, emphasizing a painless process where the preformed metal crown is simply cemented over the carious primary molar to seal the decay. The crown's appearance is explained as a shiny, silver "helmet" for the tooth, which is temporary and designed to protect the tooth until its natural exfoliation, helping to alleviate concerns about permanence or aesthetics in young children. During the procedure, if orthodontic separators are required to create space between teeth, parents should anticipate mild discomfort for the child lasting 1-2 days, similar to the sensation of tight braces, though studies indicate this does not significantly increase overall levels compared to other methods. Immediately after cementation, children can resume normal eating, but they are advised to bite firmly on the crown for 2-3 minutes to ensure proper seating, followed by guidance on such as twice-daily brushing with toothpaste, nightly flossing around the crown, and avoiding sticky foods to maintain its stability. Post-treatment, the crown may initially feel bulky or alter the bite sensation, with adaptation occurring within 24 hours and full occlusal adjustment in a few weeks; parents are encouraged to monitor for any loosening or signs of issues during routine check-ups, where minor repairs can be addressed if needed. Expectations for outcomes include a high likelihood of success, with meta-analyses reporting 80-90% of cases requiring no further intervention over 2-3 years, supporting the technique's reliability for managing caries in primary molars. Effective communication plays a crucial role, beginning with where clinicians explain the procedure's benefits, risks, and alternatives to address parental fears, such as concerns over sealing decay without removal, often using child-friendly analogies to build trust and . Parental education, aligned with guidelines from resources like the Scottish Intercollegiate Guidelines Network (SIGN) 83 on preventive care, focuses on integrating the Hall Technique into a broader oral health plan, including applications and dietary advice to enhance long-term results.

Training and Adoption Challenges

The implementation of the Hall Technique in faces significant barriers related to provider and systemic integration. Effective typically requires hands-on workshops to build proficiency in crown placement without caries removal or tooth preparation, as the procedure demands precise case selection and patient management skills. In the , the technique has been incorporated into undergraduate curricula since before 2010, with all dental schools now including it as a standard component, leading to widespread familiarity among new graduates. However, international gaps persist; a 2025 cross-sectional survey of general dental practitioners in found that only 50.7% had received formal university in the Hall Technique, with 82.6% expressing a need for additional through methods like hands-on courses (44.1%) or video demonstrations (51.3%). In the United States, a 2024-2025 survey of American Academy of members revealed that while 51% of pediatric dentists view the technique as a viable alternative to conventional restorations, inconsistencies contribute to lower overall compared to regions with standardized curricula. Adoption hurdles are compounded by resistance from clinicians accustomed to traditional restorative approaches, particularly concerns over pulp vitality risks from sealing untreated caries under the crown. A 2024 questionnaire-based survey in highlighted that over 50% of general dental practitioners cited fears of incomplete caries arrest and potential pulpal pathology as major deterrents, alongside technical challenges like crown insertion without tooth preparation (43.5% in the Yemen study). In low-resource settings, material availability and economic constraints further impede uptake; the same Yemen survey identified patient cooperation issues (44.9%) and cost barriers (35.7%) as key obstacles, limiting access to preformed metal crowns in underserved areas. Usage patterns reflect these divides: the study reported only 4% of general dentists routinely applying the technique, compared to 58% of pediatric dentists, underscoring lower integration among non-specialists. Policy factors also influence adoption; in , endorsements from the European Academy of Paediatric Dentistry and insurance coverage in several countries enhance accessibility, with the technique recognized as cost-effective for managing deep carious lesions in primary molars. Efforts to address these challenges include the development of accessible solutions, such as modules and programs, which aim to increase clinician confidence and standardize skills. Platforms offering verifiable CPD courses, like those from Dentaljuce and ProDental CPD, provide detailed instruction on the Hall Technique's rationale, case selection, and procedural steps, with many respondents in recent surveys (over 70% in ) advocating for its inclusion in formal curricula to bridge knowledge gaps. These initiatives, combined with targeted workshops, have shown promise in boosting adoption rates among general practitioners, particularly in regions with policy support.

Alternative Treatments

Conventional restorations for managing caries in primary molars typically involve the removal of carious tissue followed by placement of amalgam or composite fillings. These approaches are more invasive, requiring and mechanical excavation, and are associated with success rates of approximately 70-80% over 2-3 years for multi-surface lesions, with higher failure risks due to recurrent caries or restoration loss in extensive decay. Fissure sealants offer a preventive option for early, non-cavitated carious lesions on occlusal surfaces of primary molars by creating a physical barrier to bacterial ingress. They are effective in reducing caries progression by up to 37% in children when applied to at-risk teeth but are generally insufficient for managing advanced or cavitated decay, where restorative intervention becomes necessary. Pulp therapy, including for vital pulp conditions or pulpectomy for irreversible , is indicated for primary molars with deep caries approaching the pulp. These procedures aim to preserve vitality and function, achieving clinical success rates of 90-97% at 12-18 months, though they are more technically demanding, time-intensive, and costly compared to less invasive methods. Extraction serves as a last resort for non-restorable primary molars affected by severe caries, often followed by placement of space maintainers to prevent arch length loss and . Space maintainers, such as band-and-loop appliances, help preserve adjacent tooth positions but can increase plaque accumulation and require periodic monitoring. Emerging non-invasive options like silver diamine fluoride (SDF) focus on arresting caries progression in primary teeth through topical application, which inhibits bacterial activity and remineralizes affected . Recent reviews indicate SDF achieves caries arrest rates of 70-90% in children after 12 months, positioning it as a valuable adjunct for early intervention, though its black staining of treated lesions limits aesthetic acceptability and it is not a standalone replacement for restorative techniques. The Hall Technique may be preferred over these alternatives for cavitated lesions in anxious children to avoid excavation and .

References

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7148518/
  2. https://heeoe.hee.nhs.uk/sites/default/files/1311845532_nqvh_the_hall_technique_manual.pdf
  3. https://www.nature.com/articles/sj.bdj.2017.262
  4. https://pubmed.ncbi.nlm.nih.gov/16703041/
  5. https://bmcoralhealth.biomedcentral.com/articles/10.1186/1472-6831-7-18
  6. https://journals.sagepub.com/doi/10.1177/0022034511422064
  7. https://pmc.ncbi.nlm.nih.gov/articles/PMC7229363/
  8. https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-025-06691-y
  9. https://pmc.ncbi.nlm.nih.gov/articles/PMC12395743/
  10. https://pmc.ncbi.nlm.nih.gov/articles/PMC7541284/
  11. https://pmc.ncbi.nlm.nih.gov/articles/PMC5514393/
  12. https://journals.publishing.umich.edu/ujph/article/id/7616/
  13. https://www.jscimedcentral.com/public/assets/articles/pediatrics-5-1120.pdf
  14. https://www.ncbi.nlm.nih.gov/books/NBK551699/
  15. https://www.nature.com/articles/s41368-022-00186-0
  16. https://www.intechopen.com/chapters/57546
  17. https://www.researchgate.net/publication/391587488_Assessing_Anxiety_and_Pain_During_Treatment_of_Primary_Molar_Carious_Lesions_Using_Minimal_Invasive_Techniques_Randomized_Controlled_Trial
  18. https://jdsits.in/archive/volume/12/issue/2/article/10200
  19. https://www.researchgate.net/publication/5541075_The_Effect_of_Dental_Sealants_on_Bacteria_Levels_in_Caries_Lesions
  20. https://www.ingentaconnect.com/content/aapd/pd/2012/00000034/00000001/art00009
  21. https://pmc.ncbi.nlm.nih.gov/articles/PMC9209757/
  22. https://www.aapd.org/globalassets/media/policies_guidelines/p_minimallyinvasivedentistry.pdf
  23. https://www.cureus.com/articles/382629-minimally-invasive-techniques-for-managing-dental-caries-in-children-efficacy-applications-and-future-directions
  24. https://pmc.ncbi.nlm.nih.gov/articles/PMC7148518/
  25. https://pmc.ncbi.nlm.nih.gov/articles/PMC9831703/
  26. https://www.nature.com/articles/s41415-023-5515-4
  27. https://doi.org/10.1186/1472-6831-7-18
  28. https://doi.org/10.3390/dj8010011
  29. https://www.childcaries.sdcep.org.uk/guidance/dental-techniques/hall-technique/
  30. https://doi.org/10.1101/2025.05.18.25327863
  31. https://aditum.org/images/article/1753507620DSIR-Galley_Proof_pdf_ABU-HUSSEIN_MUHAMAD_.pdf
  32. https://www.mdpi.com/2077-0383/14/2/304
  33. https://www.researchgate.net/publication/284189516_The_Hall_Technique_Guide_V4
  34. https://doi.org/10.21615/cesodon.34.1.11
  35. https://clinicaltrials.gov/study/NCT07186673
  36. https://journals.sagepub.com/doi/abs/10.1177/2380084420933154
  37. https://www.sciencedirect.com/science/article/pii/S1882761622000217
  38. https://www.jocpd.com/articles/10.22514/jocpd.2025.001
  39. https://www.colgateoralhealthnetwork.com/article/a-review-of-the-hall-technique-a-minimally-invasive-option-for-treating-carious-primary-molars/
  40. https://www.mdpi.com/2304-6767/8/1/11
  41. https://iapdworld.org/wp-content/uploads/2020/12/09_Hall-Technique-for-Placement-of-Preformed-Metal-Crowns-on-Primary-Molars.pdf
  42. https://journals.sagepub.com/doi/10.1177/0022034518799742
  43. https://www.oraljournal.com/archives/2023/vol9issue4/PartD/9-4-22-991.pdf
  44. https://www.researchgate.net/publication/392924411_Knowledge_practice_and_challenges_in_the_use_of_stainless_steel_crowns_and_the_Hall_technique_among_Yemeni_general_dental_practitioners_a_cross-sectional_study
  45. https://www.pinolepediatricdentist.com/storage/app/media/uploaded-files/_sitePDFs/hall-crown-treatment.pdf
  46. https://pmc.ncbi.nlm.nih.gov/articles/PMC9520271/
  47. https://pmc.ncbi.nlm.nih.gov/articles/PMC5770477/
  48. https://www.frontiersin.org/journals/oral-health/articles/10.3389/froh.2025.1527355/full
  49. https://pubmed.ncbi.nlm.nih.gov/40075245/
  50. https://link.springer.com/article/10.1007/s40368-024-00943-1
  51. https://www.eapd.eu/uploads/files/Policy/EAPD_Deep_Carious_Lesions.pdf
  52. https://www.dentaljuce.com/the-hall-technique
  53. https://www.prodentalcpd.com/module1843/-p357-the-hall-technique
  54. https://pmc.ncbi.nlm.nih.gov/articles/PMC9225564/
  55. https://www.nature.com/articles/s41598-020-63497-4
  56. https://www.ncbi.nlm.nih.gov/books/NBK448116/
  57. https://pmc.ncbi.nlm.nih.gov/articles/PMC8832104/
  58. https://pmc.ncbi.nlm.nih.gov/articles/PMC11562508/
  59. https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-024-04411-6
  60. https://pubmed.ncbi.nlm.nih.gov/36995724/
  61. https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-023-03111-x
  62. https://pubmed.ncbi.nlm.nih.gov/39275818/
  63. https://www.jocpd.com/articles/10.22514/jocpd.2024.101
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