A Primary Care Randomized Controlled Trial of Hall and Conventional Restorative Techniques
Abstract
Objectives: To investigate treatment outcomes of different restorative techniques undertaken by dental therapists for primary molar carious lesions in a sample of children in New Zealand primary care. Methods: This was a randomized controlled trial with children aged 3 to 8 y in New Zealand’s Whanganui region. Children meeting inclusion criteria were randomly allocated to treatment with either the Hall technique (HT), in which a stainless-steel crown (SSC) is placed without any carious tissue removal or tooth preparation, or a non-Hall conventional restorative approach (NHT), including tooth preparation with selective carious tissue removal; this included SSC, amalgam, composite, or glass ionomer cement (GIC) restorations. Restorative outcomes after 12 and 24 mo were categorized as success, minor failure, or major failure. Results: Of the 295 eligible children, 149 and 146 were allocated to the HT and NHT groups, respectively, with a total of 570 carious primary molars treated by 13 dental therapists. The participant follow-up rates at 12 and 24 mo were 95% and 91%. SSCs were the most commonly used restoration in the NHT group (60%), followed by GIC (28%). SSCs were the most successful restorations regardless of whether they were placed with the HT or NHT, with success rates of 89% and 92% at 12 mo and 85% and 86% at 24 mo. In the NHT group, the treatment material was a predictor of minor failure at 12 and 24 mo, with significantly more failures with GICs. Conclusions: SSCs placed by dental therapists are a highly successful restoration for the primary dentition, regardless of whether they are placed with the HT or conventionally. The high failure rate of glass ionomer restorations means that they cannot be recommended for widespread use in New Zealand primary care (Australian New Zealand Clinical Trials Registry, ACTRN12614000844640). Knowledge Transfer Statement: The findings of this study can be used by policy makers and clinicians when deciding on which materials and which approach to use to maximize success and to minimize retreatment rates when providing restorative treatment for carious primary molars in children’s primary oral health care. Results also suggest that undertaking research in the primary care setting may enhance translation of new knowledge and techniques into clinicians’ hands.
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Hall technique had very similar failure types and rates when compared to conventional preformed metal crowns.
“HT had very similar failure types and rates when compared to conventional PMCs [23], [24].”
From Hall technique for primary teeth: A systematic review and meta-analysis (2022) · cites this paper as [23]
With regards to major failures, Hall technique was found to have similar rates when compared to conventional restorations.
“With regards to major failures, HT was found to have similar rates when compared to conventional restorations [22], [23].”
From Hall technique for primary teeth: A systematic review and meta-analysis (2022) · cites this paper as [23]
When compared to conventional restorations, specifically with GIC restorations, Hall technique was shown to have significantly lower minor failure rates.
“When compared to conventional restorations, specifically with GIC restorations, HT was shown to have significantly lower minor failure rates [22], [23].”
From Hall technique for primary teeth: A systematic review and meta-analysis (2022) · cites this paper as [23]
For studies not included in the meta-analysis, Hall technique had a success rate ranging from 85% to 93%.
“For the studies not included in the meta-analysis, [22], [23], [24] HT had a success rate ranging from 85 % to 93 %.”
From Hall technique for primary teeth: A systematic review and meta-analysis (2022) · cites this paper as [23]
The reduction in minor failures could be related to the durability of preformed metal crowns, which are less prone to wear and tear damage than GIC restorations.
“The reduction in minor failures could be related to the durability of PMCs which is less prone to wear and tear damage, unlike GIC restorations [23].”
From Hall technique for primary teeth: A systematic review and meta-analysis (2022) · cites this paper as [23]
Most of the included studies included proximal or multi-surface lesions.
“Most of the studies included proximal or multi-surface lesions.”
From Hall technique for primary teeth: A systematic review and meta-analysis (2022) · cites this paper as [23]
The setting of the included studies ranged from classrooms without dental facility by dental students, primary care facilities by dental therapists, general practice units by general dentists, and university clinics conducted by paediatric dentists or residents.
“The setting of the studies ranged from being conducted in classrooms without dental facility by dental students [17], primary care facilities by dental therapists [23], general practice units by general dentists [19], [24], and University clinics conducted by paediatric dentists/residents [18], [20], [21], [22].”
From Hall technique for primary teeth: A systematic review and meta-analysis (2022) · cites this paper as [23]
The finding of similar success rates for Hall technique and conventional preformed metal crowns was seen in studies not included in the meta-analysis.
“Similar outcome was seen in the studies not included in the meta-analysis [23], [24].”
From Hall technique for primary teeth: A systematic review and meta-analysis (2022) · cites this paper as [23]
The finding that Hall technique is more likely to succeed than direct restorations was supported by other studies not included in the meta-analysis.
“This was supported by the other studies not included in the meta-analysis [22], [23].”
From Hall technique for primary teeth: A systematic review and meta-analysis (2022) · cites this paper as [23]
Two included studies randomised at subject level and included one or more teeth per subject.
“Two studies randomised at subject level and included one or more teeth per subject [23], [24]”
From Hall technique for primary teeth: A systematic review and meta-analysis (2022) · cites this paper as [23]
Two included studies included some teeth with enamel lesions.
“with the exception of two studies including some teeth with enamel lesions [21], [23]”
From Hall technique for primary teeth: A systematic review and meta-analysis (2022) · cites this paper as [23]
Cites
Sealing Caries in Primary Molars: Randomized Control Trial, 5-year Results
Innes, N. P. T., Evans, D. J. P., & Stirrups, D. R. (2011) · Journal of Dental Research · doi:10.1177/0022034511422064 · Cited by 225 · see citing works
Santamaría, R. M., Innes, N. P. T., Machiulskiene, V., Schmoeckel, J., Alkilzy, M., & Splieth, C. H. (2017) · Caries Research · doi:10.1159/000477855 · Cited by 109 · see citing works
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Hall technique for primary teeth: A systematic review and meta-analysis
Hu, S., BaniHani, A., Nevitt, S., Maden, M., Santamaria, R. M., & Albadri, S. (2022) · Japanese Dental Science Review · doi:10.1016/j.jdsr.2022.09.003 · Cited by 31 · see citing works
- Authors
- Boyd, D. H., Thomson, W. M., Leon de la Barra, S., Fuge, K. N., van den Heever, R., Butler, B. M., Leov, F., & Foster Page, L. A.
- Affiliations
- University of Otago (NZ)
- Consulting biostatistician, Waitaki Community Gardens, Oamaru, New Zealand
- Wellington Regional Dental Service, Hutt Valley District Health Board, Lower Hutt, New Zealand
- The Dentists Taradale, Napier, New Zealand
- Palmerston North Hospital (NZ)
- Waikato District Health Board (NZ)
- Department of Oral Sciences, University of Otago, Dunedin, New Zealand
- Corresponding author
- Boyd, D.H.
- Venue
- JDR Clinical & Translational Research
- Publisher
- SAGE Publications
- Published
- 2020-06-19
- Volume
- 6
- Issue
- 2
- Pages
- 205-212
- ISSN
- 2380-0844 (ISSN-L)
- 2380-0852
- OpenAlex
- W3035804889
- Cited by
- 27
- References
- 2
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 4 · 2023: 6 · 2022: 6 · 2021: 2
- FWCI
- 3.70
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JDR Clinical & Translational Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Cure Kids (Grant 3547)
- Topics
- Health Sciences › Dentistry › Orthodontics › Dental materials and restorations
- Health Sciences › Dentistry › Oral Surgery › Endodontics and Root Canal Treatments
- Health Sciences › Dentistry › Periodontics › Dental Health and Care Utilization
- Keywords
- caries restoration, dental therapists, primary dental care, stainless steel crowns, glass ionomer cement, restoration failure, children's oral health, restorative materials
- MeSH terms
- Australia, Child, Child, Preschool, Dental Restoration, Permanent, Humans, New Zealand, Primary Health Care, Tooth, Deciduous
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