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G A M E C H A N G E R TURN CLASS II INTO SIMPLE CLASS I PATIENTS © 2015 Ortho Organizers, Inc. All rights reserved. CARRIERE® MOTION™ CLASS II APPLIANCE Simplicity, ease of use and patient compliance add up to fast, more predictable results. With its sleek, aesthetic and non-invasive design, the Motion Appliance shortens treatment time by up to four months. Easier than Herbst® , simpler than Forsus® , and faster than elastics alone, the Motion Appliance can be a real game changer for your practice. Fixed Cuspid Pad with Hook Molar Ball & Socket Sleek and Non-Invasive Class II corrected in 3 months, 1 week Total treatment time 13 months with SLX New Carriere® SLX™ Bracket OrthoOrganizers.com 18 DENTAL TRIBUNE Middle East & Africa Edition | January-February 2015Clinical 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? By Dr. Iyad Hussein I ntroduction Primary molar dental caries in childhood is a disease of epidemicproportionsthataffects all modern societies. Despite a World Health Organization (WHO) pledge in 1981 to ren- der 50% of 5-6 year old children caries free by 2000 (1), many de- veloping countries remained off target to date. In the UAE, a sur- vey showed that less than 18% of 5 year old children were caries- free (2). In comparison, 45% of 6 year-old and 69% of 3 year-old children in Sweden were noted to be caries-free (3, 4) and re- cent surveys in England showed that 88% of 3 year olds were free from obvious caries (5). The size of decay as a problem in a soci- ety is often expressed as “dmft” (decayed, missing & filled teeth) and is well established as the key measure of caries experience in dental epidemiology. The UAE regions dmft index ranged from 3.8 in Ajman to 6.6 in Dubai (2) whilst the England dmft figure average was a mere 0.48 (5). This highlights countries/social inequalities where primary den- tal caries is concerned. Conventional management of the carious primary molar Primary tooth decay manage- ment represents a challenge for those who dentally care for children, whether they are gen- eral dental practitioners (GDPs) or specialists in paediatric den- tistry. For the past 5 decades, the dental literature in the USA and Europe had advocated treating the deep carious primary molar in using the conventional “drill and fill” philosophy. That is, give local anaesthesia (LA) to the child by injection to anaesthetise the tooth, drill the carious tissue out (often after placing a rub- ber dam-Figure 1) using a high and slow speed drill (Figure 2), restore the primary tooth with a restorative material (often a preformed stainless steel crown or SSC) after carrying out pulp therapy (Figure 3). Although aesthetic crowns are available for primary teeth, they are very expensive and the SSC remains the crown of choice for the cari- ous primary molar (6,7). This relatively complex treat- ment is demanding for all par- ties involved; the dentist, the parent but especially the child (8). Even in very cooperative children the skills of a special- ist paediatric dentist are often required to achieve such treat- ment. It is well known that the larger proportion of child pa- tients are seen in the general dental practice (GDP) services rather than secondary dental services (8). Whilst there may be GDPs with a special interest in children’s dentistry, many find managing such young children a major challenge, and many patients go untreated (8). Whilst all paediatric dentists agree that SSCs are the restorations of choice for multi surface caries in the primary molars (7), the conventional doctrine of their placement (i.e; using LA and drills) has been challenged by less invasive techniques such as the “biological approach” which is embodied by the “ Hall tech- nique” (8-10) . The Hall technique: “Sealing in” the caries In 2007 a new technique took the paediatric dentistry world by storm. It recommended a simple way in managing early enamel and dentinal decay in the primary molar using a SSC; it was named the Hall technique (8). This technique involved no local anaesthesia, no rubber dam, no drilling and took place in a child friendly play manner. In essence there was no dental caries removal at all from the carious lesion. The technique relied on sealing the carious le- sion in situ cutting off its supply of sugary substrate, thus altering the lesion’s bacterial plaque ul- timately leading to the arrest of the caries process in the tooth. The Hall technique involves the Figure 1: The conventional spe- cialist approach: the child having had local anaesthesia and rubber dam placement in preparation for the restoration of 55 which had deep caries into the pulp Figures 2 (a, b & c) The conventional specialist approach: Having car- ried out a pulpotomy on 55 (Figure 2a), occlusal (Figure 2b), mesial and distal preparations (Figure 2c) are carried out with a high speed drill. > Page 19 Figures 3 (a, b, c, d): The conventional specialist paediatric dentist approach: The SSC is sized up and trialed (Figure 3a), The rubber dam is removed and the SSC is cemented with a glass ionomer (Figure 3b). Figures (3 c & d) show upper and low- er arches restored conventionally with SSCs using LA, rubber dam & high speed drills. Compare these with the teeth in Figure 10