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Dental Tribune Middle East & African Edition Jan.-Feb. 2015

DENTAL TRIBUNE Middle East & Africa Edition | January-February 2015 © 2014 Ormco Corporation*As compared to Damon Clear, data on file. Standard torque, upper 3-3 brackets. TwinsDigitalAuxiliariesPracticeDevelopmentEducation SelfLigationAlignersTubes/BandsArchwiresLabProducts Damon patients treated by Dr. Stuart Frost. OrderyourDamonClear2 brackets today at ormco.com CanYouSee Who’s Wearing Braces? (Your patients can’t see them either) Introducing the only100% clear self-ligating bracket, now with 2x the rotational control* for meticulous finishing and faster treatment. An aesthetic solution for image-conscious adults and teens, Damon Clear provides the performance and control needed to treat a wide variety of cases with exceptional results. NEW! Ormco-OrthoProd-DamonClear2-June2014.indd 1 5/5/14 2:30 PM 19Clinical following simple steps that are usually carried out over a couple of 5 minute appointments A - Hall technique: Appointment 1: 1) Case selection: Diagnosing asymptomatic early enamel and dentine caries in a primary molar; clinically and radio- graphically (using bitewings). Bitewings may typically show approximal lesions that are not visible clinically but are diag- nosed radiographically (Figures 4 a & b). There should be a clear radiolucent band between the carious lesion and pulp of the tooth intended to be restored with the SSC Hall technique. There should be no signs or symptoms of pulpal pathosis; the lesion should be detected prior to the development of symptoms (See Table 1). 2) Fitting orthodontic separa- tors: Placement of two elastic orthodontic separators mesially and distally on tooth intended for restoration with a SSC Hall technique (see Figure 5) B - Hall Technique: Appointment 2: 1) Removal of separators: After 3-5 days after the first appoint- ment, the patient returns for the removal of the orthodontic sepa- rators. Space is created mesially and distally that will negate the need for crown preparation (see Figure 6) 2) Stainless steel crown selec- tion and placement: The patient is sat up in the supine position and the operator selects the cor- rect SSC in terms of tooth num- ber and size. After selecting the correct SSC, it is tried passively on the tooth to assure that it fits with gentle pressure applied to the SSC over the contact points but not completely through. For safety purposes the crown is stuck to the operator’s finger, while trying out the size, using an adhesive tape/elastoplast. The SSC should not be too loose or too tight. The crown should “spring back” from the contact points while trying it on the tooth at this stage. After crown selection, the crown should then be filled with a self curing glass ionomer cement and positioned over and on the tooth. The op- erator then digitally presses the crown through the contact points so that the crown flexibal- ly “clicks” on the tooth and fits snugly. The patient is then asked to bite on a cotton wool roll to finish off its correct position- ing (see Figure 7). The excess of the glass ionomer cement is wiped off. The crown should be level with the occlusal plane and blanching of the gingivae will be noticed buccally and palatally indicating an adequete seal (see Figure 8). The patient may feel a little tightness, however that and the gingival blanching disappear within an hour if not less (Figure 9). Equated to the tightness of a brand new pair of shoes around feet, it resolves spontaneously after a while. Occasionally the bite may be raised by a mili- metre, however dento-alveolar compensations resolves this is- sue within a week or two. Multiple SSCs using the Hall technique could be placed in one patient over several appoint- ments without any local anaes- thesia or drilling (see Figure 10). It is possible to place two SSC using the Hall technique in one appointment. This is possible in: a) contra-lateral primary molars in the same arch, for example placement of two SSC on upper Es (teeth 55 and 65) or lower Ds (74, 84). b) Diagonal teeth in opposing arches, for example, placement of SSCs on tooth 55 and 75, or placement of SSCs on 65 and 85. C - Hall technique: Follow up appointments: All teeth treated with the Hall technique should be followed up clinically and radiographically (see Figure 11) following the same protocols as conventional treatments. The tooth should be assessed for pain, sinuses, swelling and radiographically for signs of interradicular radio- lucency or root resorption. Discussion The Hall technique was named after Dr Norna Hall, a Scottish dentist who worked as a salaried GDP in a remote high dental caries risk area (Scottish West- ern Isles) north west of the UK. As she faced a high proportion of children with dental caries (dmft of Scotland was around 2.54 at the time), and was not a special- ist in paediatric dentistry, she thought “outside the box” and used SSCs to “seal in” dental car- ies with no preparation and no LA. This technique caught the attention of the team of paediat- ric dentists/clinical researchers at Dundee Dental School in Scot- land (11). They took an interest in Dr Hall’s novel work (she had audited her own work) as they were facing very high levels of dental caries themselves. Sub- sequently a pilot trial by Evans et al was published online in 2000 (11). This prospective case controlled study assessed 49 pa- tients who were fitted with SSC crowns using the Hall technique from the patient, caregiver and dentist point of view. It was deemed a success as the study reported very high levels of sat- isfaction. In addition, the team of Dundee Dental School research- ers shared their findings with The British Society of Paediat- ric Dentistry UK national con- ference meeting in Edinburgh (UK) in the same year (2000) to the astonishment of its audi- ence (the author of this paper was present that day and recalls the reaction!). Because the ini- tial reaction to this technique by other paediatric dentists in the UK was profound (12), the team of Dundee University research- ers (Innes et al) undertook it upon themselves to investigate this technique by employing the most robust methods of evi- dence- based dentistry; namely a prospective randomized con- trolled clinical trial and first pub- lished their results in 2007 (8). This study formed the pivotal event that made this technique a “school of thought” in paedi- atric dentistry by its own right. Because of its importance of this study, it will be discussed further below. The 2007 study (8) was a pro- spective split mouth randomized control study that recruited 132 child patients aged between 3-10 years all of whom had two matched dental carious lesions. Each child acted as his/her own control. The two lesions each child had were similar to the le- sions highlighted the in example given above (Figure 4a); there were no clinical or radiographic signs of pulpal pathosis. One le- sion was randomly treated using the Hall technique and the other was randomly treated conven- tionally (mostly by glass iono- mer cements). Seventeen GDPs treated these patients under the auspices of the paediatric den- tistry team at Dundee University. < Page 18 Figures 4 (a) and 4 (b): The Hall technique: Case selection: Figure 4a: Right Bitewing radiograph shows dentinal caries in teeth 53, 54, 55, 85, 84. Tooth 54 will be used as an example here (All the Es and Ds eventually received SSC using the hall technique). Figure 4b: The same lesion of 54, seen in 4a, is not visible clinically. Figure 5: The Hall Technique: tooth 54 (distal caries shad- ow obvious) with or- thodontic separators mesially and distally. They are left in situ for 3-5 days Figure 6: The Hall technique: tooth 54 with sufficient space after orthodontic sep- arator removal Figure 8: The Hall technique: Immedi- ate post op: The SSC is fully cemented on tooth 54. The excess cement is removed. Some blanching is noticed buccally and palatally. This dis- appears within the hour. Figure 9: The Hall Technique: One week later. The SSC is level with the occlusion. There is no tightness, blanching or pain. Figure 7: The Hall Technique: The patient bites on a cotton wool roll to allow the SSC to “snap” on the tooth number 54. A click is occasionally heard. > Page 20 Ormco-OrthoProd-DamonClear2-June2014.indd 15/5/142:30 PM

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