Brief Resume of the intended work
8.1 Need for study
Dental decay in primary teeth is a significant health problem.1 Selecting an ideal restorative material for restoration of a grossly decayed tooth is challenging. Glass ionomer restorative cement and amalgam are the material of choice. However the main disadvantage being marginal breakdown.
In late 1950, Dr William Humphrey introduced pre formed metal crowns for restoring primary molars and has become the accepted restoration of choice for primary molars with multi surface decay , with a proven success rate.
But, placement of stainless steel crown requires tooth preparation which was the major drawback. Dr Norna Hall from Scotland introduced a new technique,in which tooth was restored with stainless steel crowns, without tooth preparation and has proved to be successful - The Hall technique.
This study aims in evaluating the effectiveness and acceptability of Hall technique and compare the same with conventional restorations in Indian population.
8.2 Review of literature
Studies have shown that the Hall Technique is preferred over conventional restorations by the majority of children, parents. After two years, Hall technique, showed more favourable outcome for pulpal health and restoration longevity than conventional restorations. Hence, The Hall Technique appears to offer an effective treatment option for carious primary molar teeth.1
Studies have shown that Hall technique restorations placed on primary molars with decay clinically into dentine, by a single operator in general dental practice, have a similar success rate to other conventional restorative techniques.2
Studies have proven that use of stainless steel crown is a valuable procedure and has no harmful effect on gingiva and bone in primary molars provided oral hygiene is maintained.3
Studies have shown that stainless steel crowns are successful in restoring large cavities and pulp treated primary molars .4
Studies have proven that glass ionomer formulations and compomers release more fluoride than
any other sealant.5
Glass-ionomer cement is known as a biomimetic material, because of its similar mechanical properties to dentine. Its properties include adhesion and release of fluoride, and hence it is considered as ideal restorative material in most of the restorative situation.6
8.3 Objectives of the study
The aim of this study
  1. To evaluate the effectiveness of Hall technique and conventional restorative technique in carious manbibular first primary molars.
  2. To check the acceptability of Hall technique and conventional restoration technique by patients and their parents.

Materials and methods
  • Pre formed stainless steel crowns
  • Type I glass ionomer luting cement
  • Type II glass ionomer restorative cement
  • Operative instruments
  • Stainless steel crown kit
  • Radiographic film
  • Dental floss
  • Separators (Elastic)
  • Airotor handpiece
  • Micromotor handpiece
  • Cavity preparation burs
  • Crown trimming burs
9.1 Case selection
Fifteen school children are selected from Bangalorepopulation.
9.2 Inclusion criteria
  • Age group: 5-9 yrs.
  • Bilateral mandibular first primary molars having large carious lesions without considerable loss of tooth structure.
  • Carious lesion without involving pulp.
  • Intra oral peri apical radiographs of the tooth to check for peri apical pathology.
  • Parent/guardian/caregiver consent.
  • Co-operative patients.
9.3 Exclusion criteria
  • Presence of pain.
  • Presence of intra oral swelling.
  • Any relevant radiological finding which may alter the treatment plan.
  • Medically compromised patients.
  • Un-cooperative patients.
9.4 Procedure
  • Patient fulfilling the above criteria are selected.
Step1
  • Tooth to be restored in conventional method is selected.
  • Caries is completely removed and a conventional cavity preparation is done.
  • Tooth is restored with type II glass ionomer restorative cement.
Step 2
  • Patient is made to sit in upright position to protect airway and to reduce the risk of aspiration of stainless steel crown.
  • Crown selection is done.
Crown should cover all surfaces and should give a spring back when placed. But it should not be seated completely because it may cause difficulty while removing it for cementation.
  • Carious lesion is removed using a sharp spoon excavator.
  • Tooth must be rinsed and dried (If the lesion is large, cement must be placed within, just before placing crown).
  • Crown is dried and it is filled with type I glass ionomer luting cement.
  • Cement should be filled with no air inclusions.
  • Crown is seated on to the tooth. It is done in 2 methods:
  1. Clinician seats the crown by finger pressure.
  2. Child seats the crown by biting on it, after the dentist places it on to the tooth.
  • Child is made to bite the crown till the cement is set.
  • Excess cement is removed using floss.
  • Patients are recalled at 15 days, 3 months, 6 months and 9 months for follow up.
Step 3
  • During the following recall visits, a clinical and radiographic evaluation is done.
Clinical Evaluation includes:
1) Check for occlusal disturbance.
2) Check for pain / discomfort to patient.
3) Check for gingival health around the margins of crown.
4) Check for any intra oral swelling.
5) Check for any shift in the midline.
6) Check for strength of restoration.
Radiographic Evaluation includes:
  • check for any periapical pathology.
  • check for any bone loss in interdental and furcation area.
  • Parents /guardians/care givers are asked to fill a simple questionnaire.

10.1 Does the study require any investigation or intervention to be conducted on patients or other human or animal? If so, please describe briefly.
Yes, this will be done on patients primary mandibular first molars.
10.2Has ethical clearance been obtained from your institution in case of being applicable?
Yes.
References
  1. Innes NP, Stirrups.DR, Evans.DJ : The hall technique: a randomized controlled clinical trial of a novel method of managing carious primary molar in general dental practice : acceptability of the technique and outcomes at 23 months.BMC Oral Health. Dec 2007; 20(7):18
  2. Innes NP, Stirrups.DR, Evans.DJ, Hall.N, Leggate.M: A novel technique using preformed metal crowns for managing carious primary molars in general practice - a retrospective analysis.Br Dent J. Apr 2006;200(8): 451-4
  3. Sharaf A, Farsi M Najat: A clinical and radiographic evaluation of stainless steel crown for primary molar. Journal of dentistry. Jan 2004;32(1): 27-33
  4. Roberts J F , Attari N , Sheriff M: The survival of resin modified glass ionomer and stainless steel crown restoration in primary molar, placed in a specialist pediatric dental clinic Br.Dent.J Apr 2005;198(7) : 427-431
  5. Antoniades. Marie Helvatjoglu, Karantakis. Panagiotis, Papadogiannis. Yannis, Kapetanios. Hryssostomos: Fluoride release from restorative materials and a luting cement. Journal of prosthetic dentistry Aug 2001; 86( 2): 156-164
  6. Ersin N K , Candan U , Aykut A , Oncag O :Clinical evaluation of glass-ionomer cement restorations. J. Appl. Oral Sci. 2006;vol (14)