A novel technique using preformed metal crowns for managing carious primary molars in general practice - A retrospective analysis

Background There is a high level of untreated dental decay in primary teeth in Scotland. Despite evidence for the efficacy of preformed metal crowns (PMCs) for the restoration of primary molars, few are placed in general practice, possibly due to the interventive nature of the clinical procedure. There is, however, a novel way of placing PMCs involving no local anaesthesia, no caries removal and no preparation of the tooth: the Hall technique. Aim To investigate the survival of carious primary teeth treated with PMCs placed using a novel, simplified method - the Hall technique. Setting General dental practice, in Scotland. Methods A retrospective analysis of practice records from one general practitioner, from 1988 to 2001. The majority of the 978 PMCs fitted on 259 children, using the Hall technique, were placed when there was clinical evidence of approximal caries into dentine. The Kaplan-Meier approach was used to analyse survival times and the Mantel-Haenszel Log rank test for comparison between tooth types. Results For all tooth types, the probability of surviving three years without being extracted or the PMC being lost, was 73.4% (95% confidence interval 70.1% to 76.4%), and for five years was 67.6% ( 95% confidence interval 63.3% to 71.5%). The probability of surviving without extraction alone for three years was 86.0% ( 95% confidence interval 83.2% to 88.4%), and for five years was 80.5% ( 95% confidence interval 76.5% to 83.9%). Conclusion 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 some other, more conventional, restorative techniques. The technique requires further evaluation through a prospective randomised control clinical trial before its use could be generally recommended.