The Hall Technique; a randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice: acceptability of the technique and outcomes at 23 months
Tóm tắt
Scotland has high levels of untreated dental caries in primary teeth. The Hall Technique is a simplified method of managing carious primary molars using preformed metal crowns (PMCs) cemented with no local anaesthesia, caries removal or tooth preparation. This study compared the acceptability of the Hall Technique for children, their carers, and dentists, and clinical outcomes for the technique, with conventional restorations. General dental practice based, split mouth, randomized controlled trial (132 children, aged 3–10). General dental practitioners (GDPs, n = 17) in Tayside, Scotland (dmft 2.7) placed conventional (Control) restorations in carious primary molars, and Hall Technique PMCs on the contralateral molar (matched clinically and radiographically). Dentists ranked the degree of discomfort they felt the child experienced for each procedure; then children, their carers and dentists stated which technique they preferred. The teeth were followed up clinically and radiographically. 128 conventional restorations were placed on 132 control teeth, and 128 PMCs on 132 intervention teeth. Using a 5 point scale, 118 Hall PMCs (89%) were rated as no apparent discomfort up to mild, not significant; for Control restorations the figure was 103 (78%). Significant, unacceptable discomfort was recorded for two Hall PMCs (1.5%) and six Control restorations (4.5%). 77% of children, 83% of carers and 81% of dentists who expressed a preference, preferred the Hall technique, and this was significant (Chi square, p < 0.0001). There were 124 children (94% of the initial sample) with a minimum follow-up of 23 months. The Hall PMCs outperformed the Control restorations: a) 'Major' failures (signs and symptoms of irreversible pulpal disease): 19 Control restorations (15%); three Hall PMCs (2%) (P < 0.000); b) 'Minor' failures (loss of restoration, caries progression): 57 Control restorations (46%); six Hall PMCs (5%) (P < 0.000) c) Pain: 13 Control restorations (11%); two Hall PMCs (2%) (P = 0.003). The Hall Technique was preferred to conventional restorations by the majority of children, carers and GDPs. After two years, Hall PMCs showed more favourable outcomes for pulpal health and restoration longevity than conventional restorations. The Hall Technique appears to offer an effective treatment option for carious primary molar teeth. Current Controlled Trials ISRCTN47267892 – A randomized controlled trial in primary care of a novel method of using preformed metal crowns to manage decay in primary molar teeth: the Hall technique.
Tài liệu tham khảo
NDIP: Scotland's National Dental Inspection Programme 2003. [http://www.dundee.ac.uk/dhsru/publications/ndip/index.htm]
Macpherson LM, Pine CM, Tochel C, Burnside G, Hosey MT, Adair P: Factors influencing referral of children for dental extractions under general and local anaesthesia. Community Dent Health. 2005, 22 (4): 282-288.
Shepherd MA, Nadanovsky P, Sheiham A: The prevalence and impact of dental pain in 8-year-old school children in Harrow, England. Br Dent J. 1999, 187 (1): 38-41. 10.1038/sj.bdj.4800197a.
Milsom KM, Tickle M, Blinkhorn AS: Dental pain and dental treatment of young children attending the general dental service. Br Dent J. 2002, 192 (5): 280-284. 10.1038/sj.bdj.4801355a.
Fayle SA, Welbury RR, Roberts JF: British Society of Paediatric Dentistry: a policy document on management of caries in the primary dentition. Int J Paediatr Dent. 2001, 11 (2): 153-157. 10.1046/j.1365-263x.2001.011002153.x.
SHBDEP: Scottish Health Board Dental Epidemiological Programme 1989. [http://www.dundee.ac.uk/dhsru/publications/comp879.htm]
Levine RS, Pitts NB, Nugent ZJ: The fate of 1,587 unrestored carious deciduous teeth: a retrospective general dental practice based study from northern England. Br Dent J. 2002, 193 (2): 99-103. 10.1038/sj.bdj.4801495a.
Attin T, Opatowski A, Meyer C, Zingg-Meyer B, Buchalla W, Monting JS: Three-year follow up assessment of Class II restorations in primary molars with a polyacid-modified composite resin and a hybrid composite. Am J Dent. 2001, 14 (3): 148-152.
Marks LA, Weerheijm KL, van Amerongen WE, Groen HJ, Martens LC: Dyract versus Tytin Class II restorations in primary molars: 36 months evaluation. Caries Res. 1999, 33 (5): 387-392. 10.1159/000016538.
Papagiannoulis L, Kakaboura A, Pantaleon F, Kavvadia K: Clinical evaluation of a polyacid-modified resin composite (compomer) in Class II restorations of primary teeth: a two-year follow-up study. Pediatr Dent. 1999, 21 (4): 231-234.
Qvist V, Laurberg L, Poulsen A, Teglers PT: Longevity and cariostatic effects of everyday conventional glass-ionomer and amalgam restorations in primary teeth: three-year results. J Dent Res. 1997, 76 (7): 1387-1396.
Roeters JJ, Frankenmolen F, Burgersdijk RC, Peters TC: Clinical evaluation of Dyract in primary molars: 3-year results. Am J Dent. 1998, 11 (3): 143-148.
Pine CM, Harris RV, Burnside G, Merrett MC: An investigation of the relationship between untreated decayed teeth and dental sepsis in 5-year-old children. Br Dent J. 2006, 200 (1): 45-7; discussion 29. 10.1038/sj.bdj.4813124.
Fayle SA: UK National Clinical Guidelines in Paediatric Dentistry. Stainless steel preformed crowns for primary molars. Faculty of Dental Surgery, Royal College of Surgeons. Int J Paediatr Dent. 1999, 9 (4): 311-314. 10.1046/j.1365-263x.1999.00153.x.
Randall RC, Vrijhoef MM, Wilson NH: Efficacy of preformed metal crowns vs. amalgam restorations in primary molars: a systematic review. J Am Dent Assoc. 2000, 131 (3): 337-343.
Roberts JF, Attari N, Sherriff M: The survival of resin modified glass ionomer and stainless steel crown restorations in primary molars, placed in a specialist paediatric dental practice. Br Dent J. 2005, 198 (7): 427-431. 10.1038/sj.bdj.4812197.
SDPB: Trinity Park House E. Scottish Dental Practice Board Annual Report 2001/2002. [http://www.sdpb.scot.nhs.uk]
Threlfall AG, Pilkington L, Milsom KM, Blinkhorn AS, Tickle M: General dental practitioners' views on the use of stainless steel crowns to restore primary molars. Br Dent J. 2005, 199 (7): 453-455. 10.1038/sj.bdj.4812746.
Maggs-Rapport FL, Treasure ET, Chadwick BL: Community dental officers' use and knowledge of restorative techniques for primary molars: an audit of two Trusts in Wales. Int J Paediatr Dent. 2000, 10 (2): 133-139. 10.1046/j.1365-263x.2000.00182.x.
Roshan D, Curzon ME, Fairpo CG: Changes in dentists' attitudes and practice in paediatric dentistry. Eur J Paediatr Dent. 2003, 4 (1): 21-27.
Blinkhorn A, Zadeh-Kabir R: Dental care of a child in pain -- a comparison of treatment planning options offered by GDPs in California and the North-west of England. Int J Paediatr Dent. 2003, 13 (3): 165-171. 10.1046/j.1365-263X.2003.00454.x.
Rahimtoola S, van Amerongen E, Maher R, Groen H: Pain related to different ways of minimal intervention in the treatment of small caries lesions. ASDC J Dent Child. 2000, 67 (2): 123-7, 83.
van Bochove JA, van Amerongen WE: The influence of restorative treatment approaches and the use of local analgesia, on the children's discomfort. Eur Arch Paediatr Dent. 2006, 7 (1): 11-16.
Schriks MC, van Amerongen WE: Atraumatic perspectives of ART: psychological and physiological aspects of treatment with and without rotary instruments. Community Dent Oral Epidemiol. 2003, 31 (1): 15-20. 10.1034/j.1600-0528.2003.00021.x.
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. 2006, 200 (8): 451-4; discussion 444. 10.1038/sj.bdj.4813466.
Evans DJP, Southwick CAP, Foley JI, Innes NP, Pavitt SH, Hall N: The Hall technique: a pilot trial of a novel use of preformed metal crowns for managing carious primary teeth. 2000, [http://www.scottishdental.org/pbrn/research/papers/rt03.htm]
Murray PE, Smith AJ, Windsor LJ, Mjor IA: Remaining denine thickness and human pulp responses. Int Endod J. 2003, 36: 33-43. 10.1046/j.0143-2885.2003.00609.x.
Ricketts DN, Kidd EA, Innes N, Clarkson J: Complete or ultraconservative removal of decayed tissue in unfilled teeth. Cochrane Database Syst Rev. 2006, 3: CD003808-
Straffon LH, Dennison JB: Clinical evaluation comparing sealant and amalgam after 7 years: final report. J Am Dent Assoc. 1988, 117 (6): 751-755.
Handelman SL, Leverett DH, Espeland MA, Curzon JA: Clinical radiographic evaluation of sealed carious and sound tooth surfaces. J Am Dent Assoc. 1986, 113 (5): 751-754.
Department of Health: R&D in Primary Care: National Working Group Report (The Mant Report). 1997, London , Department of Health
Department of Health: NHS R&D Strategic Review: Primary Care. Report of the Topic Working Group (The Clarke Report). 1999, London , Department of Health
Pitts NB, Nugent ZJ, Smith PA: Scottish Health Boards' Dental Epidemiological Programme (SHBDEP) Report of the 1999 - 2000 Survey of 5 Year old Children. 2000, University of Dundee, [http://www.dundee.ac.uk/dhsru/publications/shbdep99/]
Evans DJP, Matthews S, Pitts NB, Longbottom C, Nugent ZJ: A clinical evaluation of an Erbium:YAG laser for dental cavity preparation. Br Dent J. 2000, 188 (12): 677-679. 10.1038/sj.bdj.4800575a.
Burke FJ, McCord JF: Research in general dental practice - problems and solutions. Br Dent J. 1993, 175 (11-12): 396-398. 10.1038/sj.bdj.4808335.
Jones CS, Billington RW, Pearson GJ: The advantages and disadvantages of running a clinical trial in general practices. Br Dent J. 2004, 197 (6): 311-313. 10.1038/sj.bdj.4811649.
Reekie D: The future of dentistry - the evidence revolution. Br Dent J. 1998, 184 (6): 262-263. 10.1038/sj.bdj.4809590.
Innes NP, Evans DJ, Clarkson JE, Foley JI: Obtaining an evidence-base for clinical dentistry through clinical trials. Prim Dent Care. 2005, 12 (3): 91-96. 10.1308/1355761054348459.
Holmes RD, Girdler NM: A study to assess the validity of clinical judgement in determining paediatric dental anxiety and related outcomes of management. Int J Paediatr Dent. 2005, 15 (3): 169-176. 10.1111/j.1365-263X.2005.00633.x.
McDowell EH, Baker IM: The skeletodental adaptations in deep bite correction. Am J Orthod Dentofacial Orthop. 1991, 100 (4): 370-375. 10.1016/0889-5406(91)70076-9.
al-Sehaibany F, White G: Posterior bite raising effect on the length of the ramus of the mandible in primary anterior crossbite: case report. J Clin Pediatr Dent. 1996, 21 (1): 21-26.
Luther F: TMD and occlusion part II. Damned if we don't? Functional occlusal problems: TMD epidemiology in a wider context. Br Dent J. 2007, 202 (1): E3; discussion 38-E3; discussion 39.
Sadowsky C, BeGole EA: Long-term status of temporomandibular joint function and functional occlusion after orthodontic treatment. Am J Orthod. 1980, 78 (2): 201-212. 10.1016/0002-9416(80)90060-3.
Duggal M, Day P: Operative treatment of dental caries in the primary dentition. Paediatric Dentistry. Edited by: Welbury . 2005, Oxford , Oxford University Press, p149-166. 3rd
Duggal MS, Nooh A, High A: Response of the primary pulp to inflammation: a review of the Leeds studies and challenges for the future. Eur J Paediatr Dent. 2002, 3 (3): 111-114.
Nooh AM: The relationship between the extent of carious involvment of the marginal ridge and pulpal inflammation in primary teeth. p.76. Paediatric Dentistry. 1998, Leeds , University of Leeds
Farooq NS, Coll JA, Kuwabara A, Shelton P: Success rates of formocresol pulpotomy and indirect pulp therapy in the treatment of deep dentinal caries in primary teeth. Pediatr Dent. 2000, 22 (4): 278-286.
Gruythuysen RJ, Weerheijm KL: Calcium hydroxide pulpotomy with a light-cured cavity-sealing material after two years. ASDC J Dent Child. 1997, 64 (4): 251-253.
Guelmann M, Fair J, Bimstein E: Permanent versus temporary restorations after emergency pulpotomies in primary molars. Pediatr Dent. 2005, 27 (6): 478-481.
Holan G, Fuks AB, Ketlz N: Success rate of formocresol pulpotomy in primary molars restored with stainless steel crown vs amalgam. Pediatr Dent. 2002, 24 (3): 212-216.
Tickle M, Milsom K, King D, Kearney-Mitchell P, Blinkhorn A: The fate of the carious primary teeth of children who regularly attend the general dental service. Br Dent J. 2002, 192 (4): 219-223. 10.1038/sj.bdj.4801338a.
Chadwick B, Evans DJP: Restoration of class II cavities in primary molar teeth with conventional and resin modified glass ionomer cements: a systematic review of the literature. Eur Arch Paediatr Dent. 2007, 8 (1): 14 -121.
Eriksson AL, Paunio P, Isotupa K: Restoration of deciduous molars with ion-crowns: retention and subsequent treatment. Proc Finn Dent Soc. 1988, 84 (2): 95-99.
Goto G, Imanishi T, Machida Y: Clinical evaluation of preformed crown for deciduous teeth. Bull Tokyo Dent Coll. 1970, 11 (3): 169-176.
Chadwick B, Dummer P, Dunstan F, al. : The Longevity of Dental Restorations. A Systematic Review. National health System Centre for Reviews and Dissemination Report 19. York: University of York, 2001. Evidence Based Dentistry. 2002, 3 (4): 96 -999. 10.1038/sj.ebd.6400146.
Marsh PD: Dental plaque as a microbial biofilm. Caries Res. 2004, 38 (3): 204-211. 10.1159/000077756.
Fejerskov O, Kidd EAM: Dental Caries. The Disease and its Clinical Management. 2003, Denmark , Blackwell Munksgaard, Ch18 p275-190.
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