Less invasive caries management techniques for treating cavitated carious primary teeth, which involve the concept of caries control by managing the activity of the biofilm, are becoming common. This study aimed to compare the clinical efficacy (minor/major failures) and survival rates (successful cases without any failures) of 3 carious lesion treatment approaches, the Hall Technique (HT), non-restorative caries treatment (NRCT), and conventional restorations (CR), for the management of occlusoproximal caries lesions (ICDAS 3-5) in primary molars. Results at 2.5 years are presented. A total of 169 children (3- to 8-year-olds) were enrolled in this secondary care-based, 3-arm parallel-group, randomised controlled trial. Participants were allocated to: HT (n = 52; sealing caries with stainless-steel crowns without caries removal), NRCT (n = 52; opening up the cavity and applying fluoride varnish), CR (n = 65; control arm, complete caries removal and compomer restoration). Statistical analyses were: non-parametric Kruskal-Wallis analysis of variance, Mann-Whitney U test and Kaplan-Meier survival analyses. One hundred and forty-two participants (84%; HT = 40/52; NRCT = 44/52; CR = 58/65) had follow-up data of 1-33 months (mean = 26). Overall, 25 (HT = 2, NRCT = 9, CR = 14) of 142 participants (17.6%) presented with at least 1 minor failure (reversible pulpitis, caries progression, or secondary caries; p = 0.013, CI = 0.012-0.018; Mann-Whitney U test). Ten (HT = 1, NRCT = 4, CR = 5) of 142 participants (7.04%) experienced at least 1 major failure (irreversible pulpitis, abscess, unrestorable tooth; p = 0.043, CI = 0.034-0.045). Independent comparisons between 2 samples found that NRCT-CR had no statistically significant difference in failures (p > 0.05), but for CR-HT (p = 0.037, CI = 0.030-0.040) and for NRCT-HT (p = 0.011, CI = 0.010-0.016; Kruskal-Wallis test) significant differences were observed. Cumulative survival rates were HT = 92.5%, NRCT = 70.5%, and CR = 67.2% (p = 0.012). NRCT and CR outcomes were comparable. HT performed better than NRCT and CR for all outcomes. This study was funded by the Paediatric Dentistry Department, Greifswald University, Germany (Trial registration No. NCT01797458).

Keywords:
Caries, Hall technique, Multisurface cavities, Non-restorative caries treatment, Primary teeth
1.
Amin M, Nouri MR, Hulland S, ElSalhy M, Azarpazhooh A: Success rate of treatments provided for early childhood caries under general anesthesia: a retrospective cohort study. Pediatr Dent 2016;38:317-324.
2.
Chadwick BL, Evans DJ: 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;8:14-21.
3.
Chu CH, Lo EC: Promoting caries arrest in children with silver diamine fluoride: a review. Oral Health Prev Dent 2008;6:315-321.
4.
Ekstrand KR, Martignon S, Ricketts DJ, Qvist V: Detection and activity assessment of primary coronal caries lesions: a methodologic study. Oper Dent 2007;32:225-235.
5.
Foster T, Perinpanayagam H, Pfaffenbach A, Certo M: Recurrence of early childhood caries after comprehensive treatment with general anesthesia and follow-up. J Dent Child 2006;73:25-30.
6.
Gruythuysen R: Non-restorative cavity treatment: managing rather than masking caries activity. Ned Tijdschr Tandheelkd 2010;117:173-180.
7.
Hansen NV, Nyvad B: Non-operative control of cavitated approximal caries lesions in primary molars: a prospective evaluation of cases. J Oral Rehabil 2017;44:537-544.
8.
Innes NP, Evans DJ: Modern approaches to caries management of the primary dentition. Br Dent J 2013;214:559-566.
9.
Innes NP, Evans DJ, Stirrups DR: Sealing caries in primary molars: randomized control trial, 5-year results. J Dent Res 2011;90:1405-1410.
10.
Innes NP, Frencken JE, Bjørndal L, Maltz M, Manton DJ, Ricketts D, Van Landuyt K, Banerjee A, Campus G, Doméjean S, Fontana M, Leal S, Lo E, Machiulskiene V, Schulte A, Splieth C, Zandona A, Schwendicke F: Managing carious lesions: consensus recommendations on terminology. Adv Dent Res 2016a;28:49-57.
11.
Innes NP, Ricketts D, Chong LY, Keightley AJ, Lamont T, Santamaria RM: Preformed crowns for decayed primary molar teeth. Cochrane Database Syst Rev 2015;12:CD005512.
12.
Innes N, Santamaria R, Duggal M, Splieth C: Letter to the editor. Pediatr Dent 2016b;38:278-279.
13.
Innes NP, Evans DJ, Stirrups DR: 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. BMC Oral Health 2007;7:18.
14.
Jameson K, Averley PA, Shackley P, Steele J: A comparison of the “cost per child treated” at a primary care-based sedation referral service, compared to a general anaesthetic in hospital. Br Dent J 2007;203:E13.
15.
Jin LJ, Lamster IB, Greenspan JS, Pitts NB, Scully C, Warnakulasuriya S: Global burden of oral diseases: emerging concepts, management and interplay with systemic health. Oral Dis 2016;22:609-619.
16.
Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJ, Marcenes W: Global burden of untreated caries: a systematic review and metaregression. J Dent Res 2015;94:650-658.
17.
Kidd E: The implications of the new paradigm of dental caries. J Dent 2011;39:3-8.
18.
Kidd E: Should deciduous teeth be restored? Reflections of a cariologist. Dent Update 2012;39:159-162, 165-166.
19.
Kidd E, Fejerskov O: Changing concepts in cariology: forty years on. Dent Update 2013;40:277-278, 280-282, 285-286.
20.
Kuzmina I, Ekstrand KR: Outcomes 18 years after implementation of a nonoperative caries preventive program - the Nexö-method - on children in Moscow, Russia. Community Dent Oral Epidemiol 2015;43:308-316.
21.
Marcenes W, Kassebaum NJ, Bernabé E, Flaxman A, Naghavi M, Lopez A, Murray CJL: Global burden of oral conditions in 1990-2010: a systematic analysis. J Dent Res 2013;92:592-597.
22.
Mertz-Fairhurst EJ, Curtis JW Jr, Ergle JW, Rueggeberg FA, Adair SM: Ultraconservative and cariostatic sealed restorations: results at year 10. J Am Dent Assoc 1998;129:55-66.
23.
Mijan M, de Amorim RG, Leal SC, Mulder J, Oliveira L, Creugers NH, Frencken JE: The 3.5-year survival rates of primary molars treated according to three treatment protocols: a controlled clinical trial. Clin Oral Investig 2014;18:1061-1069.
24.
Nainar SM: Success of Hall technique crowns questioned. Pediatr Dent 2012;34:103.
25.
Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C: The global burden of oral diseases and risks to oral health. Bull World Health Organ 2005;83:661-669.
26.
Pieper K: Epidemiologische Begleituntersuchungen zur Gruppenprophylaxe 2009. Bonn, Gerhards, 2010.
27.
Qvist V, Laurberg L, Poulsen A, Teglers PT: Class II restorations in primary teeth: 7-year study on three resin-modified glass ionomer cements and a compomer. Eur J Oral Sci 2004a;112:188-196.
28.
Qvist V, Manscher E, Teglers PT: Resin-modified and conventional glass ionomer restorations in primary teeth: 8-year results. J Dent 2004b;32:285-294.
29.
Randall RC, Vrijhoef MM, Wilson NH: Efficacy of preformed metal crowns versus amalgam restorations in primary molars: a systematic review. J Am Dent Assoc 2000;131:337-343.
30.
Ricketts D, Lamont T, Innes NP, Kidd E, Clarkson JE: Operative caries management in adults and children. Cochrane Database Syst Rev 2013;3:CD003808.
31.
Rollnick S, Miller WR, Butler CC: Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York, Guilford Press, 2008.
32.
Santamaria RM, Innes NP, Machiulskiene V, Evans DJ, Alkilzy M, Splieth CH: Acceptability of different caries management methods for primary molars in an RCT. Int J Paediatr Dent 2015;25:9-17.
33.
Santamaria RM, Innes NP, Machiulskiene V, Evans DJ, Splieth CH: Caries management strategies for primary molars: 1-year randomized control trial results. J Dent Res 2014;93:1062-1069.
34.
Schüler IM, Hiller M, Roloff T, Kühnisch J, Heinrich-Weltzien R: Clinical success of stainless steel crowns placed under general anaesthesia in primary molars: an observational follow-up study. J Dent 2014;42:1396-1403.
35.
Schwendicke F, Frencken JE, Bjørndal L, Maltz M, Manton DJ, Ricketts D, Van Landuyt K, Banderjee A, Campus G, Doméjean S, Fontana M, Leal S, Lo E, Machiulskiene V, Schulte A, Splieth C, Zandona AF, Innes NPT: Managing carious lesions: consensus recommendations on carious tissue removal. Adv Dent Res 2016;28:58-67.
36.
Schwendicke F, Stolpe M, Innes N: Conventional treatment, Hall technique or immediate pulpotomy for carious primary molars: a cost-effectiveness analysis. Int Endod J 2015, Epub ahead of print.
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2017
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