The Hall Technique as caries management approach for primary molars: a cohort study related to early exfoliation and 36 months RCT compared to Atraumatic Restorative Treatment

Author(s)

Mariana Pinheiro de Araújo

• Document type: Doctoral Thesis
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Odontologia (FO/SDO)
• Defense date: 2020-02-04

Examining board members

Daniela Prócida Raggio; Marcos Britto Correa; Nicola Patricia Therese Brady Innes; Fausto Medeiros Mendes

• Advisor: Daniela Prócida Raggio

Abstract

The aim of this thesis was to evaluate and compare scientific evidence related to the effectiveness of the Hall Technique (HT) compared to the Atraumatic Restorative Treatment (ART) for managing primary molars carious lesions in a school setting. This volume presents a compilation of a retrospective cohort study assessing the association between HT and primary molar exfoliation and a randomised controlled trial comparing the effectiveness of two different restorative approaches (ART and HT), patient reported outcomes and the cost-effectiveness of the HT applied in a different setting than dental clinics. Studies follow STROBE, CONSORT, CONSORT-PRO and CHEERS guidelines respectively. The retrospective cohort study investigated the association between the HT to restore primary molars with an early exfoliation. Children who had their primary molars restored with preformed metal crowns using the HT and had the contralateral tooth present in mouth (sound, restored with another material/technique other than HT, decayed or sealed) were included and had radiographs and clinical records assessed. A superiority randomised controlled trial (RCT) was designed and conducted having as the primary outcome the treatments survival after 3 years of occluso-proximal lesions treated according to ART and the HT in a school setting, with no dental facilities. Secondary outcomes were children\'s occlusal vertical dimension (OVD) resolution after the HT crown cementation; the exfoliation of the teeth treated in the study; the discomfort reported by the children at the time the treatments; the treatment acceptability by children and their parents/caregivers; children\'s perception related to the oral health-related quality of life (OHRQoL) and cost-effectiveness of treatments. Participants included in the RCT were treated in public schools of the city of Tietê, São Paulo by three different operators, two dental undergraduate students and one specialist in paediatric dentistry. Treatments were evaluated at 1, 2, 3 weeks and 1, 6, 12, 18, 24, 30 and 36 months and classified as \"success\" or presenting \"Minor\" or \"Major failures\". Immediately after the treatments were performed by one of the operators, children\'s discomfort was accessed through the Wong-Baker Facial Scale (WBFS). Treatments acceptability was assessed through questionnaires for the children and their parents/caregivers after the treatments. OHRQoL questionnaires were applied for children before and six months after the treatments. Treatments cost (professional and material) were calculated to estimate the incremental cost of treatments. For statistical analysis, the following statistical tests were carried out: Kaplan-Meier survival analysis, Cox Regression, Multilevel Linear Regression, Ordered Logistic Regression, Wilcoxon and Mann-Whitney tests, Bootstrap linear regression and descriptive analyses. Significance levels were adjusted at 5%. No association was found between the use of the HT for managing carious lesions in primary molars and an early exfoliation of these teeth when compared to their contralateral teeth. HT presented higher survival rates when compared to ART for managing occlusal-proximal lesions in primary molars. Although the HT presented higher discomfort when compared to ART, it does not appear to be clinically significant. Acceptability related to treatments performed was high, except for the appearance of the HT by parents/caregivers. HT was a cost-effective treatment after 3 years follow-up. (AU)

• FAPESP's process: 15/18098-2 - Atraumatic restorative treatment versus Hall technique in occluso-proximal cavities in primary molars: a randomized clinical trial
• Grantee: Mariana Pinheiro de Araújo
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)