Name the two ways of placing PMCs
- Conventional
- Hall
What’s the difference between the two methods of placing PMCs
- Convenional technique requires complete caries removal under LA
- Use of rotary instrument
- Crown preparation
Hall Technique requires no caries removal, no LA no drilling and no LA
- May or may not need orthodontic separators to create inter proximal space
- Non-invasive method
What’s the rationale behind placing PMCs using Hall Technique
- Completely sealing off a carious lesion so the environment of the plaque biofilm is affected significantly to arrest the carious progression
- Biological approach
- Evidence suggests that if caries is effectively sealed from oral environment the bacterial profile in the caries changes significantly and the lesion does not progress
How do you seat the PMC
-Either finger pressure or child’s own occlusal force
Indications for Hall Technique in terms of Black’s classification
- Class II lesions (proximal) either cavitated or non cavitated
- Occlisal Class I lesions, non-cavitated if the patient is unable to accept a fissure sealant or conventional restoration
- Occlusal Class I lesions caveatted if the patient is unable to accept partial caries removal technique or a conventional restoration
Contraindications for Hall Technique
- Irreversible pulpal involvement
- Allergy to nickel
- Insufficient sound tissue to retain the crown
- Pt cooperation (endangering patient airway)
- Patient at risk from bacterial endocarditis
- Parent or child unhappy with aesthetics
What in the patient assessment should be noted (including rx)
- Extent and activity of the carious lesion
- Use clinical experience to decide if there is likely pulp involvement
- Clinical signs or symptoms of irreversible pulpits or dental abscess
- Non-physiological mobility
On rx:
- Band of sound dentine between the lesion and the pulp
- Signs of intra radicular pathology
- Signs of a dental abscess
What 6 things are crucial in the placing of a PMC using Hall
- Choose correct size of crown
- Child must be on board
- Separators if contact points too tight for 2-3 days
- GI luting cement
- Fit should be sub gingival or at least below margins of cavitation
- Check pulpal involvement
How to form space if tight contacts
- Orthodontic separators
- Requires 2 visits
- 2-3 days
- Flossed between adjacent teeth
- Top half should remain above the marginal ridge
What must you do to prepare and consider before placing crown on tooth prior to cementation
- Ensure airway is protected with gauze
- Child sitting upright
- Correct size of PMC must be chosen
- Do not seat the crown through contacts prior to cementation as difficult to remove
- All cusps should be covered with a slight spring back feel
How to cement PMC and how would you know its worked
- Ensure child is sitting upright
- GIC luting cement used
- Get pt to bite on cotton wool roll
- Blanching of gingivae
How to finish off once cemented PMC and post tx instructions
- Clear away excess cement
- Occlusion may be high but should settle within a week
Name some of major and minor failures for placing PMCs using Hall
MAJOR
- Irreversible pulpits or dental abscess requiring pulp therapy of XLA
- Interradicular RL
- Restoration loss and tooth unrestorable
- Internal root resorption
MINOR
- Secondary caries, or new caries clinically or rx
- Restoration fracture or wear requiring intervention
- Restoration loss and tooth restorable
- Reversible pulpits treated without requiring pulp therapy or XLA
Define ECC
-Presence of one or more cavitated or non-cavitated carious lesions before a child’s sixth bday
What is S-ECC
-Presence of smooth surface caries is a child less than three years old
or
-anterior caries
or
-dmfs >age+1
what is Ludwig’s angina and how managed
- Cellulitis of the floor of the mouth
- Can compromise airway
- Rapidly progressive
- IV antibiotics, securing airway and drainage
What problems may premature loss of primary molars contribute to
- Deviation of midline
- Crowding
- Dental impaction
- Ectopic eruption
- Crossbite formation
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Behaviour Management40
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Dental Development21
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Prevention37
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History and Examination27
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Pharmacological Pain Control and LA26
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Primary Tooth Trauma45
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Review on Restoring Primary Carious Teeth17
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Hall Technique17
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Caries48
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Pulp Therapy39
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Molar Incisor Hypomineralisation30
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General Anaesthesia28
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Inhalation Sedation30
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Child Protection 132
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Child Protection 212
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Operative Techniques for Dental Trauma18
