Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Success rate of Hall Technique for restoring carious primary molars - systematic review and meta-analysis

Evidence-Based Dentistry volume 26, pages 65–66 (2025)Cite this article

Subjects

Abstract

Objectives

The overall pooled success rate of the Hall Technique (HT) in various types of studies has not been investigated. The present study aims to evaluate the success rate of HT to restore carious primary molars.

Methods

A systematic search was carried out in the MEDLINE/PubMed, Excerpta Medica Database (EMBASE), Scopus, Web of Science, and LIVIVO electronic databases, as well as the ProQuest database for grey literature review. A search was carried out up to September 2023 for studies meeting the eligibility criteria: Randomised Clinical Trials (RCTs) and Non-Randomised Studies of Interventions (NRSIs); children with primary molars treated using HT; and reporting success for at least 1-month post-treatment. Single-arm meta-analysis assessed the pooled proportion (95% CI) of HT success rates. Risk of bias and certainty of evidence using the GRADE approach were assessed.

Results

Searching identified 665 studies, with 25 (15 RCTs and 10 NRSIs) meeting the eligibility criteria. In meta-analyses of RCTs, the pooled proportion success rate was 98% (95% CI: 97–99%) at 12-month follow-up. For NRSIs, the pooled proportion success rate was 95% (95% CI: 91–100%) up to 89 months.

Conclusions

HT presents a high success rate, even though the primary studies had “low” to “high” risk of bias and demonstrated “moderate” to “low” certainty of evidence. One of the main reasons for downgrading was related to blinding, which was generally unfeasible due to visibly different restorative materials. The systematic review protocol was registered in PROSPERO (ID: CRD42021204415).

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

The datasets used and/or analysed during the current study are available in the Appendix.

References

  1. Kazeminia M, Abdi A, Shohaimi S, Jalali R, Vaisi-Raygani A, Salari N, et al. Dental caries in primary and permanent teeth in children’s worldwide, 1995 to 2019: a systematic review and meta-analysis. Head Face Med. 2020;16:22.

    Article  PubMed  PubMed Central  Google Scholar 

  2. 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;94:650–8.

    Article  CAS  PubMed  Google Scholar 

  3. Frencken J. Caries Epidemiology and its challenges. Monogr Oral Sci. 2018;27:11–23.

    Article  PubMed  Google Scholar 

  4. Gomide RT, Frencken JE, Leal SC, Kuijpers-Jagtman AM, Faber J. Impact of proximal cavities and primary molar absence on space in the dental arches. PeerJ. 2020;8:e8924.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bitencourt FV, Rodrigues JA, Toassi RFC. Narratives about a stigma: attributing meaning to the early loss of deciduous teeth on children’s caregivers. Braz Oral Res. 2021;35:e044.

    Article  PubMed  Google Scholar 

  6. Jackson SL, Vann WF Jr, Kotch JB, Pahel BT, Lee JY. Impact of poor oral health on children’s school attendance and performance. Am J Public Health. 2011;101:1900–6.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Santamaría RM, Abudrya MH, Gül G, Mourad MS, Gomez GF, Zandona AGF. How to Intervene in the Caries Process: Dentin Caries in Primary Teeth. Caries Res. 2020;54:306–23.

    Article  PubMed  Google Scholar 

  8. Aïem E, Joseph C, Garcia A, Smaïl-Faugeron V, Muller-Bolla M. Caries removal strategies for deep carious lesions in primary teeth: Systematic review. Int J Paediatr Dent. 2020;30:392–404.

    Article  PubMed  Google Scholar 

  9. Chisini LA, Collares K, Cademartori MG, de Oliveira LJC, Conde MCM, Demarco FF, et al. Restorations in primary teeth: a systematic review on survival and reasons for failures. Int J Paediatr Dent. 2018;28:123–39.

    Article  PubMed  Google Scholar 

  10. Ruengrungsom C, Palamara JEA, Burrow MF. Comparison of ART and conventional techniques on clinical performance of glass-ionomer cement restorations in load bearing areas of permanent and primary dentitions: A systematic review. J Dent. 2018;78:1–21.

    Article  CAS  PubMed  Google Scholar 

  11. Ruiz LF, Nicoloso GF, Franzon R, Lenzi TL, de Araujo FB, Casagrande L. Repair increases the survival of failed primary teeth restorations in high-caries risk children: a university-based retrospective study. Clin Oral Investig. 2020;24:71–7.

    Article  PubMed  Google Scholar 

  12. Kemoli AM. Dilemma of managing multi-surface dental caries in the primary dentition using the atraumatic restorative treatment: renaissance or dimming hope. East Afr Med J. 2012;89:224–9.

    CAS  PubMed  Google Scholar 

  13. Opdam NJ, van de Sande FH, Bronkhorst E, Cenci MS, Bottenberg P, Pallesen U, et al. Longevity of posterior composite restorations: a systematic review and meta-analysis. J Dent Res. 2014;93:943–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Cho V, King N, Anthonappa R. Presence of Interproximal Carious Lesions in Primary Molars. Pediatr Dent. 2021;43:28–33.

    PubMed  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. Chen K, Lei Q, Xiong H, Chen Y, Luo W, Liang Y. A 2-year clinical evaluation of stainless steel crowns and composite resin restorations in primary molars under general anaesthesia in China’s Guangdong province. Br Dent J. 2018;225:49–52.

    Article  CAS  PubMed  Google Scholar 

  17. Azadani EN, Peng J, Kumar A, Casamassimo PS, Griffen A, Amini H, Ni A. A survival analysis of primary second molars in children treated under general anesthesia. J Am Dent Assoc. 2020;151:568–75.

    Article  PubMed  Google Scholar 

  18. Innes N, Evans D, Stewart M, Keightley A. The Hall Technique a minimal intervention, child centred approach to managing the carious primary molar. A Users Manual. Version 4. Dundee: University of Dundee; 2015.

  19. Santamaría R, Innes N. Sealing Carious Tissue in Primary Teeth Using Crowns: The Hall Technique. Monogr Oral Sci. 2018;27:113–23.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Al-Yaseen W, Seifo N, Bhatia S, Innes N. When Less is More: Minimally Invasive, Evidence-Based Treatments for Dentine Caries in Primary Teeth - The Hall Technique and Silver Diamine Fluoride. Prim Dent J. 2021;10:33–42.

    Article  PubMed  Google Scholar 

  22. Innes NP, Ricketts D, Chong LY, Keightley AJ, Lamont T, Santamaria RM. Preformed crowns for decayed primary molar teeth. Cochrane Database Syst Rev. 2015;2015:CD005512.

    PubMed  PubMed Central  Google Scholar 

  23. Tedesco TK, Gimenez T, Floriano I, Montagner AF, Camargo LB, Calvo AFB, et al. Scientific evidence for the management of dentin caries lesions in pediatric dentistry: A systematic review and network meta-analysis. PLoS One. 2018;13:e0206296.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Badar SB, Tabassum S, Khan FR, Ghafoor R. Effectiveness of Hall Technique for Primary Carious Molars: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent. 2019;12:445–52.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Tedesco TK, Reis TM, Mello-Moura ACV, Silva GSD, Scarpini S, Floriano I, et al. Management of deep caries lesions with or without pulp involvement in primary teeth: a systematic review and network meta-analysis. Braz Oral Res. 2020;35:e004.

    Article  PubMed  Google Scholar 

  26. Schwendicke F, Walsh T, Lamont T, Al-Yaseen W, Bjørndal L, Clarkson JE, et al. Interventions for treating cavitated or dentine carious lesions. Cochrane Database Syst Rev. 2021;7:CD013039.

    PubMed  Google Scholar 

  27. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Raggio DP, Lopez Gallegos CJ, da Silva GS, Tedesco T, Gimenez T, et al. Preformed metal crowns placed by Hall technique for restoring primary molars have an optimal survival? - a Systematic Review and Meta-analysis protocol. OSF Preprints. 2021. Available from: https://osf.io/preprints/osf/fxvz7.

  29. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5:210.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898.

    Article  PubMed  Google Scholar 

  31. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Zhang Y, Akl EA, Schünemann HJ. Using systematic reviews in guideline development: the GRADE approach. Res Synth Methods. 2019;10:312–29.

    Article  Google Scholar 

  33. Innes N, Stewart M, Souster G, Evans D. The Hall Technique; retrospective case-note follow-up of 5-year RCT. Br Dent J. 2015;219:395–400.

    Article  CAS  PubMed  Google Scholar 

  34. Santamaría RM, Innes NPT, Machiulskiene V, Schmoeckel J, Alkilzy M, Splieth CH. Alternative Caries Management Options for Primary Molars: 2.5-Year Outcomes of a Randomised Clinical Trial. Caries Res. 2017;51:605–14.

    Article  PubMed  Google Scholar 

  35. Wang S, Gao Y, Liu Y, Zhang B. Clinical efficiency of three types repair methods on repairing large area defects of deciduous teeth. J Prev Treat Stomatol Dis. 2018;26:109–12.

    Google Scholar 

  36. Elamin F, Abdelazeem N, Salah I, Mirghani Y, Wong F. A randomized clinical trial comparing Hall vs conventional technique in placing preformed metal crowns from Sudan. PLoS One. 2019;14:e0217740.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Araujo MP, Innes NP, Bonifácio CC, Hesse D, Olegário IC, Mendes FM, et al. Atraumatic restorative treatment compared to the Hall Technique for occluso-proximal carious lesions in primary molars; 36-month follow-up of a randomised control trial in a school setting. BMC Oral Health. 2020;20:318.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Arrow P, Forrest H. Atraumatic restorative treatments reduce the need for dental general anaesthesia: a non-inferiority randomized, controlled trial. Aust Dent J. 2020;65:158–67.

    Article  CAS  PubMed  Google Scholar 

  39. Ebrahimi M, Alireza SS, Afshari E. Success and behavior during Atraumatic Restorative Treatment, the Hall Technique, and the Stainless Steel Crown Technique for primary molar teeth. Pediatr Dent. 2020;4:187–92.

    Google Scholar 

  40. Ayedun OS, Oredugba FA, Sote EO. Comparison of the treatment outcomes of the conventional stainless steel crown restorations and the hall technique in the treatment of carious primary molars. Niger J Clin Pract. 2021;24:584–94.

    Article  CAS  PubMed  Google Scholar 

  41. Boyd DH, Thomson WM, Leon de la Barra S, Fuge KN, van den Heever R, Butler BM, et al. A Primary Care Randomized Controlled Trial of Hall and Conventional Restorative Techniques. JDR Clin Trans Res. 2021;6:205–12.

    CAS  PubMed  Google Scholar 

  42. Kaptan A, Korkmaz E. Evaluation of success of stainless steel crowns placed using the hall technique in children with high caries risk: A randomized clinical trial. Niger J Clin Prac. 2021;24:425–34.

    Article  CAS  Google Scholar 

  43. Kezawie A, Almonaqel MB, Katbeh I, Kosyreva T, Alawwad M, Khasan A, et al. A comparison between hall’s technique and the conventional method of managing proximal caries in primary teeth. Int J Dent Oral Sci. 2021;8:1039–46.

    Google Scholar 

  44. Thakkar R, Jawdekar A. A randomized control trial of clinical success and acceptability of the Hall Technique and resin-modified glass ionomer cement restorations in sealing carious primary molars. JPRI. 2022;34:35–48.

    Article  Google Scholar 

  45. Salem GA, Sharaf RF, El Mansy M. Efficacy of diode laser application versus silver diamine fluoride (SDF) as a modification of Hall technique in primary teeth. Saudi Dent J. 2022;34:723–9.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Arepogu A, Nirmala S, Shaik I, Nuvvula S. Success and Acceptability of Stainless Steel Crowns placed using Hall Technique with Modifications: A Randomised Clinical Trial. J Clin Diagnostic Res. 2023;17:ZC13–18.

    Google Scholar 

  47. Oz E, Kırzıoglu Z, Kale C. The clinical success of ART restorations and Hall technique in primary molars: a randomized 18-month follow-up study. Restor Dent Endod. 2023;48:e19.

    Article  PubMed  PubMed Central  Google Scholar 

  48. 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;200:451–4.

    Article  CAS  PubMed  Google Scholar 

  49. Ludwig KH, Fontana M, Vinson LA, Platt JA, Dean JA. The success of stainless steel crowns placed with the Hall technique: a retrospective study. J Am Dent Assoc. 2014;145:1248–53.

    Article  PubMed  Google Scholar 

  50. Clark W, Geneser M, Owais A, Kanellis M, Qian F. Success rates of Hall Technique crowns in primary molars: A retrospective pilot study. Gen Dent. 2017;65:32–55.

    PubMed  Google Scholar 

  51. BaniHani A, Duggal M, Toumba J, Deery C. Outcomes of the conventional and biological treatment approaches for the management of caries in the primary dentition. Int J Paediatr Dent. 2018;28:12–22.

    Article  PubMed  Google Scholar 

  52. Boyd DH, Page LF, Thomson WM. The Hall Technique and conventional restorative treatment in New Zealand children’s primary oral health care - clinical outcomes at two years. Int J Paediatr Dent. 2018;28:180–8.

    Article  PubMed  Google Scholar 

  53. Bhatia HP, Sood S, Sharma N, Khari PM, Singh A. Evaluation of clinical effectiveness and patient acceptance of Hall Technique for managing carious primary molars: An in vivo study. Int J Clin Pediatr Dent. 2019;12:548–52.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Midani R, Splieth CH, Mustafa Ali M, Schmoeckel J, Mourad SM, Santamaria RM. Success rates of preformed metal crowns placed with the modified and standard hall technique in a paediatric dentistry setting. Int J Paediatric Dentistry. 2019;29:550–6.

    Article  Google Scholar 

  55. Robertson MD, Harris JC, Radford JR, Innes NPT. Clinical and patient-reported outcomes in children with learning disabilities treated using the Hall Technique: a cohort study. Br Dent J. 2020;228:93–7.

    Article  PubMed  Google Scholar 

  56. Binladen H, Al Halabi M, Kowash M, Al Salami A, Khamis AH, Hussein I. A 24-month retrospective study of preformed metal crowns: the Hall technique versus the conventional preparation method. Eur Arch Paediatr Dent. 2021;22:67–75.

    Article  CAS  PubMed  Google Scholar 

  57. Sapountzis F, Mahony T, Villarosa AR, George A, Yaacoub A. A retrospective study of the Hall technique for the treatment of carious primary teeth in Sydney, Australia. Clin Exp Dent Res. 2021;7:803–10.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Schwendicke F, Stolpe M, Innes N. Conventional treatment, Hall Technique or immediate pulpotomy for carious primary molars: a cost-effectiveness analysis. Int Endod J. 2016;49:817–26.

    Article  CAS  PubMed  Google Scholar 

  59. Schwendicke F, Krois J, Splieth CH, Innes N, Robertson M, Schmoeckel J, et al. Cost-effectiveness of managing cavitated primary molar caries lesions: A randomized trial in Germany. J Dent. 2018;78:40–5.

    Article  PubMed  Google Scholar 

  60. Schwendicke F, Krois J, Robertson M, Splieth C, Santamaria R, Innes N. Cost-effectiveness of the Hall Technique in a Randomized Trial. J Dent Res. 2019;98:61–7.

    Article  CAS  PubMed  Google Scholar 

  61. Araujo MP, Al-Yaseen W, Innes NP. A road map for designing and reporting clinical trials in paediatric dentistry. Int J Paediatr Dent. 2020;31:14–22.

    Article  PubMed  Google Scholar 

  62. Psaty BM, Prentice RL. Minimizing bias in randomized trials: the importance of blinding. JAMA. 2010;304:793–4.

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This study was partially supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Coordination for the Improvement of Higher Education Personnel) (CAPES). Conselho Nacional de Desenvolvimento Científico e Tecnológico (National Council for Scientific and Technological Development) (CNPq) provides scholarship awards for research productivity in Brazil to Dr. Braga, and Dr. Raggio. The funders had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; or decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Department of Orthodontics and Paediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil

    Tamara Kerber Tedesco, Claudia Lopez Gallegos, Gabriela Seabra Silva, Thais Gimenez, Mariana Minatel Braga & Daniela Prócida Raggio

  2. School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Heath Park, Cardiff, UK

    Nicola Patricia Innes & Waraf Al-yaseen

  3. FDI, Geneva, Switzerland

    Mariana Pinheiro Araujo

  4. Department of Pediatric Dentistry, Virginia Commonwealth University School of Dentistry, Richmond, VA, USA

    Jayakumar Jayaraman

Authors
  1. Tamara Kerber Tedesco
    View author publications

    Search author on:PubMed Google Scholar

  2. Nicola Patricia Innes
    View author publications

    Search author on:PubMed Google Scholar

  3. Claudia Lopez Gallegos
    View author publications

    Search author on:PubMed Google Scholar

  4. Gabriela Seabra Silva
    View author publications

    Search author on:PubMed Google Scholar

  5. Thais Gimenez
    View author publications

    Search author on:PubMed Google Scholar

  6. Mariana Minatel Braga
    View author publications

    Search author on:PubMed Google Scholar

  7. Mariana Pinheiro Araujo
    View author publications

    Search author on:PubMed Google Scholar

  8. Jayakumar Jayaraman
    View author publications

    Search author on:PubMed Google Scholar

  9. Waraf Al-yaseen
    View author publications

    Search author on:PubMed Google Scholar

  10. Daniela Prócida Raggio
    View author publications

    Search author on:PubMed Google Scholar

Contributions

DPR, TKT and NPI were involved in conception and design of the study. DPR, CLG and GSS were involved in data acquisition. TKT, NPI, TG, MMB, MPA and DPR were involved in data analysis and interpretation. TKT, NPI, WA and DPR drafted the manuscript. TKT, NPI, CLG, GSS, TG, MMB, MPA, JJ, WA and DPR revised and gave final approval of the manuscript.

Corresponding author

Correspondence to Daniela Prócida Raggio.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tedesco, T.K., Innes, N.P., Gallegos, C.L. et al. Success rate of Hall Technique for restoring carious primary molars - systematic review and meta-analysis. Evid Based Dent 26, 65–66 (2025). https://doi.org/10.1038/s41432-024-01044-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41432-024-01044-0

This article is cited by

Search

Advanced search

Quick links