The Hall Technique 10 years on: Questions and answers

Key Points

  • Discusses the development and acceptance of the Hall Technique.

  • Provides information on where to find out more about the Hall Technique.

  • Reports an overview of high quality evidence from randomised control trials supporting use of the Hall Technique in day to day practice.


It is ten years since the first paper on the Hall Technique was published in the British Dental Journal and almost 20 years since the technique first came to notice. Dr Norna Hall a (now retired) general dental practitioner from the north of Scotland had, for many years, been managing carious primary molar teeth by cementing preformed metal crowns over them, with no local anaesthesia, tooth preparation or carious tissue removal. This first report, a retrospective analysis of Dr Hall's treatments, caused controversy. How could simply sealing a carious lesion, with all the associated bacteria and decayed tissues, possibly be clinically successful? Since then, growing understanding that caries is essentially a biofilm driven disease rather than an infectious disease, explains why the Hall Technique, and other 'sealing in' carious lesion techniques, are successful. The intervening ten years has seen robust evidence from several randomised control trials that are either completed or underway. These have found the Hall Technique superior to comparator treatments, with success rates (no pain or infection) of 99% (UK study) and 100% (Germany) at one year, 98% and 93% over two years (UK and Germany) and 97% over five years (UK). The Hall Technique is now regarded as one of several biological management options for carious lesions in primary molars. This paper covers commonly asked questions about the Hall Technique and speculates on what lies ahead.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Figure 1: Series of three photographs showing a crown being fitted to tooth 84 (lower right 1st primary molar).
Figure 2: Radiograph of a 5-year-old child showing tooth 85 (lower right 2nd primary molar) with a mesial carious lesion and tooth 84 (lower right 1st primary molar) with a distal carious lesion extending into dentine.
Figure 3: The same child as Fig. 1.


  1. 1

    Information Services Scotland. Dental Statistics – NHS Registration and Participation. 2016.

  2. 2

    Tran L A, Messer L B . Clinicians' choices of restorative materials for children. Aust Dent J 2003; 48: 221–232.

    Article  Google Scholar 

  3. 3

    Innes N P, Evans D J, Stirrups D R . 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  Google Scholar 

  4. 4

    Innes N P, Stirrups D R, Evans D J, 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: 451–454.

    Article  Google Scholar 

  5. 5

    Martin M, Marsh P . Oral microbiology. Edinburgh: Edinburgh: Elsevier, 2009.

    Google Scholar 

  6. 6

    Takahashi N, Nyvad B . The role of bacteria in the caries process: Ecological perspectives. J Dent Res 2011; 90: 294–303.

    Article  Google Scholar 

  7. 7

    Marsh P D . Dental plaque as a biofilm and a microbial community Implications for health and disease. BMC Oral Health 2006; 6 (Suppl 1): S14.

    Article  Google Scholar 

  8. 8

    Fejerskov O, Nyvad B, Kidd E A M . Dental caries: the disease and its clinical management. Chichester Ames, Iowa: John Wiley & Sons Inc., 2015.

    Google Scholar 

  9. 9

    Innes N P, Ricketts D, Chong L Y, Keightley A J, Lamont T, Santamaria R M . Preformed crowns for decayed primary molar teeth. Cochrane Database Syst Rev 2015; 12: CD005512.

    Google Scholar 

  10. 10

    Randall RC . Preformed metal crowns for primary and permanent molar teeth: Review of the literature. Pediatr Dent 2002; 24: 489–500.

    Google Scholar 

  11. 11

    Innes N P, Evans D J, Stirrups D R . Sealing caries in primary molars: randomized control trial, 5-year results. J Dent Res 2011; 90: 1405–1410.

    Article  Google Scholar 

  12. 12

    Hesse D, de Araujo M P, Olegário I C, Innes N, Raggio D P, Bonifácio C C . Atraumatic restorative treatment compared to the Hall Technique for occluso-proximal cavities in primary molars: study protocol for a randomized controlled trial. Trials 2016; 17: 169.

    Article  Google Scholar 

  13. 13

    Santamaria R M, Innes N P T, Machiulskiene V, Evans D J P, Splieth C H . Caries management strategies for primary molars: 1yr randomized control trial results. J Dent Res 2014; 93: 1062–1069.

    Article  Google Scholar 

  14. 14

    Narbutaite J, Maciulskiene V, Splieth C H, Innes N P T, Santamaria R M . Acceptability of three different caries treatment methods for primary molars among Lithuanian children. 12th Congress of the European Academy of Paediatric Dentistry 'A passion for Paediatric Dentistry' 5th-8th June 2014; p. 68. Sopot, Poland. 2014.

  15. 15

    Maciel R, Salvador D, Azoubel K, van Amerongen E, Colares V . Restoration in Primary Molars – A Longitudinal Intervention Study. J Dent Res 2017; accepted for presentation at IADR 95th General Session(accepted for presentation Abstract no 2607651).

  16. 16

    Tonmukayakul U, Martin R, Clark R et al. Protocol for the Hall Technique study: A trial to measure clinical effectiveness and cost-effectiveness of stainless steel crowns for dental caries restoration in primary molars in young children. Contemp Clin Trials 2015; 44: 36–41.

    Article  Google Scholar 

  17. 17

    Innes N P T, Ricketts D, Chong L Y, Keightley A J, Lamont T, Santamaria R M . Preformed crowns for decayed primary molar teeth. Cochrane Database Syst Rev 2015; 10.1002/14651858.CD005512.pub3.

  18. 18

    Al-Yaseen W, Evans D J, Innes N P . How deep is too deep? A retrospective study of the relationship between radiographic caries lesion depth and successful outcomes with the Hall Technique. IAPD. 2015; Glasgow UK.

  19. 19

    Ludwig K H, Fontana M, Vinson L A, Platt J A, Dean J A . The success of stainless steel crowns placed with the Hall technique. J Am Dent Assoc 2014; 145: 1248–1253.

    Article  Google Scholar 

  20. 20

    Clark W D, Geneser M K, Owais A I, Kanellis M J, Qian F . Success Rates of Hall Technique Crowns in Primary Molars: A Retrospective Pilot Study. J Dent Res 2016; 93: 1430.

    Google Scholar 

  21. 21

    Santamaria R M, Innes N P, Machiulskiene V, Evans D J, Alkilzy M, Splieth C H . Acceptability of different caries management methods for primary molars in a RCT. Int J Paediatr Dent 2015; 25: 9–17.

    Article  Google Scholar 

  22. 22

    Maciel R, Salvador D, Azoubel K, da Franca C, van Amerongen E, Colares V . The opinion of children and their parents about four different types of dental restorations in a public health service in Brazil. Eur Arch Paediatr Dent 2017; In press.

  23. 23

    Bell S J, Morgan A G, Marshman Z, Rodd H D . Child and parental acceptance of preformed metal crowns. Euro Arch Paediatr Dentistry 2010; 11: 218–224.

    Article  Google Scholar 

  24. 24

    Foster Page LA, Boyd DH, Davidson SE, McKay SK, Thomson WM, Innes NPT . Acceptability of the Hall Technique in New Zealand. New Zealand Dent J. March 2014, 12-17.

  25. 25

    van der Zee V, van Amerongen W E . Short communication: Influence of preformed metal crowns (Hall technique) on the occlusal vertical dimension in the primary dentition. Eur Arch Paediatr Dent 2010; 11: 225–227.

    Article  Google Scholar 

  26. 26

    So D, Evans D J, Borrie F et al. Measurement of Occlusal Equilibration Following Hall Crown Placement A Pilot Study. J Dent Res 2015; 94 (Spec Iss A. Abstract no 0080).

  27. 27

    Elouafkaoui P, Bonetti D, Clarkson J, Stirling D, Young L, Cassie H . Is further intervention required to translate caries prevention and management recommendations into practice? Br Dent J 2015; 218: E1.

    Article  Google Scholar 

  28. 28

    Innes N P T, Frencken J E, Schwendicke F . Don't Know, Can't Do, Won't Change: Barriers to Moving Knowledge to Action in Managing the Carious Lesion. J Dent Res 2016; 95: 485–486.

    Article  Google Scholar 

  29. 29

    Croll T P, Killian C M, Simonsen R J . The Hall Technique: Serious Questions Remain. A hard look at the evidence base raises critical concerns. Ins Dent 2015; 11.

  30. 30

    Casamassimo P S, Seale N S . Adequacy of patient pools to support predoctoral students' achievement of competence in pediatric dentistry in U S. Dental Schools. J Dent Educ 2015; 79: 644–652.

    PubMed  Google Scholar 

  31. 31

    McKnight-Hanes C, Myers D R, Dushku J C, Barenie J T . A comparison of general dentists' and pediatric dentists' treatment recommendations for primary teeth. Pediatr Dent 1991; 13: 344–348.

    PubMed  Google Scholar 

  32. 32

    Hickel R, Kaaden C, Paschos E, Buerkle V, García-Godoy F, Manhart J . Longevity of occlusally-stressed restorations in posterior primary teeth. Am J Dent 2005; 18: 198–211.

    PubMed  Google Scholar 

  33. 33

    Randall R C, Vrijhoef M M A, Wilson N H F . Efficacy of preformed metal crowns vs. amalgam restorations in primary molars: A systematic review. J Am Dent Assoc 2000; 131: 337–343.

    Article  Google Scholar 

  34. 34

    Bagramian R A, Garcia-Godoy F, Volpe A R . The global increase in dental caries. A pending public health crisis. Am J Dent 2009; 22: 3–8.

    PubMed  PubMed Central  Google Scholar 

  35. 35

    Schwendicke F, Stolpe M, Innes N . Conventional treatment, Hall Technique or immediate pulpotomy for carious primary molars: A cost-effectiveness analysis. Int Endodont J 2015.

  36. 36

    Frencken J E . The stateofthe-art of ART restorations. Dent Update 2014; 41: 218–224.

    Article  Google Scholar 

  37. 37

    Berg J . Second opinion: The stainless-steel crown for primary molars overuse? No, I say underuse. Dentaltown Magazine 2013.

Download references

Author information



Corresponding author

Correspondence to N. P. T. Innes.

Additional information

Refereed Paper

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Innes, N., Evans, D., Bonifacio, C. et al. The Hall Technique 10 years on: Questions and answers. Br Dent J 222, 478–483 (2017).

Download citation

Further reading