Hall Technique outperforms silver fluoride

Dental Tribune International

Fri. 30. October 2026

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KAYSERI, Turkey: Although the Hall technique is highly effective in managing dentine caries in primary molars, silver fluoride offers the prospect of a simpler, less resource-intensive alternative. A recent 18-month randomised split-mouth clinical trial compared both alongside conventional restorations, assessing clinical and radiographic success, treatment duration and the patient experience. The findings raise questions about the reliability of the silver fluoride protocol as a longer-term treatment, despite its practical advantages.

In the single-centre trial, the researchers evaluated 165 primary molars in 55 children aged 4–8 years. Each child had three molars with active Class II carious lesions and radiographically confirmed proximal dentine involvement, and one molar was randomly assigned to each of the treatments. The Hall technique was performed using stainless steel crowns. The silver fluoride protocol consisted of application of an ammonia-free, water-based 38% silver fluoride solution, followed by potassium iodide and fluoride varnish at the start of the study and at six-month intervals. Conventional treatment involved complete caries removal and compomer restoration.

After 18 months, no clinical or radiographic treatment failures had occurred in the Hall technique group, and treatment success did not differ significantly from that of conventional restorations. Conventional restorations showed only minor failures, related to restoration loss or secondary caries. The silver fluoride group had significantly poorer outcomes than the Hall technique group, and most failures were classified as major, predominantly involving irreversible pulpitis or abscess formation.

Gingival index scores were significantly higher around the stainless steel crowns during follow-up, despite similar plaque index scores across the groups. Whether this difference had clinical consequences was not assessed.

The minimally invasive approaches were three times quicker to perform on average. Children reported lower pain scores with silver fluoride than with the Hall technique, but the clinical relevance of the difference was uncertain. Their behaviour during treatment was similar across groups.

The findings highlight the importance of balancing treatment success with chairside efficiency and the patient experience in children. Research is also examining whether established minimally invasive techniques can be improved for managing deep dentine caries. A 24-month randomised clinical trial investigated whether removing the outermost necrotic dentine before stainless steel crown placement would improve treatment success. The results suggest that partial caries removal might reduce the consequences of inadequate crown fit.

The study, titled “18-month outcomes of three caries management strategies in primary molars: A randomized split-mouth trial”, was published online on 12 October 2026 in BMC Oral Health, ahead of final publication.