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Procedural Pain, Hall Technique Crowns and Separators: A Randomized Controlled Clinical Pilot Feasibility Study.

Simran K Sura1, Mawlood Kowash1, Anas Salami1

  • 1Department of Pediatric Dentistry, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.

International Journal of Clinical Pediatric Dentistry
|June 24, 2026
PubMed
Summary

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The Hall technique (HT) for stainless steel crowns (SSCs) causes procedural pain primarily from elastomeric orthodontic separators (EOSs). Benzocaine topical anesthetic gel (BZG) effectively reduced pain when four EOSs were used in children.

Area of Science:

  • Pediatric Dentistry
  • Orthodontics
  • Pain Management

Background:

  • The Hall Technique (HT) for stainless steel crowns (SSCs) involves elastomeric orthodontic separators (EOSs).
  • Recent studies indicate that HT procedures can cause significant procedural pain.

Purpose of the Study:

  • To evaluate procedural pain associated with bilateral HT EOSs and SSCs.
  • To assess the efficacy of benzocaine 20% topical anesthetic gel (BZG) in mitigating child-perceived pain after EOSs placement.

Main Methods:

  • A randomized controlled, split-mouth, single-blinded pilot feasibility trial was conducted.
  • Children received BZG or placebo before EOSs placement, with pain assessed using the Wong-Baker FACES Pain Rating Scale (WBFS).
  • Pain scores were recorded post-EOSs placement and SSC cementation.
Keywords:
CariesCrownsHall techniquePainSeparators

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Main Results:

  • Bilateral SSC placement caused less pain than bilateral EOSs placement (p=0.001).
  • BZG significantly reduced pain when four EOSs were placed per child (p=0.045), but not with two EOSs.
  • Higher numbers of EOSs per tooth correlated with increased pain perception.

Conclusions:

  • Procedural pain in HT-SSCs is mainly linked to EOSs placement, not SSC cementation.
  • BZG demonstrates effectiveness in reducing immediate pain perception when multiple EOSs are used.
  • Findings support further investigation in a larger clinical trial.