International journal of clinical pediatric dentistry · 2026
Procedural Pain, Hall Technique Crowns and Separators: A Randomized Controlled Clinical Pilot Feasibility Study.
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Sura Simran K, Kowash Mawlood, Salami Anas, Al Halabi Manal, Khamis Amar H, Hussein Iyad
Аннотация
BACKGROUND: The Hall technique (HT) uses elastomeric orthodontic separators (EOSs) and stainless steel crowns (SSCs). Recent research highlighted that HT was reported to cause "procedural pain."
AIM: To assess bilateral HT EOSs and SSCs "procedural pain," and to evaluate the immediate effect of benzocaine 20% topical anesthesia gel (BZG) on child-perceived pain levels post-EOSs placement.
MATERIALS AND METHODS: A preregistered randomized controlled, split-mouth, single-blinded pilot feasibility trial (ClinicalTrials.gov ID NCT06272903) was conducted in children (N = 32) requiring bilateral HT-SSCs after BZG/placebo (both strawberry flavored) were flossed interdentally prebilateral EOSs placement. Immediate child/parent proxy pain scores post-EOSs placement (n = 104) and SSC (n = 64) cementation were recorded [using the Wong-Baker faces pain rating scale (WBFS)]. Statistical analysis-Wilcoxon signed-rank test. Significance level set at p < 0.05.
RESULTS: Bilateral SSCs placement resulted in low child-perceived pain compared to bilateral EOSs placement (p = 0.001). BZG significantly reduced immediate child pain perception when four EOSs (two mesial and two distal) were placed per child (p = 0.045), but this was not significant when two EOSs per child were placed. Separator load/number was related to pain; pain perception was significantly higher when two placebo EOSs were placed per tooth compared to one placebo EOS per tooth (p = 0.045).
CONCLUSION: In children receiving bilateral HT-SSCs, procedural pain was related to EOSs placement rather than HT-SSC cementation. When using four EOSs in children receiving bilateral HT-SSCs, BZG reduced immediate pain perception. This pilot feasibility study paves the way for a larger trial.
HOW TO CITE THIS ARTICLE: Sura SK, Kowash M, Salami A, et al. Procedural Pain, Hall Technique Crowns and Separators: A Randomized Controlled Clinical Pilot Feasibility Study. Int J Clin Pediatr Dent 2026;19(3):357-367.
AIM: To assess bilateral HT EOSs and SSCs "procedural pain," and to evaluate the immediate effect of benzocaine 20% topical anesthesia gel (BZG) on child-perceived pain levels post-EOSs placement.
MATERIALS AND METHODS: A preregistered randomized controlled, split-mouth, single-blinded pilot feasibility trial (ClinicalTrials.gov ID NCT06272903) was conducted in children (N = 32) requiring bilateral HT-SSCs after BZG/placebo (both strawberry flavored) were flossed interdentally prebilateral EOSs placement. Immediate child/parent proxy pain scores post-EOSs placement (n = 104) and SSC (n = 64) cementation were recorded [using the Wong-Baker faces pain rating scale (WBFS)]. Statistical analysis-Wilcoxon signed-rank test. Significance level set at p < 0.05.
RESULTS: Bilateral SSCs placement resulted in low child-perceived pain compared to bilateral EOSs placement (p = 0.001). BZG significantly reduced immediate child pain perception when four EOSs (two mesial and two distal) were placed per child (p = 0.045), but this was not significant when two EOSs per child were placed. Separator load/number was related to pain; pain perception was significantly higher when two placebo EOSs were placed per tooth compared to one placebo EOS per tooth (p = 0.045).
CONCLUSION: In children receiving bilateral HT-SSCs, procedural pain was related to EOSs placement rather than HT-SSC cementation. When using four EOSs in children receiving bilateral HT-SSCs, BZG reduced immediate pain perception. This pilot feasibility study paves the way for a larger trial.
HOW TO CITE THIS ARTICLE: Sura SK, Kowash M, Salami A, et al. Procedural Pain, Hall Technique Crowns and Separators: A Randomized Controlled Clinical Pilot Feasibility Study. Int J Clin Pediatr Dent 2026;19(3):357-367.