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References

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Early extraction of first permanent molars: applying the evidence

From Volume 49, Issue 7, July 2022 | Pages 562-566

Authors

Ian Murphy

BDS, MFDS(RCS Ed), MClinDent, MOrth (RCS Eng)

Orthodontic Specialist Registrar, Eastman Dental Hospital

Articles by Ian Murphy

Email Ian Murphy

Joseph H Noar

BDS, MSc, FDS RCSEd, FDS RCSEng, DOrth RCSEng, MOrth RCSEng, FHEA

Consultant/Hon Senior Lecturer, Orthodontic Unit, Division of Craniofacial and Development Sciences, Eastman Dental Hospital/Institute, 256 Gray's Inn Road, London WC1X 8LD, UK

Articles by Joseph H Noar

Abstract

First permanent molars (FPM) are often of poor prognosis due to caries or molar incisor hypomineralization. If extraction can be planned then FPM may be extracted at a suitable time to allow spontaneous space closure from the second molar, or retained for the space to be used for orthodontics in the future. There are several evidence based patient and dental factors to consider in planning these cases. This paper illustrates these factors through a case series.

CPD/Clinical Relevance: Ideally, poor prognosis 6s would be managed by a paediatric dentist and an orthodontist. However, where these services are not available, the general dentist should be aware of factors influencing treatment.

Article

First permanent molars (FPM) of poor prognosis present a restorative and orthodontic challenge. If the child is not in pain and the removal of the tooth can be planned, then there is the opportunity to extract the FPM at a time to maximize spontaneous space closure by the second permanent molar (SPM) or for it to be retained to provide space for orthodontic treatment in the future.

The following factors, however, must be considered:

The aim of this article is to illustrate the factors through clinical cases, demonstrating ideal and complex cases as well as less favourable outcomes.

This patient presented aged 9.5 years with a Class I incisor relationship, slightly spaced upper and lower arches and MIH affecting all four FPMs (Figure 1). As there was enough space to accommodate all the teeth and the FPMs had a poor long-term prognosis, Case 1 was planned for early extraction of all four FPMs to allow spontaneous space closure from the second molars.

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