Orthodontic space management in first molar missing or unusual extraction patients

Abstract

This article aimed to describe the various clinical considerations when opening or closing first molar spaces caused by missing or extracted first molars. Orthodontic patients sometimes need unusual first molar extraction or have some missing first molars. Orthodontic treatment can manage those spaces in one of two ways: prosthetic treatment preceded by regaining orthodontic space by uprighting the adjacent teeth or orthodontic space closure without additional prostheses. To determine whether to close or open the first molar missing or extracted spaces, various factors, including adjacent periodontal status, maxillary sinus pneumatization, gingival invagination, different malocclusions, and cephalometric variables and facial treatment objectives, should be considered. The first molar missing or unusual extraction spaces should be managed with careful consideration and proper orthodontic mechanics to maximize the benefits of treatment and minimize potential risks. The chances of extraction of problematic molar vs sound premolar and molar extraction space closure with missing spaces, rather than opening spaces, increase with the development of orthodontic mechanics. Therefore, it is essential to understand the factors that determine the prognosis.