Extraction Of First Permanent Molars Research Articles

The history of treatment planning the extraction of the first permanent molar in the UK.

This paper researches the history of treatment planning for extraction of the first permanent molars and the early influence of American orthodontists on dental practice in the UK. It also discusses the development of clinical guidelines for the enforced extraction of first permanent molars to the present day.

Timing for extraction of permanent first molars in school aged children: a pilot study.

Extraction of permanent first molars (P1Ms) could create gaps, tipping and/or rotating of neighboring teeth, which depend on the extraction timing. This study evaluated the outcomes of P1Ms extraction in children who were classified based on their permanent second molar's (P2Ms) dental calcification at the time of extraction. In this retrospective study, the evaluations were made for 406 panoramic radiographs (PRs) of children aged 7-14 years who had single P1M extracted. Twenty-nine children having pre- and post-treatment PRs were selected based on the inclusion criteria. First, 2 groups were formed based on the extraction time by using the pre-treatment PRs; Early extraction group (EE) (n = 15) including Nolla Grades 5-6-7, and late extraction group (LE) (n = 14) including Nolla Grades 8-9-10 for P2Ms. Then, the inclination degrees of neighbouring teeth on extraction side and contralateral quadrant (non-extraction) side were measured by using the post-extraction PRs. Mann-Whitney U test was employed, and the statistical significance was set at p < 0.05. The mesial tipping tendency of P2M was significant towards the extraction side both at EE or LE calcification grades of P2Ms (p > 0.05). The mesial inclination degrees of maxillary P2Ms showed no statistically significant difference between the two sides of LE group. The ideal extraction time should be determined according to the dental age to plan an appropriate occlusal maintenance.

Investigation of the causes and pattern of early first permanent molar extraction in children in the western Mediterranean region of Türkiye

Aim: This study aims to investigate the causes and pattern of extraction of first permanent molars (FPMs) in children aged 6-15 years in the western Mediterranean region of Türkiye. Methods: The data from the patients who applied to Department of Pediatric Dentistry, Faculty of Dentistry, Akdeniz University, between the years 2016–2020, were scanned; patients, who had at least one FPM extracted between the ages of 6–15, and who had pre-extraction panoramic radiographs were selected. Information about age, gender, reason for extraction, extracted tooth, and previous treatment status of a total of 562 patients (263 males and 299 females) were recorded. The data were statistically analyzed using chi-square tests. Results: The mean age was 11.87±1.89, and there was no difference between female and male patients (p=0.828). 727 FPMs were evaluated, and the main reason for extraction was detected to be “Excessive substance loss” (55.8%) for both genders in all age groups. The 2nd, 3rd, 4th, and 5th reasons were early FPM extraction, infection, parents’ request, and others respectively. The total number of extracted teeth of female patients was higher (53.6%) than that of males (46.4%) but there was no significant difference. It was observed that mandibular teeth were more frequently extracted than maxillary ones. Most children (75.8%) had one tooth extracted, 19.9% had two teeth, and 3.3% had three teeth. It was determined that the FPMs were not previously treated in the majority of children (90.7%). Conclusions: The most important finding from this study is that most of the extracted FPMs have not been treated previously. This indicates that individuals in our society do not have enough information about and are late in accessing oral health services. Therefore, further steps should be taken to improve public oral health. Keywords: Child; First Permanent Molar; Tooth Extraction

Frequency and causes of extraction of first permanent molar tooth in patients presented to a teaching hospital, Multan.

Objective: To know the frequency and causes of extraction of first permanent molar tooth in patients presented to a teaching hospital, Multan. Study Design: Retrospective Cross Sectional Descriptive study. Setting: Dental Outdoor Department of Ibn-e-siena Hospital. Period: July 2019 to September 2021. Material &amp; Methods: Patients between the age of 5 years to 15 years, Age, gender, fate of the first permanent molar and the cause of decay of first permanent molar were recorded. Results: Out of 4200 patients 490 patients have decayed first permanent molar. Majority of the children were below 10 years with mean age was 8.6±05. Caries was the most frequent cause of decay. Conclusion: It can be concluded from the study that rate of extraction of first permanent molar is quite high and it is mostly due to caries and periodontal disease. It is mostly in children below ten years of age and has almost equal gender distribution.

Early extraction of first permanent molars: applying the evidence

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.

Early extraction of the first permanent molars: a five-year follow-up study.

Early extraction of first permanent molars (FPMs) is generally considered successful when the second permanent molar and premolar come into contact, regardless of whether the patient has a healthy occlusion. In this study, we aimed to investigate cases in which early extraction had a successful prognosis. Study design: Pre-extraction orthopantomograms of children whose one or more FPMs were extracted were examined retrospectively. Post-extraction parameters such as status of the extraction gap, any other diastema formation, and midline shift were evaluated clinically and radiographically. For the dental age estimations, development levels of the teeth were scored using the Demirjian method and the developmental status of a particular tooth was calculated in years based on tables given by Willems et al. [2001]. The ICON index was used to determine the orthodontic treatment needs of patients. Descriptive analyses and the Kruskal-Wallis test were used for the statistical analysis of the data. Early extraction of FPM should be considered successful when there is no formation of any other diastema in the relevant quadrant, midline shift, or orthodontic treatment needs due to extraction.

Knowledge, Attitude and Clinical Practice of Dentists about Extraction of First Permanent Molars

The extraction of permanent first molar (PFM) teeth with poor prognosis allows the build of a new-and-ideal occlusion with the spontaneous movement of the healthy second and third molars by taking advantage of the patient's development. This study aimed to evaluate dentists' knowledge level about controlled tooth extractions and determine their information needs. The survey, consisting of 9 questions about balance and compensation extractions, was prepared on Google Forms and sent via email to dentists. The questionnaire was sent to 3137 dentists and 472 (15.04%) of them answered. While deciding on PFM extraction, the rate of those who checked the presence of permanent 3rd molar tooth was found to be 64.4%. Although 79% of pedodontists stated that they knew about balance extractions, only 60.9% of them apply it in the clinic. After maxillary PFM extraction, the rate of oral and maxillofacial surgeons who think that "mandibular PFM over-erupt" was 92.8%, and the rate of orthodontists was 68.7%. 87.1% of the participants stated that they needed more information about controlled extractions. It is possible to raise awareness, encourage the common and follow-up of correct clinical practices, and avoid complications; by adding controlled extractions to the undergraduate education program.

Extraction of first permanent molars severely affected by molar incisor hypomineralisation: a retrospective audit

AimThe aim of this study was to evaluate possible spontaneous space closure after extraction of first permanent molars in children and their eventual need for orthodontic treatment.MethodsTwenty-seven children with at least one first permanent molar planned for extraction were enrolled in the study. The children were referred to the Department of Paediatric Dentistry, University of Oslo, between 2009 and 2017. All extracted teeth were severely affected by Molar Incisor Hypomineralisation and/or caries. The children and their parents had consented to extraction and follow-up. Data were analysed with SPSS 26.ResultsThe age of the children was between 5.5 and 12.1 years (mean 8.7) at extraction. The mean follow-up time was 3.2 years (range 1.1–6.3). Sixteen children (59.3%) had all four molars extracted, five (18.5%) had three, five had two and one had one molar extracted. In the maxilla, the second permanent molar had erupted in the place of the first molar in all the children, and none of them needed orthodontic space closure. In the mandible, eight children (29.6%) needed orthodontic treatment to close the spaces after extraction. In three children, the second molar was not yet erupted and treatment need was not settled.ConclusionExtraction of severely affected first permanent molars before the eruption of the second molar is a treatment option causing little additional treatment in the majority of cases.

Does molar-incisor hypomineralization (MIH) affect only permanent first molars and incisors? New observations on permanent second molars.

The second permanent molar plays an important role when considering extraction of first permanent molars severely affected by molar-incisor hypomineralization (MIH). To assess the association between MIH and enamel hypomineralization of the second permanent molars in terms of presence and severity. In this retrospective cross-sectional study, permanent teeth were evaluated in 453 patients between the ages of 13 and 16 at a dental clinic, using intraoral photographs. A calibrated examiner classified enamel hypomineralization using the MIH index and dental caries experience using the DMFT and DMFS indices. Statistical analyses were performed using a linear generalized model and ordinal logistic regression. The most commonly affected teeth by enamel hypomineralization were permanent molars, whereas incisors, premolars, and canines were less affected. The presence of severe defects in the first permanent molars was associated with mild defects in the second permanent molars (OR=4.01; 95% CI: 2.50-7.77). Enamel hypomineralization was associated with increased caries experience (PR=5.54; 95% CI: 3.81-9.06). Enamel hypomineralization mainly affects the first and second permanent molars. Mild defects in the second permanent molars tend to be more frequent in patients with severe MIH in the first permanent molars. The presence of enamel hypomineralization was associated with higher dental caries experience.

Orthodontic treatment after extraction of non-restorable first permanent molars in early permanent dentition: A case report

Background: The first permanent molar (FPM) is the most caries prone tooth in the permanent dentition. Sometimes early extraction of badly decayed first permanent molars must be considered because of their poor long-term prognosis. This is a complex problem, and there is no consensus in the literature for the treatment management of these children. That is why the pediatric dentist and the orthodontist must work as a team and consider many factors before determining the appropriate treatment method. Case Report: The aim of this clinical report is to present a complex interdisciplinary treatment approach for an 11-year-old girl with history of early childhood caries and multiple restorations on her permanent upper front teeth and 4 non-restorable first permanent molars. Conclusion: The compromised teeth were extracted and new stable positions of the second permanent molars were achieved. The future eruption of the third molars will allow this patient to have fully functional dentition with 28 teeth. Clinical significance: This case illustrates that extraction of all 4 FPM and a careful planed orthodontic treatment can be beneficial to the oral health of young patients if it is done well. Extraction of first permanent molars at a young age is a difficult decision. Therefore, it is recommended that a team of pediatric dentist and an orthodontist plan the treatment together as soon as possible after detection of a compromised FPM. Keywords: Extraction, First permanent molars, Interdisciplinary treatment, Orthodontic treatment.

Adherence to RCS recommendations for extraction of first permanent molars in a teaching hospital: To compensate or not to compensate?

To observe whether paediatric dentists and orthodontists balance and compensate the extraction of first permanent molars (FPMs) in children aged 7-11 years. Service evaluation. UK dental teaching hospital. Retrospective analysis of FPM extraction patterns in patients aged 7-11 years that attended for extraction of FPMs from 1 January 2019 to 31 January 2020 (13-month period). A total of 194 patients were included and they collectively had 435 FPMs extracted. No balancing extractions to prevent dental centreline shifts and no lower FPM compensatory extractions were performed. Compensatory extraction of good prognosis upper FPMs were performed in 64% (94/146) of cases to avoid overeruption. Orthodontic input was sought for poor prognosis lower FPMs in 76% of cases compared to 51% for poor prognosis upper FPMs. Compensatory extraction of good prognosis upper FPMs to avoid overeruption appears to be a common practice at Guy's and St Thomas' Hospitals. There was also higher demand for orthodontic advice for cases presenting with poor prognosis lower FPMs compared to poor prognosis upper FPMs, which suggests that paediatric dentists may prefer for the final decision on upper FPM compensatory extractions to be made by an orthodontist, even with national guidelines available. More high-quality research on the topic is required to determine the necessity of this practice for achieving optimal long-term oral health in children.

Spontaneous space closure following the extraction of the first permanent mandibular molar.

The aim of this study was to determine the prognostic factors, such as the developmental stage of second permanent molar (SPM), the angulation of SPM, and presence/absence of the third molar associated with the spontaneous space closure after the mandibular first permanent molars (FPM) extraction. A total of 177 mandibular SPMs were evaluated in this cross-sectional study. The prognostic factors determining successful space closure such as SPM developmental stage, SPM angulation, and presence/absence of the third molar were evaluated. The mean age of the patients at the time of extraction of SPM was 9.4 years and post-extraction assessment at the time of the study was 12.7 years. Of the total 177 mandibular SPMs, 36 SPMs (20.3%) were at Demirjian stage D, 63 (35.6%) at stage E, 60 (34%) at stage F, 18 (10.1%) at stage G. 18 SPMs (10.1%) had distal angulation, 23 SPMs (13.0%) had mesial angulation and 136 SPMs (76.9%) had upright angulation. At the time of radiographic assessment, 79.1% of the mandibular quadrants showed evidence of third molar formation. Of the 177 mandibular SPMs, 93 (52.5%) exhibited successful space closure in the mandibular arch. There is no statistical significance between the chronological age and the developmental stage of the mandibular SPM with regard to the successful spontaneous space closure at the time of the dental extraction of FPMs. The presence of the mandibular third molar may be a consideration for spontaneous space closure in the mandibular arch.

Consequences of early extraction of compromised first permanent molar: a systematic review

BackgroundThe aim of this study was to systematically review the literature to determine the sequelae of early extraction of compromised first permanent molars (FPMs) with regard to the skeletal and dental development of 5- to 15-year-old children. Meta-analysis was conducted when applicable.MethodsOur research protocol included a search strategy, inclusion/exclusion criteria, and a data extraction plan. The search engines used were PubMed, Scopus, and Science Direct. Study selection was performed independently by three reviewers. Articles published from 1960 to 2017 were reviewed based on inclusion and exclusion criteria. Meta-analysis was performed to compare space closure between upper and lower arches.ResultsEleven studies fulfilled the inclusion criteria. The consequences were decrease in post extraction space, accelerated development and eruption of second permanents molars (SPMs) and third molars, a decrease in caries and/or fillings on the proximal surfaces of adjacent teeth, lingual tipping and retrusion of incisors, and counter clockwise rotation of the occlusal plane.ConclusionThere were several consequences of early extraction of FPMs, which were related to skeletal and dental development. Our systematic review suggests that comprehensive evaluation of the compromised FPMs should be performed before planning an extraction. The ideal time for FPM extraction is when the SPM is at the early bifurcation stage in order to achieve complete closure of the extraction space by the SPM. Benefits should be weighed over the risks to decrease the risk of unfavorable outcomes as much as possible. However, due to the limited evidence on the outcomes and variables that influence them, high-quality prospective studies are needed.

Radiographic prognostic factors determining spontaneous space closure after loss of the permanent first molar.

Permanent first molars (PFM) with a poor prognosisare routinely extracted in children throughout the United Kingdom. National guidelines suggest that to achieve spontaneous closure for the mandibular arch, the PFM should be extracted at 8 to 10years of age, during bifurcation formation of the secondmolar. The literature is of limited quality and has suggested alternative variables that may be associated with successful space closure. Our aim was to investigate the radiographic prognostic factors associated with space closure after extraction of PFM. Two objectives of the research are reported in this article: to determine factors that might predict space closure of the secondmolar after extraction of the PFM, and to develop a tool kit to aid clinical decision making. We assessed 148 maxillary and 153 mandibular PFM extracted from 81 participants retrospectively. Dental age, secondmolardevelopmental stage, second premolar and secondmolar angulations, and presence or absence of the third molar were assessed on the preextraction orthopantomograms. Outcome was assessed via visual examination, study models, or radiographs. Closure occurred in 89.9% of the maxillary and 49.0% of the mandibular quadrants. Dental age was statistically, but not clinically, significant in the maxillary arch (P<0.05). For the mandibular arch, presence or absence of the third molar and secondmolar angulation were statistically and clinically significant (P<0.01 and P<0.05, respectively). A tool kit was developed in relation to the mandibular arch variables. These findings are contradictory to the Royal College of Surgeons guidelines and suggest that the presence of the third molar and a mesially angulated secondmolar are favorable for space closure. The developed tool kit requires further validity testing.

Is there sufficient evidence to support an optimum time for the extraction of first permanent molars?

To evaluate whether the literature contains evidence, of an appropriate quality, to support the fundamental belief that there is an "optimal time" for extraction of FPMs with a poor prognosis. A comprehensive search, limited to human studies, was performed using five databases. PICO based inclusion and exclusion criteria were employed to facilitate article selection. Three independent reviewers assessed the quality of included studies using STROBE and GRADE criteria. Initially, 56 articles were selected, of which 9 were included for final assessments. None of the included studies obtained moderate or high GRADE level rating and neither did they meet all of the STROBE requirements with only one study satisfying 95%, and another study satisfying 73%, of the requirements. The inter-observer agreement was excellent. There is no scientific evidence, of an appropriate quality, to support the "optimal time" for extraction of FPMs with a poor prognosis.

A Systematic Review of the Consequences of Early Extraction of First Permanent First Molar in Different Mixed Dentition Stages.

Aims and Objectives:The aim of this study was to consider the available evidence regarding early extraction of permanent first molars (PFMs) in different mixed dentition stages that affect the integrity of occlusion and the implications for treatment planning.Materials and Methods:Electronic database, including PubMed and Science Direct, searches were conducted for available evidence. Key terms used in the search were “extraction,” “ first permanent molar,” and “mixed dentition.”Results:The initial search identified 56 studies to be related to the review. Although a significant number of published articles had dealt with early extraction of PFM, only three studies had fulfilled the final selection criteria to be considered for this systematic review.Conclusion:Future active appliance treatment is important after extraction of PFMs with poor prognosis. If such therapy is not needed, consideration should be given to extraction at the ideal developmental age to achieve spontaneous space closure. Each case should be assessed for the need of balancing or compensating extractions to preserve the dental midline and prevent overeruption.

The timing of extraction of non-restorable first permanent molars: a systematic review.

To identify the ideal timing of first permanent molar extraction to reduce the future need for orthodontic treatment. A computerised database and subsequent manual search was performed using Medline database, Embase and Ovid, covering the period from January 1946 to February 2013. Two reviewers (JE and ME) extracted the data independently and evaluated if the studies matched the inclusion criteria. Inclusion criteria were specification of the follow-up with clinical examination or analysis of models, specification of the chronological age or dental developmental stage at the time of extraction, no treatment in between, classification of the treatment result into perfect, good, average and poor. The search was limited to human studies and no language limitations were set. The search strategy resulted in 18 full-text articles, of which 6 met the inclusion criteria. By pooling the data from maxillary sites, good to perfect clinical outcome was estimated in 72% (95% confidence interval 63%-82%). Extractions at the age of 8-10.5 years tended to show better spontaneous clinical outcomes compared to the other age groups. By pooling the data from mandibular sites, extractions performed at the age of 8-10.5 and 10.5-11.5 years showed significantly superior spontaneous clinical outcome with a probability of 50% and 59% likelihood, respectively, to achieve good to perfect clinical result (p<0.05) compared to the other age groups (<8 years of age: 34%, >11.5 years of age: 44%). Prevention of complications after first permanent molars extractions is an important issue. The overall success rate of spontaneous clinical outcome for maxillary extraction of first permanent molars was superior to mandibular extraction. Extractions of mandibular first permanent molars should be performed between 8 and 11.5 years of age in order to achieve a good spontaneous clinical outcome. For the extraction in the maxilla, no firm conclusions concerning the ideal extraction timing could be drawn.

Lower first permanent molars: developing better predictors of spontaneous space closure.

First, first permanent molars (FPMs) of poor prognosis are often planned for extraction at an 'ideal time' so that second permanent molars (SPMs) erupt favourably to replace them. However for lower FPM extractions, timing is not an accurate predictor of success. The aim of this study was to identify additional radiographic factors that could better predict the degree of spontaneous space closure of the lower SPM following FPM extraction. Data from a previous study of 127 lower SPMs from 66 patients was re-analysed by incorporating additional radiographic factors. These included calcification stage of the bifurcation of the SPM, position of the second premolar, mesial angulation of SPM in relation to the FPM, and presence of the third permanent molar. Results were analysed using ordered logistic regression. Only 58 per cent of FPMs extracted at the 'ideal time' (SPM development at Demirjian stage E) had complete space closure. The best outcomes resulted from a combination of SPMs not at Demirjian development stage G, together with the presence of mesial angulation of the SPM and presence of the third permanent molar, where 85 per cent of those cases had complete space closure. Apart from extraction timing of the FPM, consideration must also be given to the presence of the third permanent molar and angulation of the SPM in order to ensure a reliable degree of spontaneous space closure of the lower SPM.

Planned extraction of first permanent molars during late childhood: A clinical note and mini-review

Planned extraction of first permanent molars during late childhood: A clinical note and mini-review

National clinical guidelines for the extraction of first permanent molars in children.

This article summarises recently updated guidelines produced by the Clinical Governance Directorate of the British Orthodontic Society through the Clinical Standards Committee of the Faculty of Dental Surgery, Royal College of Surgeons of England (FDSRCS) on the extraction of first permanent molars in children. The first permanent molar is susceptible to chronological enamel defects, molar-incisor hypomineralisation and caries, which may necessitate enforced extraction in the developing dentition. In the right circumstances, the extraction of these teeth can be followed by successful eruption of the second permanent molar and ultimately, third molar eruption to complete the molar dentition. For this reason, elective extraction of first permanent molars with a questionable long-term prognosis should be considered when planning enforced extractions. However, a number of factors can influence the decision-making process, including the necessity for a general anaesthetic to allow extraction, potential cooperation with restorative or orthodontic treatment and likely future preventative practice within the family. Moreover, the presence of any underlying malocclusion also needs to be evaluated within the context of extraction planning. The current available evidence has been evaluated and awarded a grade based upon those recommended by the Scottish Intercollegiate Guidelines Network.