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

Abstract

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.Electronic supplementary materialThe online version of this article (10.1186/s12903-018-0516-4) contains supplementary material, which is available to authorized users.

Spontaneous Space Closure After the Extraction of the Permanent First Molar on Mandibular Arch: A Retrospective Study

“…In this study, when a statistical model using regression analysis was undertaken to determine the factors affecting the success of spontaneous space closure, the presence of third molar was found to be statistically significant among all the variables. A recent systematic review included observational and retrospective studies mentioned that the consequences of FPM extraction include a decrease in post extraction space, via development and eruption of SPM and presence of third molar [12]. Eichenberger et al [26] also agreed that the presence of developing third molar could have a positive effect on spontaneous space closure compatible with our data in the mandibular arch.…”

“…These teeth are commonly associated with short and long-term clinical dilemmas. In the literature, the incidence of developmental defects (hypomineralization)varies between 10% and 30% [12]. An report showed that primary indication for FPM extraction was extensive dental caries (70%) [29].…”

“…Even early loss of FPMs have undesirable consequences, some studies report early extraction of FPMs may have favorable results from orthodontics perspective considering spontaneous space closure of FPMs [12][13][14]. Eruption of developing second permanent molars (SPM) may achieve to close mandibular FPM extraction space, before the chronological age of 8-9 years of the patients [15,16].…”

“…The United Kingdom national guidelines, which were updated within the last decade, have been advocated that early extraction of FPMs should be performed between the age of 8 and 10 years for the spontaneous space closure [17]. A recent review claimed that the time to extraction of FPM should be taken into consideration using the Demirjian classification for development of the SPM rather than by chronological age [12]. Similarly, Teo et al highlighted the importance of the Demirjian classification for development of SPM rather than by chronological age [18].…”

Timely extraction of the first permanent molars severely affected in mixed dentition

“…1 The first permanent molar (FPM) erupts early in the oral cavity, thus becoming prematurely exposed to noxae, making it more prone to caries before 15 years of age. 2 In addition, it is the tooth most susceptible to developmental defects such as molarincisor hypomineralization (MIH). 3 The prevalence of MIH in children 6 to 12 years old in the Metropolitan Region of Santiago de Chile was 12.7%, mostly at 8 and 9 years of age.…”