Extraction Timing of Heavily Destructed Upper First Permanent Molars

Abstract

The first permanent molar as the first permanent tooth in the mouth and with a general insufficient oral hygiene of the children, is commonly subject to significant compromise which may arise due to caries or endodontic complication, or from developmental anomalies such as hypoplasia. Compromised teeth with questionable prognosis may result in short-and long-term clinical dilemmas. The aim of this research is to highlight the factors that require careful consideration when a compromised UFPM is detected and the importance of timely UFPM extraction to ensure the mesial drift of the upper second permanent molar (USPM) to fulfill the space of the extracted UFPM without any orthodontic intervention. For this purpose 52 heavily destructed UFPMs were extracted at age of 10.5 years old, 44 (84.6%) USPMs erupted exactly distal to the second premolar while only 7 (13.4%) USPMs erupted 1 mm distal to the second premolar. Clinically it is recommended to extract the heavily destructed upper first molars at age of 10.5 years old to ensure the complete closure of the extraction space by the passive mesial drift of upper second permanent molar.

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

“…Eight of the included studies were cross-sectional [12–19], two were case-control [7, 20], and one was prospective and observational [21]. One study [12] was excluded because the data for malocclusion as an outcome of FPM extraction were invalid; in addition, the criteria used to classify normal and abnormal malocclusion were not uniform or acceptable.…”

“…Rahhal [12, 21] studied the timing of extraction of severely decayed upper FPMs. In his sample of children (mean age 10.5 years) who underwent extraction of an upper FPM, Rahhal found that 84.6% of upper SPMs had complete space closure without any orthodontic intervention and only 15.4% of upper SPMs erupted 1 mm distal to the second premolar.…”

“…The sequelae were closely related to age at the time of extraction. Two articles [16, 21] did not mention age at the time of evaluation of the consequences of extraction. In addition, three of the studies did not clearly state their duration of follow-up [19–21].…”

“…Two articles [16, 21] did not mention age at the time of evaluation of the consequences of extraction. In addition, three of the studies did not clearly state their duration of follow-up [19–21]. Two studies did not undertake case ascertainment in their study participants [16, 20]; however, the other nine studies addressed case ascertainment by intraexaminer or interexaminer reproducibility or by using precise methods for assessment of the outcomes.…”

“…Seven studies were retrospective in design and extracted information from patient records, which is considered a limitation [13, 16–18]. Interexaminer or intraexaminer reliability tests were performed in all except three articles [7, 15, 21]. Confounding factors such as age, gender, and geographic location were discussed by only one study [20] that matched patients for age, while four studies [14, 16–18] reported the age of their patients but did not match them in this regard.…”