IN THE NAME OF GOD

Dr:Nahvi

EXTRACTION OF FIRST PERMANENT MOLARS

THE EFFECT OF LOSS OF THE FIRST PERMANENT MOLAR

Diminished local functionDrifting of teethContinued eruption of opposing teethMidline deviationIncreasing overbite

Shaheed Beheshti University of Dental Journal

FACTORS TO CONSIDER WHEN PLANNING EXTRACTION OF FIRST PERMANENT MOLARS

the restorative state of the toothpresence and condition of the other teeth dental age of the patientthe occlusal relationship

Dental update 2001

the restorative state of the tooth

presence and condition of the other teeth

• If any are absent, extraction of the first permanent molar in that quadrant should be avoided.

The absence of third molars does not generally contraindicate the extraction of FPMs. However, the presence of mesially directed forces from developing third molars may aid space closure.

Dental update 2001

presence the other teeth(same quadrant)

yesNo

dental age of the patientIdeal time to extract first molar is 8.5-10 yearsEarlier extraction : second premolar have a

tendency to drift distallyDelayed extraction : the second molars will show

less bodily movement and more tilting

Journal of dentitry Tehran university of medical sciences 2002

Mcdonald 2011

A greater degree of movement will occur in children in the 8.5 to 10 year age group

radiographic evidence of early dentine calcification within the second molar root bifurcation

Journal of dentitry Tehran university of medical sciences 2002

Dental calcification stages(Nolla)

Radiographs taken at 6-month intervals after the loss of a maxillary first molar

Mcdonald 2011

After extraction of the mandibular primary teeth and first permanent molars

3.2 years after extraction of the first permanent molars

dental age of the patient in mandible

8.5-10

others

dental age of the patient

In maxilla

7-11.5

Permanent

dentition

The occlusal relationshipclass I with labial segment crowdingwith buccal segment crowding

Dental update 2001

class II division 1class II division II

extractions in the lower arch should be avoided if at all possible in deep bite cases

class III

Dental update 2001

class I

buccal segment crowding

labial segment crowding

class II division 1

maxillamandib

le

class II division II

maxillamandibl

e

class III

mandile

maxilla

Ideal conditionpresence and condition of the other teethclass Iwith buccal segment crowdingIn children in the 8.5 to 10 year age group

Balancing and compensating extractionsCompensating involves extraction of an

antagonistic molar to prevent its overeruption.overeruption of the upper FPM can prevent mesial migration of the mandibular second permanent molar.

Balancing involves removal of a contralateral tooth, which needn’t

necessarily be a FPM, to preserve the dental midline.

Dental update 2001

One carious first permanent molar

BRITISH DENTAL JOURNAL 2001

One carious first

permanent molar

(Upper)

maxillamandi

ble

One carious first

permanent molar

(lower)

maxilla

mandible

Two carious first permanent molars

BRITISH DENTAL JOURNAL 2001

Two carious first

permanent molars

(lowers)

Two carious first

permanent molars

(uppers)

maxillamandibl

e

maxilla

mandible

One upper and one

lower(different sides)

maxilla

mandible

Three carious first permanent molars

BRITISH DENTAL JOURNAL 2001

Three carious first permanent

molars

Maxilla and mandible

Prevalence of Loss of Permanent First Molars in a Group of Romanian Children and Adolescents

Anca Maria Rãducanu, Victor Feraru

Distribution of loss of permanent first molars by quadrant.

OHDMBSC, 2009

Effects of early loss of permanent first molars on the development of third molarsPanoramic radiographs and dental casts of 165

adolescent patients (103 boys, 62 girls) with unilateral early loss of a permanent first molar were used to assess the developmental stages of the third molars. The formation stages of third molars on the extraction sides were evaluated, and the formative conditions of the contralateral teeth were used as controls. Early loss of the permanent first molars might have an accelerating effect on the development of the third molar on the extraction side compared with the contralateral teeth. Therefore, emergence of the third molars on the extraction side might be hastened, and these teeth might erupt earlier than the contralateral teeth.

(Am J Orthod DentofacialOrthop 2006)

Evaluation of spontaneous space closure and development of permanent dentition after extraction of hypomineralized permanent first molarsBIRGITTA JÄLEVIK & MARIE MÖLLER

Twenty-seven children who had one to four permanent first molars extracted due to severe MIH. Each case was followed up on individual indications 3.8–8.3 (median 5.7) years after extractions. The eruption of the permanent dentition, and space closure were documented by orthopantomograms, casts, photographs, and/or bitewings. Fifteen children were judged to have a favourable spontaneous development of their permanent dentition without any orthodontic intervention. Seven children were or should be subjected to orthodontic treatment for other reasons registered prior to the extraction. Five children were judged to have a treatment at least caused by the extractions, but three of them abstained because of no subjective treatment need.

International Journal of Paediatric Dentistry 2007

7,7

7.7

8.8

10.2

13.8International Journal of Paediatric

Dentistry

Thank You