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