Transcript Slide 1

IN THE NAME OF GOD
EXTRACTION OF
FIRST PERMANENT
MOLARS
Dr:Nahvi
 THE EFFECT OF LOSS
OF THE FIRST PERMANENT MOLAR
 Diminished local function
 Drifting of teeth
 Continued eruption of opposing teeth
 Midline deviation
 Increasing overbite
Shaheed Beheshti University of Dental Journal
FACTORS TO CONSIDER WHEN PLANNING EXTRACTION
OF FIRST PERMANENT MOLARS
 the restorative state of the tooth
 presence and condition of the other teeth
 dental age of the patient
 the 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)
No
yes
dental age of the patient
 Ideal time to extract first molar is 8.5-10 years
 Earlier extraction : second premolar have a tendency to drift distally
 Delayed 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 maxilla
Permanent
dentition
7-11.5
dental age of the patient
in mandible
others
8.5-10
The occlusal relationship
 class I
 with labial segment crowding
 with buccal segment crowding
Dental update 2001
 class II division 1
 class 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
class II division 1
mandible
maxilla
labial segment
crowding
class III
class II division II
mandible
maxilla
buccal segment
crowding
mandile
maxilla
Ideal condition
 presence and condition of the other teeth
 class I
 with buccal segment crowding
 In children in the 8.5 to 10 year age group
Balancing and compensating
extractions
Compensating 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)
mandible
maxilla
One carious first
permanent molar
(lower)
mandible
maxilla
Two carious first permanent molars
BRITISH DENTAL JOURNAL 2001
Two carious first
permanent molars
(lowers)
Two carious first
permanent molars
(uppers)
mandible
mandible
maxilla
One upper and one
lower(different sides)
mandible
maxilla
maxilla
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 molars
 Panoramic 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 molars
BIRGITTA 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
8.8
7,7
10.2
13.8
International Journal of Paediatric Dentistry
Thank You