Multidisciplinary management of permanent first molar extractions

•Orthodontists are treating more adult patients who have extracted and decayed first molars.•Molar uprighting after old molar extractions vs orthodontic space closure.•Strategic of compromised molars instead sound premolars.•Management impacted ankylosed molars.•Early extraction permanent with enamel hypoplasia in young children. The has been reported to be the most caries prone tooth dentition. Orthodontists likely missing severely molars. This article will show various restorative options for that already or extracted. following clinical situations addressed: its advantages future restoration closure, strategic salvable molars, early Early advocated literature over a century.1Maclean S. Improved forceps & c.Am J Dent Sci. 1857; 7: 106-108PubMed Google Scholar Considered caries, removal such teeth was believed reduce decay incidence remaining teeth.2Nazir M.A. Bakhurji E. Gaffar B.O. Al-Ansari A. Al-Khalifa K.S. First association carious lesions other teeth.J Clin Diagn Res. 2019; 13: 36-39Google Scholar,3Halicioglu K. Toptas O. Akkas I. Celikoglu M. Permanent adolescents adults effect on development third molar.Clin Oral Investig. 2014; 18: 1489-1494Crossref PubMed Scopus (12) After World War II, became standard procedure. Hence, term “extraction prevention” presented as way solving “spread” caries.4Wilkinson A.A. best method preserving dentition whole.Dent Rec. 1944; 64: 2Google importance occlusion controversial.5Stamatis J. Orton H. debate.Aust Orthod 1994; 117-121PubMed Edward Angle, father modern orthodontics, described it keystone dental arch, whereas others routine basis. Many studies tried counteract uncontrolled by showing detrimental occlusion.6Salzmann J.A. Effect molars: prevention treatment.J Am Assoc. 1943; 30: 1681-1690Abstract Full Text PDF Scholar,7Thilander B. Skagius Orthodontic sequelae A longitudinal study.Rep Congr Eur Soc. 1970; : 429-442PubMed Despite all preventive prophylaxis measures available today, we still deal our daily practices.1Maclean Scholar,8Ong D.C. Bleakley J.E. Compromised an perspective.Aust 2010; 55 (quiz 105): 2-14Crossref (34) Scholar,9Yavuz Baydaş Ikbal Dağsuyu I.M. Ceylan Effects loss molars.Am Dentofacial Orthop. 2006; 130: 634-638Abstract (36) For referred dentists migrated extractions, treatment should aimed at facilitating process rather than correcting existing malocclusion when is not patient's chief complaint. In long-standing compensated prosthetically, edentulous partially closed mesiolingual tipping second molar. late mixed can also lead residual spaces because distal premolars. Spaces redistributed replacement orthodontically. main advantage closure whole finished right completion without patient dependence less cost. Space difficult atrophic sites, which require remodeling cortical bone.10Dhole P.M. Maheshwari D.O. using simple mechanics spaces: case series.J Indian 2018; 52: 51-59Crossref Adults bone apposition moving into narrowed greater likelihood alveolar crest height mesial roots, some gingival recessions root resorption.11Saga A.Y. Maruo I.T. Guariza Filho Camargo E.S. Tanaka O.M. Treatment several mandibular sites.Am 2011; 140: 869-878Abstract Scholar,12Thilander versus implant placement subjects Rehabil. 2008; 35: 64-71Crossref (24) Efficient must used ensure delivery light forces increase interval between activations so tissues involved time recover avoid soft-tissue clefts, tendency reopen spaces.10Dhole maxillary posterior area low sinus movement through limited.13McGrowan D. Baxter P. James Maxillary Sinus Dental Implications.1st ed. Wright, London, United Kingdom1993Google Pneumatization extend ridge making difficult.14Park J.H. Tai Kanao Takagi sinus.Am 145: 95-102Abstract (28) Scholar,15Wehrbein Bauer W. Wessing G. Diedrich [The floor movement].Fortschr Kieferorthop. 1990; 51 (German): 345-351Crossref (43) recent sites better predictable results ancient sites. Although technically demanding, sometimes advisable extract healthy premolar. mostly hypoplasia, seen stage. Consideration given ideal developmental age, corresponds chronological mean age 8-10 years, achieve spontaneous eruption molars.16Penchas Peretz Becker dilemma children: restore extract.ASDC Child. 61: 199-205PubMed describe approaches common “strategic” premolars, replaced prosthetically overeruption antagonist this 27-year-old (Fig 1, B). By tipped only facilitates prosthetic rehabilitation but enables design, periodontal conditions, function, stability solution.17Roberts 3rd, W.W. Chacker F.M. Burstone C.J. segmental approach uprighting.Am Orthod. 1982; 81: 177-184Abstract (47) had facilitate alignment blocked out addition, would uprighting. removable biteplane enable C). conventional spring made 0.019 × 0.025-in stainless steel wire against archwire engaged passively canine premolars 0.022-in brackets D). anchor unit reinforced from bonded lingual canines.17Roberts maintainer secured temporary bridge during phase E). As both abutment adjacent site large restorations, full-coverage crown indicated. allowed occlusal grinding compensate extrusion spring. reduction yields favorable crown-to-root ratio.18Tuncay O.C. Biggerstaff R.H. Cutcliffe J.C. Berkowitz Molar T-loop springs.J 1980; 100: 863-866Abstract (19) Correction angular osseous defect aspect access oral hygiene pretreatment posttreatment periapical radiographs F G). favored parallel preparations insertion retention H). 8 months. objective correct Class II Division 2 solution remained functional stable 20 years I J). 32-year-old prosthetically. replacing attractive avoids restoration. Light increased intervals recommended greatly increases compared solution, especially arch density.19Roberts W.E. Huja S.S. Bone physiology, metabolism, biomechanics practice.in: Graber L.W. Vanarsdall Jr., R.L. Vig K.W. Huang G.J. Orthodontics: Current Principles Techniques. Mosby, St Louis1994: 193-257Google What needs considered site, often appears small premolar 2, A). distance apices reduced until adequate parallelism achieved. Optimal position essential correction defect, good occlusion, stability. extent movement, resorption shown minimal closure.20Stepovich M.L. study closing mandible.Angle 1979; 49: 227-233PubMed There decrease average 1.3 mm does compromise support.20Stepovich Scholar,21Hom B.M. Turley P.K. effects adults.Am 1984; 85: 457-469Abstract (61) diagnostic setup end up B alternatives were upright close bringing forward. Even though challenging consuming, selected extracting replace them restorations. Uprighting springs started drive roots. Tip-back bends fully position, power chains Progress helped monitor parallelism. Occlusal equilibration necessary mild extrusion. Complete second, achieved 15 months 0.0215-in twisted F). reopening long-term open contact problem even roots twist wire. 52-year-old 14 resulting spaced 3, A-D). redistribution complex time-consuming. Instead, setup, minor canines left facilitated 3 single-tooth implants E photographs taken 6 G usually faster easier mechanically mandible consisted thick connected coarse trabecular bone, extremely wide buccolingually.19Roberts may associated pneumatization, hinder movement.13McGrowan structured compact formed part hard palate.13McGrowan constant longer adjustment could effectively move wall.14Park When extends vertically front moved, occur flat base.15Wehrbein optimal cannot achieved, prevent acceptable outcome, pneumatization contraindication extractions.22Sun Xia X. Cen Liu Q. Knowledge sinus: systematic review.BMC Health. 91Crossref (11) 24-year-old girl growth. Because insufficient opening lack maintenance, 4 remains. Meanwhile, erupted no 4, midline shift toward side anterior edge bite. She rejected full comprehensive treatment, she additional space. An required lift surgery antagonist. driving was, therefore, appropriate. Two miniscrews avoided relying units extension soldered hook band direct force closer center rotation, favoring bodily movement. continuous delivered nickel-titanium coil. overerupted intruded occluded prevented parallelism, total proper 9 molar, home care instruction interdental toothbrush maintain periodontium 16-year-old recently unerupted crowding, indication 5, Three bands attachments rotations 5 spontaneously appliance crestal levels C Extraction accelerating tends erupt earlier contralateral tooth.2Nazir 25-year-old similar situation hopeless 6, absence ruled closure. surgery, needed solution. Aligning palatally displaced done 7 enabled inlay–onlay preparation B-D). saved structure endodontic involvement. 35-year-old too big 1 7, Considering 3.75 diameter commonly region, embrasures plaque accumulation, together teeth. To space, moved mesially. placed ideally relative initially device secondarily radiograph shows well-centered newly created months, there 13-year-old Angle relationship 8, length discrepancy mm. normally if restoration, possible lengthening save Rather leaving instead. Nance holding distalize creating before fixed 30 Posttreatment well-aligned seated 12-year-old deeply curved 9, corresponding bulge palpated lower border mandible. horizontally. later unrealistic. It leave unopposed partial denture till uprighted intermaxillary elastic hooked bracket surgical uncovering Hawley-type extended arm clasp miniscrew interfered unereupted Therefore, cooperation complete repositioning horizontally CT scan region management showed inferior nerve inserted damage fracture coronectomy obtain enough later. years. panoramic intraoral photograph 10 overall result Severely dentition, present pedodontist; these restored questionable prognosis extraction?16Penchas conditions (1) poor quality, (2) presence (3) crowding reasonably positioned, (4) willing pursue follow-up (5) bite tendency.23Sabri R. L'extraction précoce des quatre premières molaires permanentes à propos d'un cas.Rev Orthop Dento Faciale. 1996; 407-415Crossref Scholar,24Sandler P.J. Atkinson Murray A.M. four sixes.Am 2000; 117: 418-434Abstract Conversely, severe protrusion contraindications Spontaneous drift allow use relieve protrusion. patients, delayed maintainers 9-year-old All signs 10, exfoliation primary sign deficiency. pedodontist questioned feasibility anyway. overjet 11 appearance calcification interradicular bifurcation radiograph, suitable A).25Demirjian Goldstein Tanner J.M. new system assessment.Hum Biol. 1973; 45: 211-227PubMed Scholar, 26Jälevik Möller Evaluation hypomineralized molars.Int Paediatr Dent. 2007; 17: 328-335Crossref (64) 27Teo T.K. Ashley P.F. Derrick Lower developing predictors closure.Eur 2016; 38: 90-95Crossref 9-10 One year mesially axial inclination deciduous retained, underlying successor inclined. Third completed calcification. mesiopalatal rotation unlike where remained. C-F). Fixed initiated intercuspation normal overbite 25 G-J). Careful timely simplified mechanotherapy child prognosis. Extracted prevalent. Significantly great potential enter cycle, eventually ending extraction. Tooth migrations nonreplaced complicate treatment. requires control extractions. how well-coordinated multidisciplinary and/or rewarding outcomes.