National clinical guidelines for the extraction of first permanent molars in children

The history of treatment planning the extraction of the first permanent molar in the UK

This paper researches the history of treatment planning for extraction of the first permanent molars and the early influence of American orthodontists on dental practice in the UK. It also discusses the development of clinical guidelines for the enforced extraction of first permanent molars to the present day.

The value of a remote orthodontic assessment for children having permanent teeth extracted under general anaesthesia

Introduction The number of children undergoing dental extractions under general anaesthetic (GA) remains high. The newly published Royal College of Surgeons guidelines in 2023 take a less prescriptive approach on balancing and compensating extractions for first permanent molars. In an effort to maintain an effective and efficient patient care pathway, an orthodontic remote assessment triage model was developed in West Dorset for the special care dentistry and community dental service.Aims The orthodontic triage form is now used across Dorset. This service evaluation assesses whether the form is still effective despite the upscaling. Furthermore, qualitative feedback was obtained from the clinicians involved in referring and triaging.Design The sample of 352 forms consisted of children aged 16 years or younger undergoing GA for dental extractions for whom orthodontic triage had been requested between March 2019 and March 2023. The clinician feedback was collected using a questionnaire.Results This service evaluation found that 53.1% of patients had their treatment plan modified following an orthodontic assessment. Positive feedback from all clinicians involved suggests there is potential to expand this model to other services.Discussion Involving the orthodontist can address orthodontic concerns which has the potential to simplify or obviate the need for future orthodontic treatment. Remote assessment reduces the need for face-to-face appointments. The clinician perspective influences willingness to further develop and expand the current pathway.Conclusion Remote triage has proved successful in Dorset. There is potential to build an initiative between primary and secondary care in the hopes of creating a universal national proforma to increase access to orthodontic opinions for children requiring dental extractions.

Knowledge and management of molar-incisor hypomineralisation amongst dentists in The Netherlands

BACKGROUND

Molar-incisor hypomineralisation (MIH) is a frequently encountered dental condition in the clinical setting, and correct diagnosis can influence management outcomes.

AIM

To assess the knowledge of and attitudes towards the management of MIH amongst dentists in the Netherlands.

DESIGN

The study was conducted as a cross-sectional web survey. The questionnaire used included questions regarding respondent characteristics, awareness, knowledge and management of MIH and was distributed through the Royal Dutch Association for Dentistry (KNMT) to a random sample of 900 dentists. Variables were analysed using descriptive statistics, and differences between distinct groups of dentists were tested using the chi-squared test.

RESULTS

Respondents consisted of 76.6% general dental practitioners, 9.1% paediatric dentists and 14.3% differentiated (specialist) dentists, with a 25.6% overall response rate. The majority knew the term MIH and its clinical characteristics, and could distinguish MIH from other enamel defects. Regarding aetiological factors, 76.6% reported a genetic component. In an asymptomatic case, 47.3% reported non-invasive treatments. In a mild symptomatic case, treatments from non-invasive to invasive were reported (p < .05). In a severe symptomatic case, the majority reported invasive treatments. Two-thirds of respondents were interested in further clinical training about MIH.

CONCLUSIONS

Most respondents knew the term MIH and its clinical characteristics and would like further clinical training about MIH.

Detecting missing teeth on PMCT using statistical shape modeling

The identification of teeth in 3D medical images can be a first step for victim identification from scant remains, for comparison of ante- and postmortem images or for other forensic investigations. We evaluate the performance of a tooth detection approach on mandibles with missing parts or pathologies based on statistical shape models. The proposed approach relies on a shape model that has been built from the full lower jaw, including the mandible and teeth. The model is fitted to the target, resulting in a reconstruction, in addition to a label map that indicates the presence or absence of teeth. We evaluate the accuracy of the proposed solution on a dataset consisting of 76 target mandibles, all extracted from CT images and exhibiting various cases of missing teeth or other cases, such as roots, implants, first dentition, and gap closure. We show an accuracy of approximately 90% on the front teeth (including incisors and canines in our study) that decreases for the molars due to high false-positive rates at the wisdom teeth level. Despite the drop in performance, the proposed approach can be used to obtain an estimate of the tooth count without wisdom teeth, tooth identification, reconstruction of the existing teeth to automate measurements taken as part of routine forensic procedures, or prediction of the missing teeth shape. In comparison to other approaches, our solution relies solely on shape information. This means it can be applied to cases obtained from either medical images or 3D scans because it does not depend on the imaging modality intensities. Another novelty is that the proposed solution avoids heuristics for the separation of teeth or for fitting individual tooth models. The solution is therefore not target-specific and can be directly applied to detect missing parts in other target organs using a shape model of the new target.

Why orthodontists need to know about molar incisor hypomineralization

Molar incisor hypomineralization (MIH) is a systemic developmental qualitative defect of the enamel that affects 1-4 first permanent molars with or without incisor involvement. Enamel hypomineralization is identified visually as a demarcated opacity with a clear border with varying extensions and can be white, yellow, or brown. This opacity is characterized by a reduced quality of enamel that is of normal thickness but not fully mineralized. It is very common for the affected teeth to present with posteruptive breakdown, making them susceptible to caries, leading to their subsequent loss. Thus, MIH is a significant dental problem with clinical, economic, and psychosocial implications. The planned extraction of compromised teeth is a valid alternative to complex restorative treatment. Orthodontists' involvement is essential in developing effective treatment strategies for children affected by MIH, contributing to their oral health and well-being.

Spontaneous space closure in patients treated with early extraction of the first permanent molar: a retrospective cohort study using radiographs

OBJECTIVES

To assess the success rate of spontaneous space closure after extraction of the first permanent molar (FPM) in the maxilla and the mandible, and to identify the factors that make spontaneous space closure most favorable in each.

MATERIALS AND METHODS

A retrospective records-based cohort study was conducted through a search of the database of the Public Dental Service, Stockholm County Council, Stockholm, for young adults born between 2000 and 2001, who underwent extraction of one or more FPM between 2006 and 2016. A total of 995 extracted teeth were identified, of which 203 teeth in 155 patients met the inclusion criteria.

RESULTS

Of the 203 extracted teeth, 166 (81.8%) did not receive any orthodontic treatment. The success rate for space closure in orthodontically treated patients was 91.9%. The success rate for spontaneous space closure was 84.3%. All unsuccessful spontaneous space closure in the maxilla occurred in patients older than 12 years. The dental developmental stage of the second permanent molar (SPM) had a statistically significant association with spontaneous space closure in the mandible (P < .001).

CONCLUSIONS

The success rate of spontaneous space closure was high (84.3%) and was higher in the maxilla (94.1%) than the mandible (74.1%). Age at time of extraction and dental developmental stage of the SPM were significant factors for successful spontaneous space closure in the maxilla and mandible, respectively.

Treatment choice for first permanent molars affected with molar-incisor hypomineralization, in patients 7-8 years of age: a questionnaire study among Swedish general dentists, orthodontists, and pediatric dentists

PURPOSE

The aim of this study was to investigate attitudes and preferred therapy choice for first permanent molars (FPM) with Molar-Incisor Hypomineralization (MIH).

METHODS

An online questionnaire was sent out to general dentists (n = 559) working in the Public Dental Service in Region Västra Götaland, orthodontists (n = 293), and pediatric dentists (n = 156) (members from each interest association), in Sweden. The questionnaire contained three parts: general questions regarding the respondents, patient cases, and general questions regarding extraction of FPMs with MIH. Statistics were carried out using Chi-squared tests, with a significance level of 5%.

RESULTS

A response rate of 36% was obtained. Orthodontists and pediatric dentists were more prone to extract FPMs with both moderate and severe MIH, compared to general dentists. When restoring FPMs with moderate MIH, resin composite was preferred. Compared to the general dentists, the pediatric dentists were more prone to choose glass-ionomer cement in the FPMs with severe MIH. The most common treatment choice for FPMs with mild MIH was fluoride varnish. "When root furcation is under development of the second permanent molar on radiographs" was chosen as the optimal time for extracting FPMs with severe MIH, and the general dentists based their treatment decisions on recommendations from a pediatric dentist.

CONCLUSION

Extraction of FPMs with moderate and severe MIH is considered a therapy of choice among general dentists and specialists, and the preferred time of extraction is before the eruption of the second permanent molar.

Clinical and radiographic performance of preformed zirconia crowns and stainless-steel crowns in permanent first molars: 18-month results of a prospective, randomized trial

BACKGROUND

The treatment of young permanent first molars with extensive carious tissue loss may often require restoration with preformed crowns. This study compared the clinical and radiographic performance of stainless-steel crowns (SSCs) and preformed zirconia crowns (ZCs).

METHODS

Forty-eight molar incisor hypomineralisation (MIH)- or caries-affected permanent molars in 20 healthy patients between 6-13-year-old were randomly divided into ZC and SSC groups (n = 24 teeth/group) in a split-mouth design. The oral hygiene levels of patients were assessed using Greene and Vermillion simplified oral hygiene index (OHI-S). Plaque accumulation and gingival health were evaluated using the Silness&Löe plaque index (PI) and Löe&Silness gingival index (GI), respectively. Clinical retention, marginal extension level, marginal adaptation of crowns and wear of the antagonist teeth were assessed at baseline, 1, 6, 12 and 18 months. The radiological assessments for evaluating the marginal adaptation of crowns and periapical pathology of crowned teeth were performed at 6 and 12 months. The data were analyzed using Kaplan-Meier analysis, Mann-Whitney U test, and two-way ANOVA.

RESULTS

A total of forty teeth in 17 children were evaluated for 18 months. ZCs had significantly lower gingival and plaque index values than teeth restored with SSCs during all evaluation periods (p < 0.05). Neither crown type resulted in clinically-detectable wear on opposing dentition or periapical pathology. One ZC was lost at 13 months, while all SSCs survived in function clinically. The cumulative survival rates of ZCs and SSCs were 95.2% and 100% respectively.

CONCLUSIONS

Both ZCs and SSCs showed high clinical retention rates in young permanent molars. ZCs had lower plaque accumulation and better gingival health than SSCs, which were consistently associated with mild gingival inflammation.

CLINICAL TRIAL REGISTRATION NUMBER

NCT05049694.

Should compromised first permanent molar teeth in children be routinely removed? A health economics analysis

OBJECTIVE

To evaluate the cost-effectiveness of retaining one or more compromised first permanent molars (cFPMs) affected by dental caries or enamel hypomineralization, compared to timely extraction, in children aged 8 years.

METHODS

A Markov model was developed to simulate the lifetime of a cFPM. Two management strategies were compared: extraction facilitating spontaneous space closure or maintenance of teeth with restorations. Ten health states were utilized to capture long-term outcomes including various tooth restorations, prostheses or a retained gap at the cFPM site. Outcomes were expressed as Quality Adjusted Tooth-Years (QATYs). The model was informed by survey data on patient preferences for treatment outcomes and UK data on costs. Discounted costs and QATYs were calculated over 62 years.

RESULTS

Regardless of the number of cFPMs, retaining cFPMs was more effective than early removal, generating an additional 2.3 QATYs per cFPM. Early removal of one or two cFPM under general anaesthetic (GA) was more expensive than retention and hence never cost-effective. Retaining a cFPM was more expensive than early removal under local anaesthesia or where four cFPMs were extracted under GA. In these cases, retaining cFPMs was cost-effective if a QATY was valued at £100 or £35, respectively. Results were robust to sensitivity analysis.

CONCLUSION

Preserving a cFPM was more cost-effective than the early loss of one, or two cFPMs under GA. Preservation of four cFPMs was cost-effective if sufficient value was placed on a QATY. These findings can guide clinical practice on management of cFPMs alongside patient/payer values on maintaining teeth.

Criteria for early diagnosis of mandibular third molar agenesis based on the developmental stages of mandibular canine, first and second premolars, and second molar: a retrospective cohort study

BACKGROUND

Permanent first molars with severe dental caries, developmental defects, or involved in oral pathologies are at risk of poor prognosis in children. Accordingly, using the third molar to replace the first molar can be a good treatment option when third molar agenesis is predicted early. Thus, this retrospective cohort study aimed to develop criteria for early detection of mandibular third molar (L8) agenesis based on the developmental stages of mandibular canine (L3), first premolar (L4), second premolar (L5), and second molar (L7).

METHOD

Overall, 1,044 and 919 panoramic radiographs of 343 males and 317 females, respectively, taken between the ages of 6 and 12 years were included. All developmental stages of L3, L4, L5, L7, and L8 were analyzed based on the dental age, as suggested by Demirjian et al. The independent t-test was used to assess age differences between males and females. The rank correlation coefficients were examined using Kendall's tau with bootstrap analysis and Bonferroni's correction to confirm the teeth showing developmental stages most similar to those of L8s. Finally, a survival analysis was performed to determine the criteria for the early diagnosis of mandibular third molar agenesis.

RESULTS

Some age differences were found in dental developmental stages between males and females. Correlation coefficients between all stages of L3, L4, L5, and L7 and L8 were high. In particular, the correlation coefficient between L7 and L8 was the highest, whereas that between L3 and L8 was the lowest.

CONCLUSION

If at least two of the following criteria (F stage of L3, F stage of L4, F stage of L5, and E stage of L7) are met in the absence of L8 crypt, agenesis of L8 can be confirmed.

Alveolar bone loss and root resorption in mesialized second molars in mandibular first molar extraction cases as compared to contralateral non-extraction side in young adults: A retrospective cross-sectional study

INTRODUCTION

The alveolar bone loss (ABL) and external apical root resorption (EARR) depict the safety of mesialization of mandibular second molars into the extraction space of mandibular first molars. The aim of this study was to evaluate the ABL and EARR after closure of mandibular first molar extraction space by mesialization of second molar on extraction side (ES) as compared to the contralateral non-extraction side (NES).

MATERIAL AND METHODS

A retrospective cross-sectional study was carried out using the pre and posttreatment orthodontic records of young adults with complete set of permanent dentitions treated with extraction of unilateral mandibular first molar and non-extraction treatment on the contralateral side. All patients underwent mini-implant supported mesialization of second molar on ES. The ABL and EARR of second molar on ES and contralateral NES were measured on digital orthopantomograms. The ABL and EARR of second molars on ES and contralateral NES were compared using independent sample t-test.

RESULTS

A total of 36 subjects (14 males and 22 females) were included in the study. The mean treatment duration for molar mesialization was 28.75±8.05months. The mean crown and root movements of mandibular second molar on ES were 10.94±1.25mm and 9.04mm±1.14mm, as compared to 0.91±1.01mm and 0.77±0.83mm on contralateral NES, respectively. The mean ABL and EARR at mandibular second molar were found to be significantly greater on the ES than the contralateral NES (P<0.001 and<0.05, respectively). A total of seven patients (19.4%) experienced ABL≥1mm on ES as compared to none in the contralateral NES. EARR of>2mm of at least one root was found in seven patients (19.4%) in ES as compared to four (11%) in contralateral NES.

CONCLUSION

There was small but statistically significant difference in the ABL and EARR of mesialized mandibular second molar at first molar ES as compared to the contralateral NES. For majority of patients this difference was small but few isolated cases experienced severe ABL and EARR.

Eruption Pattern of Third Molars in Orthodontic Patients Treated with First Permanent Molar Extraction: A Longitudinal Retrospective Evaluation

The aim of this study was to evaluate angular and positional changes in the second (M2) and third molars (M3) of orthodontically treated patients undergoing a first molar (M1) extraction. A retrospective longitudinal study with a sample of 152 pre- and post-treatment panoramic radiographs was conducted. Thirty-nine patients (51.3%) were orthodontically treated with M1 extraction and thirty-seven (48.7%) were treated without extraction. Angulations of M2 and M3 relative to the infraorbital (IOP) and the palatal planes (PP) were measured and compared between the groups before orthodontic treatment (T1) and after the completion of orthodontic space closure (T2). The prognosis of M3 eruptions was evaluated by assessing their horizontal and vertical position (inclination) using different classification systems. The angular (p < 0.001) and inclination improvement (p < 0.01) of the maxillary M3 was significant for the M1 extraction group. The mandibular M3 inclination significantly improved (p < 0.01), whereas the groups' angulation and vertical position were not significantly different. These findings suggest that extraction therapy has a favorable effect on the maxillary M2 and M3 angulation, but not on the mandibular. M1 extraction showed a signi- ficant effect on the horizontal position of M3 and thus may improve the eruption space and prognosis.

OPTIMAL RESTORATIVE OPTION FOR PERMANENT FIRST MOLARS AFFECTED BY HYPOMINERALIZATION REMAINS UNCERTAIN

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Restorative techniques for permanent first molars affected by hypomineralization: a systematic review. Lopes-Fatturi A, Wambier L, Rolim TZC, Reis A, Feltrin de Souza J. Pediatr Dent 2022; 44(1):17-24.

SOURCE OF FUNDING

None.

TYPE OF STUDY/DESIGN

Systematic review.

Management of compromised first permanent molars in a cohort of UK paediatric patients referred to hospital-based services

BACKGROUND

There are diverse opinions among dentists about managing compromised first permanent molars (cFPMs) in children and a perceived lack of guidance to help them evaluate prognosis.

AIM

To evaluate the current management of cFPM in children referred to a UK hospital centre and to report the severity of the affected teeth.

DESIGN

A service evaluation was undertaken, based on case records of medically fit children (6-11 years) referred to for the management of cFPMs. The presence of hypomineralisation, post-eruptive breakdown and the proposed care plans were recorded. Radiographic signs of severity were scored using the ICDAS index (intra/inter-rater kappa 0.96/0.82).

RESULTS

From 349 records screened over a 4-month period, 249 met the selection criteria. Almost 81% were planned to have extraction of at least one cFPM, whereas 19.3% were managed without extraction. More than half of the extraction cases (n = 105) had radiographic radiolucencies not exceeding the middle third of dentine in the worst-affected FPM. At the time of extraction, the mean age of the patients was 9.8 years (±0.9). GA was used in 196 (97.5%) cases, and 40.8% had not received previous treatment in any of their cFPMs.

CONCLUSION

Potentially restorable cFPMs in children is, most of the time, in a cohort of UK patients referred for tier 3 services, being managed by timed extractions under general anasethesia.

Molar-incisor hypomineralisation combat: exploratory qualitative interviews with general dental practitioners in England regarding the management of children with molar-incisor hypomineralisation

Introduction Molar-incisor hypomineralisation (MIH) presents as a spectrum, with severe cases becoming increasingly complex to manage. This study aimed to investigate the perceptions and experience of general dental practitioners (GDPs) in England when managing children with MIH.Method Semi-structured telephone interviews with GDPs who regularly treat children took place in May 2020. A sample of four male and six female GDPs with 1-15 years of experience was achieved through purposively sampling interested parties following advertisement via professional groups. Thematic analysis using a realist and inductive approach was used in analysis.Results The overarching theme was of managing uncertainty, with four subthemes: setting the scene; fighting the tooth; working within the system; and self and interpersonal insight. Despite being knowledgeable, participants expressed varying levels of confidence in many aspects while managing children with MIH. There was a great deal of uncertainty surrounding 'doing the right thing' across the themes. Systemic barriers to managing children with MIH within the general dental service were identified.Conclusion The challenges of managing children with MIH was experienced as 'uncertainty'. Barriers within the general dental service made managing children with MIH difficult and participants relied on colleagues in secondary care to manage severe cases.

The effect of extraction of the lower first permanent molar on the developing third molar in children

Objective:

To find the effect of extraction of the lower first permanent molar in children (aged 8–11 years) on the position and angle of the developing third molar.

Design:

Retrospective radiographic analysis.

Participants:

Two cohorts of participants were identified: an extraction group, who had extraction of one or more first permanent molars aged 8–11 years; and a non-extraction group, who retained all mandibular teeth. Both cohorts previously had panoramic radiographs taken at mean ages of 9.7 years (T1), before extraction, and 12.12 years (T2). In total, there were 61 third molars with an associated extracted first permanent molar and 60 third molars with an associated retained first permanent molar.

Methods:

A digital radiographic analysis was carried out on the panoramic radiographs to measure the movement of the third molar, vertically and horizontally, and its angle. The magnification of the T1 and T2 radiographs was calibrated. Reliability of the radiographic analysis was confirmed via intra- and inter-rater reliability tests. The extraction and non-extraction groups were compared via independent sample tests

Results:

The third molar moved significantly more mesial in the extraction group (P < 0.001) and the angle uprighted significantly more than the non-extraction group (P < 0.001). Vertically, the third molar moved inferiorly in both cohorts with no significant difference.

Conclusion:

In the developing dentition, extraction of the lower first permanent molar encouraged mesial movement and uprighting of the developing third molar. This may improve the likelihood of future eruption of the third molar.

Worldwide trends on molar incisor and deciduous molar hypomineralisation research: a bibliometric analysis over a 19-year period

AIM

To identify the worldwide trends in scientific evidence and gaps in knowledge regarding molar incisor hypomineralisation (MIH) and deciduous molar hypomineralisation/hypomineralised second primary molars (DMH/HSPM), exploring the contribution of authors and countries, possible etiological factors and proposed treatments, in order to guide future research in the area.

METHODS

Searches were conducted in MEDLINE, Scopus, Web of Science, Cochrane Library, Lilacs/BBO, Embase and Google Scholar. Studies employing the terms MIH, DMH/HSPM and their linguistic variations were included. The following data were extracted: title, authors, year and journal of publication and first author's affiliation country. Studies were categorized according to topic, dentition, study design, etiological factors and types of treatments. Categories were analysed in relation to their distribution, co-occurrence, cross-correlation and/or autocorrelation.

RESULTS

Five hundred and three studies were included. The most published authors were Manton D (n = 47), de Souza JF (n = 22) and Ghanim A (n = 22) and four main collaboration clusters have been identified. Most of the studies were conducted on permanent dentition (MIH) (87.4%); with observational design (57.2%). The "European Archives of Paediatric Dentistry" was the most published journal (13.3%) and a significant increase in the number of publications was observed in the last decade. MIH was most studied in relation to prevalence/incidence, systemic factors involved in its aetiology and treatment with composite restorations, while a gap in knowledge was observed for extraction and sealants. Less studies were published on DMH/HSPM and most of them evaluated risk factors or prevalence/incidence. The gap of knowledge was observed in relation to treatments and patient's quality of life.

CONCLUSIONS

This bibliometric review provided a comprehensive overview of research in MIH and DMH/HSPM over the past 19 years. Within the limitations of the present study, the following conclusions can be drawn: global trends point to an increasing peak of scientific publication, especially in the last decade, while there is a shortage of clinical studies on treatments, mainly evaluating tooth extractions. Finally the multifactorial nature should be further explored, considering environmental and systemic factors together.

Parental Views on Minimally Invasive Dentistry versus General Anaesthesia Extractions of Children's Compromised First Permanent Molars: An Exploratory Qualitative Study

INTRODUCTION

The current standard of care for first permanent molars (FPMs) requiring extraction is removal of these teeth between the chronological ages of eight to ten years, as per UK guidelines.¹ This often involves a general anaesthetic (GA) with surgical admission to hospital. This study explores parental views on minimally invasive (MI) techniques as an alternative to the UK current standard of care for extractions of FPMs deemed to require removal between the chronological ages of eight to ten years.

METHODS

A qualitative investigation, using semi-structured interviews was conducted with parents/carers of children attending a teaching hospital for extraction of compromised FPMs under GA. Thematic framework analysis was used to present the findings. The consolidated criteria for reporting qualitative research (COREQ) were used as a guide to ensure quality.

RESULTS

The main themes emerging were: participants' surprise at how poor the prognosis was for their child's FPMs; acceptance that care was beyond the scope of primary care; willingness by some to undergo GA again; requests for information about the guarantee of success of MI treatment; concerns about the residual black staining from silver diamine fluoride (SDF); and acceptance of extraction spaces because of potential future failure of MI.

CONCLUSION

This exploratory qualitative study has shown that, while extraction of compromised FPMs under GA is accepted by most parents/carers, there appears to be a growing acceptance of MI approaches to restore FPMs instead of extraction of these teeth.

Extraction of first permanent molars severely affected by molar incisor hypomineralisation: a retrospective audit

AIM

The aim of this study was to evaluate possible spontaneous space closure after extraction of first permanent molars in children and their eventual need for orthodontic treatment.

METHODS

Twenty-seven children with at least one first permanent molar planned for extraction were enrolled in the study. The children were referred to the Department of Paediatric Dentistry, University of Oslo, between 2009 and 2017. All extracted teeth were severely affected by Molar Incisor Hypomineralisation and/or caries. The children and their parents had consented to extraction and follow-up. Data were analysed with SPSS 26.

RESULTS

The age of the children was between 5.5 and 12.1 years (mean 8.7) at extraction. The mean follow-up time was 3.2 years (range 1.1-6.3). Sixteen children (59.3%) had all four molars extracted, five (18.5%) had three, five had two and one had one molar extracted. In the maxilla, the second permanent molar had erupted in the place of the first molar in all the children, and none of them needed orthodontic space closure. In the mandible, eight children (29.6%) needed orthodontic treatment to close the spaces after extraction. In three children, the second molar was not yet erupted and treatment need was not settled.

CONCLUSION

Extraction of severely affected first permanent molars before the eruption of the second molar is a treatment option causing little additional treatment in the majority of cases.

Management of Patients with Poor Prognosis First Permanent Molars Beyond 'Ideal' Timing

The management of compromised first permanent molars is a common clinical conundrum in paediatric dentistry. Extensive guidance exists which supports the timed extraction of severely affected molars presenting at 8-10 years to allow favourable eruption of unaffected second permanent molars. However, treatment planning becomes more of a challenge when this window of opportunity is missed. In these situations, we are left with a tooth of guarded long-term prognosis in a patient where access and cooperation can be challenging. Delays to routine care as a result of the COVID-19 pandemic are likely to make this a more common clinical presentation so this article aims to discuss management options for these patients.

Spontaneous space closure following the extraction of the first permanent mandibular molar

Aim

The aim of this study was to determine the prognostic factors, such as the developmental stage of second permanent molar (SPM), the angulation of SPM, and presence/absence of the third molar associated with the spontaneous space closure after the mandibular first permanent molars (FPM) extraction.

Material and Methods

A total of 177 mandibular SPMs were evaluated in this cross-sectional study. The prognostic factors determining successful space closure such as SPM developmental stage, SPM angulation, and presence/absence of the third molar were evaluated.

Results

The mean age of the patients at the time of extraction of SPM was 9.4 years and post-extraction assessment at the time of the study was 12.7 years. Of the total 177 mandibular SPMs, 36 SPMs (20.3%) were at Demirjian stage D, 63 (35.6%) at stage E, 60 (34%) at stage F, 18 (10.1%) at stage G. 18 SPMs (10.1%) had distal angulation, 23 SPMs (13.0%) had mesial angulation and 136 SPMs (76.9%) had upright angulation. At the time of radiographic assessment, 79.1% of the mandibular quadrants showed evidence of third molar formation. Of the 177 mandibular SPMs, 93 (52.5%) exhibited successful space closure in the mandibular arch.

Conclusions

There is no statistical significance between the chronological age and the developmental stage of the mandibular SPM with regard to the successful spontaneous space closure at the time of the dental extraction of FPMs. The presence of the mandibular third molar may be a consideration for spontaneous space closure in the mandibular arch.

Molar Incisor Hypomineralisation: Current Knowledge and Practice

BACKGROUND

Molar incisor hypomineralisation (MIH) is a common developmental dental condition that presents in childhood. Areas of poorly formed enamel affect one or more first permanent molars and can cause opacities on the anterior teeth. MIH presents a variety of challenges for the dental team as well as functional and social impacts for affected children.

OBJECTIVES

Here, we provide an up-to-date review of the epidemiology, aetiology, diagnosis and clinical management of MIH.

MATERIALS AND METHODS

A review of the contemporary basic science and clinical literature, relating to MIH, was undertaken using information obtained (up to 10 April 2020) from the electronic databases PubMed, Scopus, Web of Science and the Cochrane Library.

RESULTS

There is a growing body of evidence relating to the aetiology, presentation and clinical management of MIH. Current knowledge appears to be focused on potential genetic aspects, as well as the development and validation of indices for the diagnosis and management of MIH. There has also been increasing recognition of the global and individual burden of this common condition.

CONCLUSIONS

Dental health professionals should regularly appraise the basic science and clinical MIH literature to ensure that they provide the best possible short- and long-term care for their young patients.

Children's dental treatment requirements of first permanent molars with poor prognosis

OBJECTIVES

This retrospective study aimed to (i) survey the correlation between decayed, missing, filled teeth (DMFT), and presence of first permanent molars (FPMs) with poor prognosis and (ii) evaluate the treatment requirements.

MATERIALS AND METHODS

Seven hundred seventy-three children with fully erupted FPMs were included in this study. DMFT for the permanent dentition, FPMs, and Global DMFT were evaluated based on clinical and radiographic evaluation. The ratio of deep dentin caries (DDC) and apical lesion presence among FPMs, including treatment requirements, were analysed. Spearman rank correlation coefficient and t tests were used for statistical analysis.

RESULTS

The caries prevalence was found at 61.4%, where the mean DMFT was calculated as 1.89 ± 2.15. There was a positive correlation between DMFT values and age (r_s = 0.27). On the other hand, there was a negative correlation between global DMFT values and age (r_s =  - 0.29). Regarding treatment needs of FPM with poor prognosis, 12.03% of the teeth needed pulpectomy, 8.93% pulpotomy, 8.93% pulp capping, and 5.3% extraction. Having higher DMFT values was correlated significantly (p < 0.01) with the presence of DDC (r_s = 0.50) and apical lesion (r_s = 0.34). Susceptibility to DDC and apical lesions was significantly higher at mandible than maxilla (p < 0.01). The correlation was significant between DMFT values and apical lesion presence (p < 0.01).

CONCLUSION

The ratio of FPMs with poor prognosis was found high in the study group. Treatment requirements of FPMs increased with age, and pulp interventions often took part in the majority. This study successfully concluded that higher DMFT values were correlated with the presence of DDC and apical lesion.

CLINICAL RELEVANCE

FPMs with poor prognosis demonstrate a risk factor for apical lesion presence.

Role of teledentistry in paediatric dentistry

Introduction As a result of the COVID-19 pandemic, teledentistry has been used more frequently due to social distancing regulations to minimise the need for face-to-face attendances. Aims Evaluate uses of teledentistry within Newcastle Dental Hospital's Paediatric Dentistry New Patient Service. Establishes potential roles of teledentistry within paediatric dentistry and advantages and disadvantages of this service method. Methods Service evaluation of 653 new patient teledentistry appointments at Newcastle Dental Hospital across a one-month period (13 May- 12 June 2020).Discussion By implementing a telephone consultation as the first point of contact with our team, we were able to reduce the number of face-to-face appointments required by over a third. Teledentistry can be used for numerous applications within paediatric dentistry including initial triage, remote assessment, reinforcement of prevention, implementing initial management and building rapport. Conclusion Teledentistry is an emerging field and has the potential to improve patient journeys, reduce waiting lists and reduce unnecessary face-to-face attendances which is especially important both within and beyond the current COVID-19 pandemic to maximise safety and minimise inconvenience for both parent and child. However, care must be taken to ensure a clinician is confident in their diagnosis prior to discharging or delaying management of a patient.

Management of molar-incisor hypomineralisation by general dental practitioners - part two: treatment

Introduction Molar-incisor hypomineralisation (MIH) is a common occurrence in primary and secondary care settings. While severe cases may need specialist care, mild cases should be managed in primary care.Aims To assess how UK-based general dental practitioners (GDPs) plan treatment for children with MIH using two clinical vignettesDesign An electronic vignette survey was designed using clinical photographs and radiographs. Vignette one presented a child with mild MIH who was unhappy about the appearance of his teeth. Vignette two presented an anxious child with severe MIH, caries and sensitivity. Further questions relating to confidence in management of MIH and referral were included. Participants were UK-based GDPs who regularly treat children. The survey was distributed by email and across social media platforms. Data collection occurred between February and May 2019.Results Fifty-eight GDPs completed the survey. Around half of participants addressed the aesthetic concerns of the child in vignette one. The majority of participants demonstrated sound treatment planning in terms of preventive care and management of molars. More GDPs identified increased caries risk in vignette two.Conclusion These findings demonstrate most GDPs in this study were working as effective tier one and two providers when faced with management of children with MIH.

Molar and Incisor Hypomineralization

Molar and incisor hypomineralization is a developmental defect that is systemic in origin that affects one or more than one permanent first molars, and is often associated with permanent incisors. It is usually characterized by well demarcated opacities and qualitative enamel defects caused by decreased inorganic enamel components, and reduced mineralization. It can cause esthetic, functional, psychological, and behavioral problems in children. Its reported prevalence varies widely, from 2.5% to 40.2%. Multiple aspects of dental treatment for it are challenging, such as behavior management, difficulty in achieving adequate local anesthesia, tooth hypersensitivity, and retention of restorations. This review discusses the most important considerations pertaining to its prevalence, severity, etiology, differential diagnosis, and some of the challenges and treatment modalities applicable in young patients. Data is collected from PubMed, Medline, and Embase databases.

For four sixes, revisited

Rarely is the extraction of the four first molars the ideal choice in the course of orthodontic treatment, particularly in older patients. Although this approach can offer distinct advantages in carefully selected patients, it is also associated with a number of well-recognized problems, including the extension of treatment times, anchorage management, and control of second molars during space closure. However, by careful use of contemporary materials and techniques, a high standard of treatment can be achieved, even in patients with complex malocclusions. This is illustrated in a report of a case that highlights both the challenges and some of the solutions this treatment modality can offer.

Adherence to RCS recommendations for extraction of first permanent molars in a teaching hospital: To compensate or not to compensate?

OBJECTIVE

To observe whether paediatric dentists and orthodontists balance and compensate the extraction of first permanent molars (FPMs) in children aged 7-11 years.

DESIGN

Service evaluation.

SETTING

UK dental teaching hospital.

METHODS

Retrospective analysis of FPM extraction patterns in patients aged 7-11 years that attended for extraction of FPMs from 1 January 2019 to 31 January 2020 (13-month period).

RESULTS

A total of 194 patients were included and they collectively had 435 FPMs extracted. No balancing extractions to prevent dental centreline shifts and no lower FPM compensatory extractions were performed. Compensatory extraction of good prognosis upper FPMs were performed in 64% (94/146) of cases to avoid overeruption. Orthodontic input was sought for poor prognosis lower FPMs in 76% of cases compared to 51% for poor prognosis upper FPMs.

CONCLUSION

Compensatory extraction of good prognosis upper FPMs to avoid overeruption appears to be a common practice at Guy's and St Thomas' Hospitals. There was also higher demand for orthodontic advice for cases presenting with poor prognosis lower FPMs compared to poor prognosis upper FPMs, which suggests that paediatric dentists may prefer for the final decision on upper FPM compensatory extractions to be made by an orthodontist, even with national guidelines available. More high-quality research on the topic is required to determine the necessity of this practice for achieving optimal long-term oral health in children.

Should we root treat children's first permanent molars?

Study selection Medline via PubMed and Embase were searched on 6 November 2019 and all studies up to this date were included, including case reports and case series. This was noted as being due to the limited number of studies available in this research area. The outcome measured was clinical success, which was defined as the tooth being present and an assumption that it was sound and asymptomatic at the end of the study. Studies that did not include a minimum of six months' follow-up were excluded, as were editorial letters, in vitro studies and studies not reported in English.Data extraction and synthesis One reviewer searched databases for appropriate studies, then a second reviewer assisted in assessing studies by title and abstract. For each eligible article the operator, sample size, and a full dental diagnosis were recorded. Treatment method, follow-up and treatment success were also assessed.Results The systematic review included eleven studies. The GRADE approach was used to assess quality of evidence. Three studies were of high quality, six of low quality, and two of very low quality. Cochrane and Robins-I risk tools were used to assess bias. All randomised controlled trials were assessed to be of high risk of bias, due to the blinding process not being stated. Six non-randomised controlled trials were assessed to be of critical risk of bias, as the measurement of treatment outcomes was not stated. There was a high risk of bias determined overall.The review reported a 90.5% (range 70-100%) success rate over a mean follow-up period of 28.4 months (range 6-73.6 months) for coronal pulpotomies, which is in line with the results from adult studies. For partial pulpotomies the review reported a 91.3% (range 78.5-100%) success rate over a mean follow-up period of 34.4 months (range 12-140 months), which is slightly lower than reported in adult studies.Only one study on conventional pulpectomies was included in the review that reported a success rate of 36% for a small sample of patients (n = 10).No studies on apexification of molar teeth were included in the review. Therefore, further evidence is required to assess the success of this therapy.One case report showed success with regenerative endodontics for a single molar. Therefore, significant further evidence will be required to assess this approach.Conclusion The systematic review ascertained that partial and coronal pulpotomies had successful treatment outcomes for treating compromised first permanent molar teeth.

Management of Molar Incisor Hypomineralisation (MIH): A 1-Year Retrospective Study in a Specialist Secondary Care Centre in the UK

(1) Background: Molar incisor hypomineralisation (MIH) is an enamel defect that affects an estimated 14.2% of children worldwide. Care takes place in primary and secondary care facilities. (2) Aim: To investigate how children with MIH are managed within a specialist centre in the north of England. (3) Method: A retrospective service evaluation within the paediatric dentistry department was registered with the clinical governance unit. Children who attended consultant-led new-patient clinics between 1 January and 31 December 2015 with a diagnosis of MIH were included. The data collected concerned the pre-referral treatment, the history and diagnoses and the treatments completed. (4) Results: Out of 397 records reviewed, 48 (12.1%) had MIH, where 81.3% and 18.8% of patients had severe and mild MIH, respectively. The majority of patients (n = 44 (91.7%)) were referred appropriately. Treatment was completed at the specialist centre for 44 (91.7%) patients. Twenty-five (52.1%) patients had an extraction of one or more first permanent molar teeth. Sixteen patients had the extractions at between 8 and 10 years old and 2 had the extractions later as part of an orthodontic plan. (5) Conclusion: Most children had severe MIH and were referred at an appropriate time to facilitate the consideration of loss of poor prognosis of first permanent molars (FPMs). Most children required specialist management of their MIH.

Orthodontic treatment of children with class II division 1 with severe MIH involving first permanent molars extractions: A case report

BACKGROUND

Class II division 1 is the most common malocclusion in Europe. When the overjet is severe, the risk of trauma on anterior maxillary teeth as well as the risk of being bullied at school is increased. From this point of view, early treatment reduces the risk of dental fracture and increases patient self-esteem. In another hand, MIH is frequent with a prevalence of around 15% in children with country specificity, and molars in particular are difficult to treat endodontically with good long-term results when the MIH is severe. In many cases when the third molars are present, the extraction of the affected teeth followed by an orthodontic treatment remains the best solution but requires adequate orthodontic mechanics.

OBJECTIVE

The purpose of this article is to display one case of class II division1 with MIH treated by orthopaedic therapy and followed by molar extractions and fixed appliance.

Minimally invasive judgement calls: managing compromised first permanent molars in children

This paper aims to update the reader on how minimally invasive (MI) techniques may be used to improve the longevity of carious or defective/compromised first permanent molars (cFPMs) in young children. Clinical and radiographic diagnosis and the prognostic factors will be discussed in view of recent studies showing that these teeth can be kept in function and have an improved prognosis as the child gets older. Clinical protocols for their care, based on the latest evidence and techniques for MI restorations, together with longevity information of possible restorative options, are described. This paper also explores the rationale behind enforced extractions and related morbidity, in order to help oral healthcare practitioners to determine the optimal management of these key elements in the dentition for the benefit of the patients.

Molar Incisor Hypomineralisation-To Extract or to Restore beyond the Optimal Age?

The management of compromised first permanent molars (FPMs) in children presents a clinical challenge to the dental team. Hypomineralised FPMs in molar incisor hypomineralisation (MIH) conditions could undergo post-eruptive breakdown, making them susceptible to caries, leading to their subsequent loss. The planned extraction of compromised FPMs is a valid alternative to complex restorative treatment. However, establishing the presence or absence of third permanent molars, amongst other considerations, is crucial to reaching a successful outcome. Clinicians should understand the importance of an orthodontic examination around the age of 8 years old with regard to establishing a differential therapeutic decision about the ideal timing of MIH-affected FPMs’ extraction in children. The aim of this article is to highlight that, with an interdisciplinary approach, a good outcome can be achieved following the extraction of poorly prognosed FPMs. The most cost-effective way of addressing MIH-affected FPMs is extraction, followed by orthodontic space closure when indicated. This obviates the need for the repeated restorative replacement and saves perfectly healthy premolars from being extracted for space creation in orthodontic treatment in several clinical scenarios.

Molar incisor hypomineralisation and dental anomalies: A random or real association?

BACKGROUND

Clinical observations suggest molar incisor hypomineralisation (MIH) may present with other dental conditions.

AIMS

The study aimed to determine the prevalence and variety of dental anomalies in children presenting with MIH.

DESIGN

A convenience sample of children referred to a UK dental hospital was recruited. Orthopantogram radiographs, taken as part of routine care, were assessed for dental anomalies. Two calibrated examiners reviewed the films separately and determined the presence and character of anomalies.

RESULTS

Radiographs were obtained from 101 patients, with an age range of 6-15 years. Co-existing hypodontia was identified in 12%, with lower second premolars being the most commonly missing teeth. Concurrent ectopic first permanent molars were identified in 8%, and infraocclusion of one or more primary molars was identified in 9%. Abnormal morphology was found in 9%, including macrodont and microdont teeth. In total, 29% of patients had an associated dental anomaly. Examiners had perfect agreement using Cohen's kappa coefficient.

CONCLUSION

This high prevalence of dental anomalies, particularly hypodontia, in children with MIH is a novel and clinically important finding. Further research is warranted considering the potential implications for assessment and treatment planning.

Success of endodontic management of compromised first permanent molars in children: A systematic review

BACKGROUND

Endodontic therapies may be required in the management of compromised first permanent molar teeth; their success in children, however, is unknown.

AIM

To determine the success of endodontic therapies used on first permanent molar teeth in children aged sixteen and under.

DESIGN

MEDLINE, Embase, Cochrane library, CENTRAL, Clinicaltrials.gov, and the ISRCTN registry as well as relevant paediatric, endodontic, and traumatology journal were searched using a detailed search strategy. References of included studies were hand-searched. A PICOS question was formulated: (P): children aged sixteen and under; (I): endodontic therapies (not pulp capping) on a first permanent molar tooth; (C): no treatment; (O): clinical success of endodontic therapy; and (S): all study types included. Bias was assessed using the Cochrane and Robins-I risk tools. Quality of evidence was assessed using the GRADE approach. Significant heterogeneity precluded meta-analysis.

RESULTS

4172 studies were retrieved and eleven were included in the narrative review. Partial and coronal pulpotomies have high success rates in the short term and long term. Limited evidence is available for conventional pulpectomy or regenerative techniques.

CONCLUSIONS

Partial and coronal pulpotomies are successful endodontic therapies for use in a compromised child's first permanent molar.

Knowledge and Management of First Permanent Molars with Enamel Hypomineralization among Dentists and Orthodontists

Purpose: Molar Incisor Hypomineralization (MIH) is a developmental enamel anomaly of systemic origin affecting the first permanent molars and often the permanent incisors. Despite MIH being a prevalent anomaly, its diagnosis and management are challenging for practitioners; including poor anesthesia, failure of restorations, rapid enamel breakdown, poor resin adhesion, and related child anxiety. This study aimed to evaluate knowledge regarding and management of MIH amongst orthodontists and dentists. Study design: The study was performed from March to September 2017 and included 336 dentists and 32 orthodontists. Questionnaires comprised questions on MIH diagnosis, socio-demographic characteristics of the subjects, and photographs of a case of MIH with related questions regarding management. Results: Our results showed that 48% of dentists and 25% of orthodontists misdiagnosed MIH; with misdiagnosis associated with graduation prior to 1986 (p < 0.001). Amongst dentists, 59% applied a fluoridated product and 34% applied fissure sealants in the case of moderate MIH. The application of fluoride was associated with graduation after 1986 (p < 0.0001).Conclusion: Large disparities about knowledge and management of MIH exist between dental practitioners in France. Education regarding diagnosis and management of MIH is necessary.

Clinical Considerations for Dental Management of Children with Molar-Root Incisor Malformations

Molar root-incisor malformation (MRIM) or molar-incisor malformation (MIM) is a new type of dental anomaly characterized by dysplastic roots of permanent first molars, occasionally second primary molars, and the crowns of maxillary central incisors. MRIM involving permanent first molars and second primary molars is characterized by normal crowns with short, thin, and narrow roots, whereas MRIM involving permanent maxillary central incisors exhibits constrictions of the crown in the cervical area. In the first case, we extracted the affected first permanent molars at the optimal timing to minimize space deficiencies and induce space closure. In addition, composite resin restorations were performed on the anterior central incisors. In the second case, a mandibular lingual arch was used to stabilize the affected teeth in order to mitigate discomfort by reducing rotational biting forces.

Correlation between the caries status of the first permanent molars and the overall DMFT Index: A cross-sectional study

To analyze whether a correlation exists between the caries status (Decayed, Missing and Filled Teeth, DMFT Index) of the first permanent molars (FPMs) and that of the full permanent dentition of Mexican adolescents, and to propose its use in large epidemiological studies of dental caries.We conducted a cross-sectional study of 1538 adolescents from 12 to 15 years old. Based on a clinical oral examination, we determined the DMFT Indices of their FPMs (FPM-DMFT) and of their full permanent dentition (comprehensive DMFT Index). We explored each FPM to determine whether it was with or without caries, filled, missing or sealed. For our statistical analysis, we used Fisher exact test and Spearman correlation in Stata software.After examining a total of 6157 FPMs, we found that 56.8% of our sample of adolescents had no caries in their 4 FPMs whereas 4.9% experienced caries in all 4. No significant differences emerged by sex (P > .05); however, by age, the older adolescents experienced greater FPM-DMFT (P < .05). Analysis yielded a correlation of r = 0.8693 between the FPM-DMFT and comprehensive DMFT scores (P < .0001) of participants. The underestimation of caries prevalence (DMFT > 0) was 5.4% (48.6% vs 43.2%), while the DMFT Index was underestimated at 0.34 (1.15 vs 0.81).The strong correlation between the FPM-DMFT and comprehensive DMFT Indices suggests that overall caries status can be inferred on the basis of FPM caries status. This evidence is useful when conducting large epidemiological studies such as national surveys.

An email triage model for personalising paediatric permanent tooth extractions under general anaesthesia

It is important that dental extractions under general anaesthesia (GA) are planned appropriately to avoid a repeat GA in the future. Current guidelines recommend the input of an orthodontist when the treatment plan involves a permanent tooth extraction but the number of children undergoing GA extractions makes this challenging. A model has been developed where the records of children planned for GA extraction of permanent teeth are triaged, via secure email, by an orthodontist. The orthodontist identifies patients where modification of the extraction pattern could be beneficial to longer-term oral health. For some patients this is possible from review of the records alone, but the triage also identifies those patients with more complex occlusal problems who require a face to face orthodontic assessment. This service review found that 22% of the patients triaged had their treatment plan modified by the orthodontist. For 76% of the patients, a review of their records was sufficient before finalising the plan and only 24% needed a further face to face orthodontic assessment. This model has been successful in reducing the burden of an additional orthodontic assessment for most patients while providing personalised care.

Management of compromised first permanent molars in children: Cross-Sectional analysis of attitudes of UK general dental practitioners and specialists in paediatric dentistry

BACKGROUND

It is unclear on how children with compromised first permanent molars (cFPMs) are currently managed in the UK by either general dental practitioners (GDP) or specialists in paediatric dentistry (SPD).

AIM

Explore the current attitudes to the management of compromised first permanent molars amongst UK general dental practitioners and specialists in paediatric dentistry.

DESIGN

Self-completed online questionnaire including three clinical vignettes of 7, 9, and 15 years old with cFPM. All registered SPDs (n = 236), as of May 2017, 500 randomly selected GDPs from England, selected from a national performers list, and 52 Scottish GDPs, part of Scottish dental practice research network, were invited to complete the questionnaire.

RESULTS

About 71.6% (n = 53) of SPDs agreed that children with cFPM should be referred to a paediatric specialist for treatment planning, whereas the reverse for GDPs is true, as 86.8% (n = 138) believe they have a responsibility to treat these teeth. Responses to clinical vignettes suggest a slight preference amongst GDPs to restore cFPM, including root canal treatment, whereas SPDs have a slight preference towards extraction.

CONCLUSION

Current pathways for cFPM, amongst UK general dental practitioners and specialists in paediatric dentistry, vary greatly between and within each professional group.

United Arab Emirates dentists' perceptions about the management of broken down first permanent molars and their enforced extraction in children: a questionnaire survey

PURPOSE

The broken down first permanent molar (BDFPM) is common in children. Enforced extractions of first permanent molars (EExFPMs) guidelines were published in the United Kingdom (UK) in 2014. We aimed to assess the knowledge and practice of dentists in the United Arab Emirates (UAE) of BDFPMs in children in light of the guidelines.

METHODS

A cross-sectional sample of UAE-based dentists treating children completed a self-administered questionnaire covering; knowledge and practice of the principle of EExFPMs; to whom dentists would refer in case of BDFPMs; knowledge of the ideal age for EExFPMs (8-10 years) and finally actual awareness of the EExFPMs guidelines. Chi-square tests (p < 0.05).

RESULTS

A total of 199 questionnaires were completed (total return rate was 66.33%). There was no agreement on how to deal with a scenario of BDFPMs. Over 85% majority believed in saving BDFPMs rather than extracting them but 89% would consult/refer to other specialists. Whilst 51% of the participants had never carried out EExFPMs in children, 69% were aware of the EExFPMs concept and 61% knew the ideal timing of a lower FPM extraction. More than 82% were unaware of the actual UK EExFPMs guidelines. Paediatric dentists would consider EExFPMs more than other groups (p = 0.007).

CONCLUSION

In the UAE dentist sample surveyed, there was a preference for preserving BDFPMs rather than extracting them in children, despite knowing when the ideal time for extraction was. Training background and specialty were influencing factors. There was a lack of awareness of the actual UK 2014 EExFPMs guidelines.

The first permanent molar: spontaneous eruption after a five-year failure

BACKGROUND

It is rare for a first permanent molar (FPM) to temporarily exhibit clinical features of failure of eruption, followed by regeneration of full eruptive capacity 5 years later. Indeterminate failure of eruption (IFE) is a diagnosis of exclusion where the distinction between primary failure of eruption (PFE) and mechanical failure of eruption (MFE) is unclear, including patients too young to specify.

CASE REPORT

An 11-year-old girl attended the orthodontic clinic at Mid Yorkshire Hospitals NHS Trust regarding an unerupted lower right FPM. Her medical and dental trauma history was unremarkable. She presented with a Class II division 2 malocclusion in the mixed dentition, with all other FPMs fully erupted.

CONCLUSION

This report documents that an unerupted FPM in an 11-year-old patient may still have the eruptive potential to become functional within the dentition. The period spent monitoring the FPM's outcome prior to surgical intervention has avoided an operation under general anaesthetic and potentially unnecessary orthodontic treatment, as the tooth subsequently erupted without treatment.

Is there sufficient evidence to support an optimum time for the extraction of first permanent molars?

AIM

To evaluate whether the literature contains evidence, of an appropriate quality, to support the fundamental belief that there is an "optimal time" for extraction of FPMs with a poor prognosis.

METHODS

A comprehensive search, limited to human studies, was performed using five databases. PICO based inclusion and exclusion criteria were employed to facilitate article selection. Three independent reviewers assessed the quality of included studies using STROBE and GRADE criteria.

RESULTS

Initially, 56 articles were selected, of which 9 were included for final assessments. None of the included studies obtained moderate or high GRADE level rating and neither did they meet all of the STROBE requirements with only one study satisfying 95%, and another study satisfying 73%, of the requirements. The inter-observer agreement was excellent.

CONCLUSION

There is no scientific evidence, of an appropriate quality, to support the "optimal time" for extraction of FPMs with a poor prognosis.