Ectopic Eruption of First Permanent Molars for Pediatric Patients Attended King Saud University, Riyadh, Saudi Arabia: A Radiographic Study

Self-correction of the ectopic eruption of the maxillary first permanent molar and its predictive factors: A systematic review

BACKGROUND

Ectopic eruption of the maxillary first permanent molar is a local disturbance that affects the development of the occlusion.

AIM

To evaluate the occurrence of self-correction of maxillary first permanent molar's ectopic eruption and its predictive factors.

DESIGN

Five electronic databases and part of the gray literature were investigated. The risk of bias was assessed using the Newcastle-Ottawa scale and the certainty of evidence using the GRADE tool.

RESULTS

Four studies were selected: Three had a low risk of bias, and one, moderate. Evidence with a moderate level of certainty was generated, indicating a possibility of 47%-78% of spontaneous correction up to 7 years of age. Supporting the prognosis, whether reversible or irreversible, there was a positive correlation between the severity of the atypical distal resorption of the second primary molar, a higher magnitude of impaction, a larger eruption angle, and a bilateral occurrence with the irreversibility of the cases.

CONCLUSION

Spontaneous correction of the ectopic eruption of the maxillary first permanent molar is feasible and dependent on the severity of predictive factors. Early intervention is mandatory in irreversible cases.

Guidance of Erupting First Permanent Molar in Complex Clinical Scenarios: A Case Series

Aim

The aim of this current case series is to propose various design modifications of the conventional distal shoe space maintainers in relation to complex clinical scenarios.

Background

Primary dentition plays a significant role in preserving space for underlying unerupted permanent teeth; early childhood caries (ECC) is a serious public health problem in both developing and developed countries, and it is often left untreated. Its consequences can have an immediate and long-term impact on the child's quality of life and overall health. Premature loss of primary dentition can result in loss of arch length, thereby hampering the eruption of the succeedaneous tooth, which can further lead to malalignment, crowding, rotation, and impaction of the permanent teeth. Space maintainers are advocated in cases where extraction of primary molars is inevitable. In the early loss of the second primary molar, a distal-shoe space maintainer is advocated to guide the eruption, as well as prevent mesial migration of the first permanent molar (FPM) during the eruption. In clinical scenarios where multiple losses of deciduous molars occur bilaterally, obtaining adequate anchorage is questionable and futile. The following clinical modifications, however, are useful in overcoming the problems related to the same. The following case series intends to project various modifications of distal shoes in complex scenarios.

Case description

Various modifications of the distal shoe have been proposed in our current case series. The appliances were adjusted individually on a case-to-case basis depending on the clinical scenario. A 1-year clinical follow-up was carried out on all the patients.

Conclusion

All the clinical modifications were successful in guiding the eruption of a FPM; there were no complications during any follow-up visit.

Clinical significance

In cases where the traditional design is not indicated, certain modifications in distal shoes by adding new components to the appliance will allow the appliance to be placed and the space to be maintained effectively. Along with this, reinforcement of parents and the child for oral hygiene maintenance will maintain the remaining healthy tooth structure and increase the success of treatment.

How to cite this article

Gunjal PY, Chauhan RS, Tirupathi S, et al. Guidance of Erupting First Permanent Molar in Complex Clinical Scenarios: A Case Series. Int J Clin Pediatr Dent 2024;17(3):362-367.

Prevalence and Severity of Ectopic Eruption of First Permanent Molars in Pediatric Patients in Makkah, Saudi Arabia

Background Early detection and management of ectopic eruption (EE) of first permanent molars (FPMs) are crucial to avoid complicated treatments later. Aim This study aimed to assess the prevalence and severity of EE of FPMs among children in Makkah, Saudi Arabia. Methods This retrospective study was based on a radiographic evaluation of 1,008 dental panoramic radiographs performed for children attending the Dental Educational Hospital at Umm Al-Qura University and the Security Forces Hospital in Makkah. Patients' age, sex, tooth location, and severity of EE were assessed. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline for cross-sectional studies.  Results Of the 1,008 reviewed cases, 18 (1.79%) were diagnosed with EE of FPMs. Among the 11 male patients, 81.82% showed severe EE, while 57.14% exhibited moderately severe EE among the seven female patients. The prevalences of EE in the maxilla and mandible were 1.59% and 0.20%, respectively. In contrast, the occurrence of EE of FPMs was similar between the right and left sides. Conclusion In this study, the prevalence of EE of FPMs among children in Makkah was 1.79%. The frequency and severity were both greater in male patients compared to female patients. While significantly more EE of FPMs was observed in the maxilla than in the mandible, there was no significant difference between the right and left sides.

Ectopic Permanent Molars: A Review

Ectopic permanent molar is a condition in which the permanent tooth deviates from its normal path of eruption. The etiology of this eruption anomaly is multifactorial, with both general and local factors. The principal results suggest that a valid indicator of irreversible consequences is the degree of impaction of the first permanent molar. Self-correction is most common between the ages of 7 and 8, after which help may be required. Accordingly, early management can assist in preventing subsequent potential challenges that could interfere with maintaining a balanced occlusion. Several variables, including the degree of mesial tilting, the level of root resorption, and the condition of the second primary molar, may be crucial in choosing the most effective method of treatment. Interproximal wedging and distal tipping are the two basic therapeutic strategies for ectopic permanent molars. Additionally, the use of fixed or removable appliances might also be required. Delaying treatment until a later stage is not recommended because early diagnosis and treatment are essential for optimal management. This review aims to provide a comprehensive overview of ectopic permanent molars, including their prevalence, etiologic factors, self-correction rates, clinical implications for adjacent teeth, and various treatment techniques, that emphasizes the importance of early detection and intervention in the successful management of ectopic permanent molars. In addition, it highlights the importance of future research into the contributing variables of irreversible ectopic molar outcomes.