For four sixes

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.

Asymmetric Extraction Decision in Orthodontics

During the treatment planning process, extraction decisions are crucial. As a therapy option, the extraction of teeth should be considered in instances where there is a lack of facial harmony and stability in the occlusion. Treatment aims, the kind of malocclusion, aesthetic considerations, and growth patterns are all factors that influence asymmetric extraction. For the most part, premolar extractions are required when there is a significant midline difference or an asymmetrical connection between the teeth. Premolars, which are the first teeth to erupt and occupy the posterior position in chewing, are more vulnerable to injury than other permanent teeth. The optimal time to remove a second molar is at the moment when the connection between the molars has normalized or when a major front cross-bite can be remedied.

Management of children with poor prognosis first permanent molars: an interdisciplinary approach is the key

Although there have been continuous improvements in child oral health over recent decades, first permanent molars (FPMs) remain susceptible to early caries and can often be affected by hypomineralisation. We highlight current thinking in caries management and the restoration of hypomineralised FPMs, while also discussing enforced loss of these teeth within the context of interceptive extractions or extractions as part of orthodontic treatment. Compromised FPMs can negatively impact on quality of life for a child and present significant management challenges for the dental team. Although a high-quality evidence base is lacking for the different treatment options, early diagnosis and multidisciplinary treatment planning are key to achieving the best outcomes.

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.

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.

Multidisciplinary management of permanent first molar extractions

The first molar has been reported to be the most caries prone tooth in the permanent dentition. Orthodontists are treating more adult patients who are more likely to have missing and severely decayed first molars. This article will show the various orthodontic and restorative options for first molars that are already extracted or have to be extracted. The following clinical situations will be addressed: molar uprighting and its advantages for the future restoration vs orthodontic space closure, strategic extraction of salvable first molars, impacted molars, and early extraction of compromised permanent first molars in young children.

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.

The extraction of first, second or third permanent molar teeth and its effect on the dentofacial complex

The extraction of permanent molar teeth was first introduced in 1976 as a substitution for premolar extraction in cases with mild crowding. Since then, a number of studies have investigated the effect of permanent molar extraction on dentofacial harmony. Undertaking the procedure of molar extraction is most commonly recommended in response to factors such as: gross caries, large restorations and root-filled teeth, along with its application in the management of anterior open bite and reduction in crowding in facial regions. It has been indicated, however, that before undertaking the extraction of molar teeth it is important to investigate the potential influence of the procedure on other molars, with particular consideration of their eruption path. This is due to the doubt as to the effect of the exact molar teeth extraction and their consequences. In light of this, This review was undertaken to investigate and compare the effect of first, second and the third molar teeth extraction and their subsequent dentofacial complex changes.

Efficacy of intraligamentary anesthesia in maxillary first molar extraction

INTRODUCTION

Infiltration anesthesia (IA) is the method to anaesthetize maxillary teeth successfully. In contrast, intraligamentary anesthesia (ILA) has been used as supplementary anesthesia during tooth extraction, particularly when regional block anesthesia has failed. In this study, we compare the efficacy of and patient satisfaction with ILA vs IA when extracting maxillary first molar teeth.

METHODS

Forty patients were enrolled in this study and 80 maxillary first molars extracted. All patients served as their own control, with ILA as the experimental side and IA as the control side. The two techniques were compared for efficacy using a visual analog scale (VAS) and patient satisfaction compared using a verbal rating scale (VRS).

RESULTS

The mean VAS pain score for extraction using ILA was lower than that for IA (20.30±3.18 and 13.93±1.95 mm, respectively; P<0.001). For injection pain, the mean VAS pain score in the ILA side was higher than the IA side (42.28±4.51 and 31.73±3.1 mm, respectively; P<0.001). VRS results showed a higher number of patients who felt that pain during ILA was greater than expected compared with IA.

CONCLUSION

IA appears less painful during injection compared with ILA, and provides sufficient pain relief during extraction. However, ILA can be used when IA fails to achieve the desired pain suppression, as it provides higher extraction-pain relief.

Endodontic and Restorative Treatment Patterns of Pulpally Involved Immature Permanent Posterior Teeth

Objective

The study aims at investigating the treatment patterns for young permanent posterior teeth with pulp involvement.

Materials and Methods

A random sample of 1793 dental records of patients aged 6-18 years old who had received dental treatment was investigated. 663 permanent posterior treated teeth had pulp involvement. Demographic and treatment data were gathered from patients' records.

Results

Prevalence of young permanent teeth with pulp involvement was 36.9%. Treatments received significantly increased as patients' age increased (P=0.001). The first mandibular molar had the most pulp involvement among all teeth (43.89%). Temporary restoration was the most received restoration (59%). The most common pulpal diagnosis, leading to treatment, was irreversible pulpitis (43.04%). Only 19.8% of treated teeth received completed root canal treatment.

Conclusion

There is a high percentage of children and adolescents with immature permanent posterior teeth with pulp involvement. Similarly, a variety of treatment patterns is present, with a small percentage of completed root canal treatment.

Clinical Relevance

The study has identified the need to provide guidelines to provide high-quality root canal treatments for young permanent posterior teeth that have pulpal involvement. Only 21.8% of root canal treatments were completed, while 24% of teeth were extracted, and 59% of patients received temporary restorative treatments. This suggests that there might be several factors that might prevent completion of the dental treatment, such as patient preference, insurance coverage, or dentist capability. These factors and guidelines for patient care should be investigated and resolved.

Treatment of Class III Malocclusion: Atypical Extraction Protocol

The treatment of Angle Class III malocclusion is rather challenging, because the patient's growth pattern determines the success of long-term treatment. Early diagnosis and treatment are still highly discussed issues in orthodontic literature. This type of early intervention has been indicated more frequently in order to eliminate primary etiological factors and prevent an already present malocclusion from becoming severe. However, when a patient is diagnosed in adulthood, manipulation of the bone bases becomes extremely limited, as there is no longer any potential for growth. Treatments are restricted to dental compensations when possible or orthognathic surgery. However, owing to the high cost and inherent risk of the surgical procedure, this treatment option is often denied by the patient; in such a case, the orthodontist has little choice but to perform, where possible, compensatory treatments to restore a functional occlusion and improve facial esthetics. This article reports a case of Class III malocclusion in a patient who opted for compensatory treatment with lower molar extraction that allowed for correction of the midline and the overjet. Good facial esthetics and functional normal occlusion were achieved at the end of the treatment.

Extraction of four first molars: a case for a general practitioner?

It has been suggested that the extraction of four first molars 'doubles the treatment time and halves the prognosis' (Mills). It is also thought by some that these cases are unsuitable for treatment by General Dental Practitioners. The aim of this article is to illustrate that, with careful case selection, space analysis and good anchorage control, first molar extraction cases can be relatively straightforward

Permanent first molar extraction in adolescents and young adults and its effect on the development of third molar

OBJECTIVES

The aim of the present study was to determine the prevalence of permanent first molar (P1M) extraction among Turkish adolescents and young adult subpopulation, and to investigate the effects of P1M extraction on development of the third molars (3Ms) in the same quadrant.

MATERIALS AND METHODS

A retrospective study including 2,925 panoramic radiographs (PRs) taken from patients (aged 13-20 years) who were examined to identify cases of had at least one maxillary or mandibular P1Ms extracted was performed. Additionally, 294 PRs with the maxillary or mandibular unilateral loss of a P1M were used to assess the developmental grades of the 3Ms. Statistical analyses were performed by means of parametric tests after performing a Shapiro-Wilks normality test to the data.

RESULT

A total of 945 patients (32.3 %) presented with at least one P1M extraction with no gender difference (P = 0.297). There were more cases of mandibular P1Ms extracted (784 patients, 1,066 teeth) than maxillary P1Ms extracted (441 patients, 549 teeth) (P < 0.001). The development of the 3Ms on the extraction side, in the both maxilla and mandible, was significantly accelerated when compared with the contralateral teeth (P = 0.000, P = 0.000, respectively). No statistically significant differences were found in the differences in the developmental of the 3Ms between the maxilla and mandible (P = 0.718).

CONCLUSIONS

High prevalence of P1Ms extraction among Turkish adolescents and young adults shows a need for targeted dental actions, including prevention and treatment. The development of the 3Ms on the extraction side, in the both maxilla and mandible, was significantly accelerated.

CLINICAL RELEVANCE

To date, no information about prevalence of P1Ms extraction among Turkish adolescents and young adults is documented. In addition, the present study has a larger population and complementary information about 3Ms development than previous studies.

Class II treatment by extraction of maxillary first molars or Herbst appliance: dentoskeletal and soft tissue effects in comparison

AIM

To compare dentoskeletal and soft tissue treatment effects of two alternative Class II division 1 treatment modalities (maxillary first permanent molar extraction versus Herbst appliance).

METHODS

One-hundred-fifty-four Class II division 1 patients that had either been treated with extractions of the upper first molars and a lightwire multibracket (MB) appliance (n = 79; 38 girls, 41 boys) or non-extraction by means of a Herbst-MB appliance (n = 75; 35 girls, 40 boys). The groups were matched on age and sex. The average age at the start of treatment was 12.7 years for the extraction and for 13.0 years for the Herbst group. Pretreatment (T1) and posttreatment (T2) lateral cephalograms were retrospectively analyzed using a standard cephalometric analysis and the sagittal occlusal analysis according to Pancherz.

RESULTS

The SNA decrease was 1.10° (p = 0.001) more pronounced in the extraction group, the SNB angle increased 1.49° more in the Herbst group (p = 0.000). In the extraction group, a decrease in SNB angle (0.49°) was observed. The soft tissue profile convexity (N-Sn-Pog) decreased in both groups, which was 0.78° more (n. s.) pronounced in the Herbst group. The nasolabial angle increased significantly more (+ 2.33°, p = 0.025) in the extraction group. The mechanism of overjet correction in the extraction group was predominantly dental (65% dental and 35% skeletal changes), while in the Herbst group it was predominantly skeletal (58% skeletal and 42% dental changes) in origin.

CONCLUSION

Both treatment methods were successful and led to a correction of the Class II division 1 malocclusion. Whereas for upper first molar extraction treatment more dental and maxillary effects can be expected, in case of Herbst treatment skeletal and mandibular effects prevail.

Angle Class III malocclusion treated with mandibular first molar extractions

A Class III malocclusion associated with dental asymmetry is a complex diagnostic and treatment problem in orthodontics. The goals of maintaining or improving the facial profile and achieving good function are decisive factors when considering whether to plan a surgical or a nonsurgical treatment approach. A fixed appliance in combination with extractions could be considered for nonsurgical management of this type of malocclusion in the permanent dentition. This article presents the results of an orthodontic approach to a Class III subdivision malocclusion in an adult treated with mandibular first molar extractions. The extractions provided the space needed to correct the overjet and overbite and to improve the intercuspation.

Therapeutic decisions in the presence of decayed permanent first molars in young subjects: a descriptive inquiry

The aim of this exhaustive descriptive epidemiological study was to determine the clinical approach to be adopted by practitioners specializing exclusively in pediatric odontology and by orthodontists when confronted with decayed molars in children and adolescents.

MATERIAL AND METHOD

A questionnaire was sent out to all corresponding practitioners (n=2076). Six questions related to treatment decisions taken when faced with decayed permanent first molars (unfavorable short or middle-term prognosis) in patients needing, or not, orthodontic care. The Chi(2) test was used to compare responses.

RESULTS

Thirty-eight per cent of pedodontists (n=38) and 12.5% (n=246) of orthodontists answered the questionnaire. Faced with a permanent first molar with an unfavorable middle-term prognosis, 75.7% needed criteria to help them reach their treatment decision. In decreasing order of importance, these criteria were: presence of the third molar, patient motivation, inter-arch relationship, patient's oral hygiene, facial type, anterior jaw-teeth discrepancy and the number of molars to be extracted. Faced with a permanent first molar requiring extraction and when orthodontic treatment was not required, 31.7% of practitioners decided to close the maxillary space immediately as opposed to 13.4% who closed the space at the mandible. In the presence of a single decayed first molar, 68.7% of practitioners did not extract the antagonist or contralateral first molars.

CONCLUSION

These treatment decisions were not always unanimous and call for a combined approach between dental surgeon and orthodontist.

Extrações de molares na Ortodontia

O tratamento ortodôntico com extração de molares em pacientes adultos é tecnicamente mais complexo, devido a inúmeros fatores. Em geral, o espaço a ser fechado é maior do que o espaço dos pré-molares e, por isso, a ancoragem é crítica e o tempo de tratamento mais longo. É comum esses casos apresentarem algum grau de comprometimento periodontal por causa da idade dos pacientes e, portanto, necessitam de maior controle da mecânica ortodôntica para reduzir os efeitos colaterais do fechamento do espaço. Por isso, bons resultados de finalização são mais difíceis de ser alcançados. Sendo assim, este artigo tem como objetivo apresentar as razões para a indicação de extração de molares nos tratamentos ortodônticos, as contraindicações, as diferentes fases da mecânica ortodôntica, esclarecer os fatores envolvidos nesse tipo de planejamento e tratamento e apresentar casos clínicos tratados com extração de molares.

Compromised first permanent molars: an orthodontic perspective

The first permanent molar (FPM) is commonly subject to significant compromise which may arise due to caries or endodontic complication, or from developmental anomalies such as hypoplasia. Compromised teeth with questionable prognosis may result in short and long-term clinical dilemmas. This review article highlights the factors that require careful consideration when a compromised FPM is detected and the importance of timely FPM extraction. Several clinical cases are described in detail to discuss possible treatment options from the orthodontic perspective.

Effects of first molar extraction on third molar angulation and eruption space

OBJECTIVES

The aim was to investigate the effects of orthodontic treatment with 4 first molar extractions on the angulations and eruption spaces of all third molars and to compare these changes with outcomes of nonextraction samples used as a control group.

STUDY DESIGN

This study was carried out on standardized panoramic radiographs of 41 subjects (8 male, 33 female) with a mean age of 16.6 years (range 13 to 20 years). Twenty-one of the subjects were orthodontically treated with extraction of the 4 first permanent molars, and 20 had nonextraction treatment. The angulational changes and eruption spaces of third molars were evaluated on the panoramic radiographs taken before treatment and at the end of the observation period.

RESULTS

Analysis of the linear variables demonstrated a statistically significant difference between the 2 groups for all third molar eruption spaces (P < .001). The mean differences in the third molar eruption spaces between the pretreatment and posttreatment values for the first molar extraction group were higher than those of the nonextraction cases.

CONCLUSION

Orthodontic treatment accomplished with extractions of the permanent first molars increases the eruption spaces of third molars and decreases their impaction. In addition, it has greater favorable effect on the angulation of the upper third molars than of the lower third molars.

Running loop in unusual molar extraction treatment

Running loops have been used in mandibular second premolar extraction treatment instead of cherry or shoehorn closing loops in the Tweed technique. They can also be used when molar extraction patterns are unusual or if molars are missing or hopeless, or have extensive restorations. A running loop archwire is usually made of 0.018 x 0.025-in stainless steel, with a helical loop 5 mm mesial to the buccal tube. The effective tipback is usually about 20 degrees to 30 degrees to upright molars, and a slight toe-in is necessary to prevent mesiolingual rotation. As the extraction space closes, the distance between the running loop and the buccal tube is shortened. Then a helical loop can be moved mesially to maintain the distance and the force between them by simple archwire manipulation. Consequently, the extraction space can be closed with 1 running loop archwire after initial leveling.

Extraction of maxillary first permanent molars in patients with Class II Division 1 malocclusion

INTRODUCTION

Our objectives were to assess treatment outcomes in Class II Division 1 patients who were treated orthodontically with extraction of the maxillary first permanent molars and to describe the changes in their facial profiles.

METHODS

This was a prospective, longitudinal, 1-group outcome analysis in a private practice, with outcome evaluation by independent observers at an academic clinic. One hundred consecutively treated patients were enrolled prospectively and treated by 1 orthodontist. The inclusion criteria were white, Class II Division 1, sagittal overjet of > or =4 mm, extraction of maxillary first permanent molars, no missing teeth or agenesis, maxillary third molars present, and 1-stage full fixed appliance treatment. Standardized lateral cephalometric radiographs were made before and after active treatment. Occlusal outcome was scored on dental casts by comparing pretreatment and posttreatment casts with the peer assessment rating (PAR) index. Backward regression analysis was used to explain the soft-tissue changes on the basis of dental changes and the soft-tissue characteristics.

RESULTS

The mean reduction in weighted PAR score was 89.9% (SD, 0.9). During treatment, the lower lip retruded 1.6 mm (SD, 1.7) relative to the esthetic line. The nasolabial angle became 2.1 degrees (SD, 7.0) more obtuse during treatment. Overjet reduction and initial upper lip thickness could explain 15% of the variation in upper lip position. The changes in the position of the mandibular incisor relative to the Point A-pogonion line and initial lower lip thickness could explain 23% of the variation of lower lip position.

CONCLUSIONS

Orthodontic treatment involving extraction of the maxillary first permanent molars has a good treatment outcome. Extraction of the maxillary first permanent molars has only a small effect on the soft-tissue profile.

Evaluation of spontaneous space closure and development of permanent dentition after extraction of hypomineralized permanent first molars

AIM

The aim of this study was to evaluate spontaneous space closure, development of the permanent dentition, and need for orthodontic treatment after extraction of permanent first molars due to severe molar-incisor hypomineralization (MIH).

SUBJECTS

Twenty-seven children aged 5.6-12.7 (median 8.2) years 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.

RESULTS

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.

CONCLUSION

Extraction of permanent first molars severely affected by MIH is a good treatment alternative. Favourable spontaneous space reduction and development of the permanent dentition positioning can be expected without any intervention in the majority of cases extracted prior to the eruption of the second molar.

Extraction of first permanent molar teeth: results from three dental hospitals

OBJECTIVE

To evaluate and compare the reasons for and pattern of extraction of first permanent molars (FPMs) in three UK dental hospitals.

DESIGN

Prospective multicentre study.

SETTING

Hospital.

SUBJECTS

Three hundred children attending Manchester Dental Hospital, Liverpool Dental Hospital and Charles Clifford Dental Hospital (Sheffield) who required extraction of at least one FPM.

RESULT

The mean age in months was 129 (SD 22.7), 139 (SD 29.4), and 133 (SD 26.8) for Manchester, Liverpool and Sheffield respectively. Forty-five percent and 48% of children had four FPMs extracted at Manchester and Sheffield respectively, compared to 25% in Liverpool. The main reason for extraction was caries with poor prognosis (70%); molar incisor hypomineralisation was the reason for extraction in 11% of cases. General anaesthesia was the main anaesthetic method used in 77%, 55%, and 47% of cases in Manchester, Liverpool and Sheffield respectively. Sixty-eight percent of cases had not received previous treatment for the FPMs and 5% had fissure sealants detected. Forty percent of children had had previous extractions.

CONCLUSION

The children who are attending the hospitals for extraction of FPMs tend to be older than the recommended age for achieving spontaneous space closure. This study highlights the need for extensive prevention programs targeted at those children with high caries risk.

Bilaterally impacted maxillary canines and multiple missing teeth: a challenging adult case

AUTHORS: Mesotten K, Naert I, van Steenberghe D, Willems G.

OBJECTIVES

Orthodontic correction of bilateral maxillary canine impaction with agenesis of the lower second premolars and extraction of the lower first molars in an adult patient.

METHODS

After surgical exposure, the canines were relocated in the arch by means of immediate orthodontic traction. Endosseous Branemark system implants were inserted in the lower jaw with a double purpose: stabilization of orthodontic anchorage and prosthetic tooth replacement.

RESULTS

Closure of the edentulous space in the lower arch was accomplished by a multidisciplinary approach while orthodontic correction of the initial malocclusion was achieved.

CONCLUSION

Implants provided anchorage control for tooth movement and created the possibility of prosthetic rehabilitation through a multidisciplinary treatment approach.

Prevalence of pulpally involved permanent teeth in Saudi schoolchildren

OBJECTIVE

To determine the prevalence of pulpally involved permanent teeth in children and adolescents aged 6-18 years in Saudi Arabia.

METHOD

A systematic random sample was collected from the primary care files in the College of Dentistry in Riyadh. Data were collected from a total of 997 files and entered into a database and statistical program.

RESULTS

A high prevalence rate of 35.8% of individuals with pulpally involved teeth was found. More extractions, pulp cappings, and root canal treatments were provided as the age increased. In all age groups molars were the most affected, and canines were the least. Maxillary incisors were affected more than mandibular incisors, while mandibular molars were affected more than maxillary molars. Females had more pulpally involved teeth than males.

CONCLUSIONS

It is suggested that early oral interventions, prevention and dental education for the patients and their families may decrease this high prevalence level of pulpal involvement in teeth in this age group.

Orthodontics. Part 8: Extractions in orthodontics

Extractions in orthodontics remains a relatively controversial area. It is not possible to treat all malocclusions without taking out any teeth. The factors which affect the decision to extract include the patient's medical history, the attitude to treatment, oral hygiene, caries rates and the quality of teeth. Extractions of specific teeth are required in the various presentations of malocclusion. In some situations careful timing of extractions may result in spontaneous correction of the malocclusion.