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

Factors related to spontaneous space closure following early first permanent molar extraction: A systematic review

BACKGROUND

Dental caries and molar-incisor hypomineralization (MIH) are primary reasons for the extraction of first permanent molars (M1) in children, which can lead to significant dental and facial development issues such as a midline shift and temporomandibular joint disorder.

AIM

This systematic review aimed to identify key factors influencing spontaneous space closure following the early extraction of first permanent molars (M1) in children aged 5-15.

DESIGN

We conducted a comprehensive search across Scopus, PubMed, Dimensions, Web of Science, and Cochrane databases, including the literature from 1960 to 2024. The inclusion criteria focused on clinical trials, case-control, cross-sectional, cohort studies, and case series that evaluated the impact of various factors on the spontaneous closure after M1 extraction.

RESULTS

The analysis highlights that chronological age and the developmental stage of the second permanent molars (M2) at the time of extraction are significant predictors of successful spontaneous space closure. Additionally, the presence and angle of M2, along with the presence of third permanent molars (M3), play crucial roles but require further investigation.

CONCLUSION

Early assessment of M2's developmental stage and inclination, and the presence of M3 are essential for enhancing the likelihood of successful spontaneous space closure following M1 extraction in children.

Clinical risk factors caused by third molar levelling following extraction of a mandibular second molar

BACKGROUND/OBJECTIVES

Mandibular second molar (MdM2) is often lost, and its space is filled with a bridge or implant. MdM2 extraction followed by orthodontic treatment protracting mandibular third molar (MdM3) towards the MdM2 position may overcome the missing of MdM2. The objectives of our study were to describe the outcome of the procedure and examined clinical risk factors such as external apical root resorption (EARR) and alveolar bone loss (ABL), as the indicators of poor orthodontic treatment outcomes.

MATERIALS/METHODS

This retrospective study included 70 cases in 56 patients who received orthodontic treatment at Tokyo Medical and Dental University Hospital between 2007 and 2018. Multi-bracket appliances were used in all patients for MdM3 protraction. Using linear mixed effects models, EARR and ABL were regressed on various factors, including panoramic and cephalometric variables.

RESULTS

With the mean treatment duration of 1040.4 ± 441.8 days, MdM2 space closure was achieved in 92.8% (65 cases). The ANB angle (P = .023) and the use of temporary anchorage devices (TADs) (P = .021) were significantly associated with the greater EARR, while the mandibular plane angle (P = .033) was associated with the greater ABL. MdM3 protraction using the fixed appliances resulted in the closure of MdM2 space in > 90% of cases without evident root resorption.

LIMITATION

There is a possibility of residual confounding due to the nature of observational study.

CONCLUSION/IMPLICATION

Orthodontic treatment of MdM3 protraction may be a feasible strategy to close the space of the missing MdM2.

Expert consensus on orthodontic treatment of protrusive facial deformities

Protrusive facial deformities, characterized by the forward displacement of the teeth and/or jaws beyond the normal range, affect a considerable portion of the population. The manifestations and morphological mechanisms of protrusive facial deformities are complex and diverse, requiring orthodontists to possess a high level of theoretical knowledge and practical experience in the relevant orthodontic field. To further optimize the correction of protrusive facial deformities, this consensus proposes that the morphological mechanisms and diagnosis of protrusive facial deformities should be analyzed and judged from multiple dimensions and factors to accurately formulate treatment plans. It emphasizes the use of orthodontic strategies, including jaw growth modification, tooth extraction or non-extraction for anterior teeth retraction, and maxillofacial vertical control. These strategies aim to reduce anterior teeth and lip protrusion, increase chin prominence, harmonize nasolabial and chin-lip relationships, and improve the facial profile of patients with protrusive facial deformities. For severe skeletal protrusive facial deformities, orthodontic-orthognathic combined treatment may be suggested. This consensus summarizes the theoretical knowledge and clinical experience of numerous renowned oral experts nationwide, offering reference strategies for the correction of protrusive facial deformities.

Therapeutic extraction of second molars in orthodontics: a scoping review

OBJECTIVE

To review the literature to identify the present evidence on the extraction of second molars in orthodontics.

MATERIALS & METHOD

A search of the MEDLINE/PubMed®, Scopus, Web of Science™, and ProQuest® databases for full-text articles was done on March 5, 2024. The search went back till the 1st of January 1991 and was limited to articles in English. The results of the first search went through a preliminary check to remove duplicates and then the titles and abstracts of the articles were read to exclude the irrelevant studies, case studies, or reviews. The abstracts of the selected studies were read carefully to verify if the inclusion criteria were met. Finally, the full texts of the potentially eligible studies were read to apply the eligibility criteria and decide whether to include them in the review or not. The eligibility criteria were set following the PICO (population, intervention, comparison, and outcome) standard. The included studies were thoroughly summarized by extracting the most important information.

RESULTS

The electronic search located a total of 103 articles distributed among the databases. Removing duplicates left 48 Studies. After careful assessment of the titles and abstracts, 32 studies were excluded leaving 16 studies. Applying the inclusion/exclusion criteria resulted in the exclusion of 2 studies and including 14 studies in the scoping review.

CONCLUSIONS

There is quite low level of evidence to support second molar extraction in orthodontics. Conducting a systematic review would not add much to the evidence as well-conducted RCTs are needed first.

Factors influencing treatment decisions in permanent mature teeth with irreversible pulpitis: a questionnaire-based study

BACKGROUND

Decision-making in dentistry is a complex process, and this study evaluated factors that influence dentists' approaches in permanent mature teeth with irreversible pulpitis.

METHODS

An online questionnaire was distributed to a group of dental practitioners. The questionnaire surveyed dentists' opinions about the management of vital permanent teeth with irreversible pulpitis including a case scenario.

RESULTS

Data from 262 respondents were analysed. Barriers to perform vital pulp therapy (VPT) included presuming it an inappropriate long-term treatment (29.7%), lack of knowledge, insufficient access to materials, inadequate training and lack of confidence. Patient's preference (79.44%) and tooth restorability (91%) were the most frequently reported factors influencing treatment decisions. Dentists aged 25-35 years and who have 1-5 years of experience ranked extraction as a more successful treatment (P = 0.008; P = 0.003, respectively). Non-Australian graduates ranked pulpotomy to be a more successful procedure (P = 0.007), and public sector/hospital practitioners favoured extraction more than practitioners from other sectors (P = 0.003). Postgraduates/specialists preferred pulpotomy (P = 0.012) more than general dentists. Participants' clinical approaches for the management of symptomatic irreversible pulpitis: root canal treatment (45.0%), indirect pulp capping (22.9%), direct pulp capping (15.8%), pulpotomy (17.1%) and extraction (6.3%).

CONCLUSIONS

Female, more experienced, overseas-educated dentists and endodontists preferred VPT for irreversible pulpitis in permanent mature teeth more than other participants. © 2024 Australian Dental Association.

Second molar eruption disturbances in borderline extraction orthodontic patients

INTRODUCTION

Nonextraction treatment is associated with a greater prevalence of third molar impactions, whereas data on second molars are lacking. This study investigated whether there is a difference in the prevalence of second molar eruption disturbances when crowding is treated with or without extractions.

METHODS

Patients were grouped by maxillary and mandibular crowding, including mild crowding (<5 mm) without extractions, borderline crowding (5-9 mm) without extractions, and borderline crowding with extractions. The 535 evaluated arches were from 346 patients aged 10-15 years with unerupted second molars at treatment start. The frequency and severity of second molar eruption disturbances were scored in final records using a severity classification based on a modified Archer system, a hybrid Archer Pell-Gregory system, and a partial impaction scale. Pretreatment panoramic radiographs were scored for impaction-risk indicators. Fisher exact test was used.

RESULTS

In the maxilla, 20.0% of nonextraction patients with borderline crowding had second molar eruption disturbances compared to 5.2% of extraction patients with borderline crowding (P = 0.010). In the mandible, 27.6% of nonextraction borderline crowding patients had second molar eruption disturbances compared to 7.1% of extraction patients with borderline crowding (P = 0.006). There was no difference in the frequency of eruption disturbances between mild crowding without extractions and borderline crowding without extractions. The prevalence of impactions was higher in the maxilla when molars were apically positioned and in the mandible when molars were mesially angulated or had insufficient space pretreatment.

CONCLUSIONS

In patients with borderline crowding, extraction treatment reduces the risk of second molar eruption disturbances; however, nonextraction treatment does not increase the risk when compared with patients with mild crowding. When considering extractions for crowding, providers should evaluate second molar impaction-risk indicators on pretreatment radiographs.

Influence of the maxillary third molars and the surrounding cortical plate during maxillary tooth movement with TADS- A CBCT Study

OBJECTIVE

To determine the influence of the presence/absence of third molars and intact/loss of cortical plate of the maxillary tuberosity on the amount of distal movement of the maxillary first permanent molar during distal movement of the maxillary dentition with mini-implants.

MATERIALS AND METHODS

Thirty six maxillary tuberosity sites were evaluated in eighteen young adult patients. The distal movement of the entire maxillary dentition was performed with mini-implants with 200 g of distalising force applied from the mini-implant placed in the maxillary posterior buccal region to attachments placed on the arch wire between the maxillary lateral incisor and canine bilaterally. The distal movement of the maxillary first permanent molars was measured on lateral cephalograms. The maxillary tuberosity sites with intact cortical plate due to congenitally missing third molars or atraumatic extraction of third molars (G1), partial loss of cortical plate due to surgical removal of third molars (G2), fully erupted third molars (G4), third molars located at (G3), and below the cementoenamel junction (G5) were evaluated with cone beam computed tomography. One way Anova and Fisher LSD test was done.

RESULTS

The order of greater to lesser amount of distal movement of the maxillary first permanent molar depending on the integrity of maxillary of tuberosity was partial loss of cortical plate, third molars at the cementoenamel junction, third molars below the cementoenamel junction, intact cortical plate and fully erupted third molars.

CONCLUSION

The integrity of the cortical plate and the relative position of the maxillary third molar to the second molar influence the amount of distal movement of the maxillary first permanent molar during distal movement of the maxillary teeth with TADS.

CLINICAL RELEVANCE

The amount of distal movement of the maxillary dentition appears to depend on the presence or absence of the third molars and the condition of the cortical plate in the region of the maxillary tuberosity and thereby greatly influence the outcome of treatment.

Bilateral distalization of maxillary first molars in a group of adult patients after extraction of maxillary second molars using infra-zygomatic mini-implants: A prospective clinical trial

BACKGROUND

It is now possible to predictably distalize maxillary first molars in nongrowing patients with the infra-zygomatic gear distalizer and to improve malocclusions without having to extract the premolars and regardless of the patient's compliance. The purpose of this study was to investigate the amount and rate of distal movement of the maxillary first molars using our proposed appliance after extraction of maxillary second molars.

METHODS

Ten nongrowing female patients successfully treated with our proposed appliance were the subjects of this study. The amount, rate, and type of distalization, were analyzed through upper jaw cone beam computed tomography (pre- and post-treatment) and scanned casts taken on a monthly interval.

RESULTS

The average amount of distalization of the maxillary first molars was 4.03 mm at the crown level and 2.88 mm at the root level. The rate of distalization had an average of 0.61 mm per month with a maximum of 0.79 mm in the first month because of the regional acceleratory phenomena after extracting the maxillary second molar.

CONCLUSIONS

The maxillary first molars were distalized in a significant manner and all patients reached a Class I relation within an average duration of 6.4 months. The proposed appliance proved to be a viable noncompliance modality to distalize maxillary first molars correcting maxillary Class II malocclusions characterized by maxillary protrusion or maxillary incisor crowding.

Vital pulp therapy-Factors influencing decision-making for permanent mature teeth with irreversible pulpitis: A systematic review

BACKGROUND

There is an increased tendency towards adopting minimally invasive interventions in dentistry, supported by advancement in materials and techniques. However, the decision-making process in choosing conservative or invasive treatments is influenced by several factors, particularly in permanent teeth with irreversible pulpitis.

OBJECTIVES

The objective of the study was to systematically review the literature regarding factors that influence decision-making for vital pulp therapy (VPT) as definitive treatment option in permanent mature teeth diagnosed with irreversible pulpitis.

METHODS

Two independent reviewers searched five electronic databases (PubMed, Embase, Web of Science, Scopus and Cochrane Library). Grey literature was searched through Google Scholar and contact with experts. Defined search keys were applied, and all peer-reviewed literature published with no language nor publication date limits were included. The All studies investigating the factors influencing treatment decision-making in mature permanent teeth with irreversible pulpitis were included. The quality of included studies was assessed by two independent reviewers using the Joanna Briggs Institute quality assessment tool.

RESULTS

Six articles were included in the review. All included studies used questionnaires to characterize clinician preferences and attitudes in choosing treatment options for mature permanent teeth with irreversible pulpitis. The available evidence suggests that dentist-related factors have a significant influence on the chosen treatment in teeth with irreversible pulpitis, with speciality training and years of experience influencing the choice of VPT over other treatment options. COVID-19 reportedly swayed the dentists' decision to favour VPT. Only one article studied the influence of patient-related factors, such as age and presence of spontaneous pain on decision-making. Of note, a history of cardiovascular disease moved dentists towards prescribing VPT.

DISCUSSION

Collectively, the included studies demonstrated an overriding influence of dentist-related factors on choosing among treatment options for painful teeth diagnosed with irreversible pulpitis. Patient-related factors were acknowledged but there are also potential factors such as socio-economic constraints that were not included in the component studies.

CONCLUSION

In teeth with irreversible pulpitis clinicians educational background influence the decision towards a specific treatment option. Further data, preferably derived from clinical records, is necessary in future investigations to explore the effect of other important factors related to both dentists and patients.

REGISTRATION

PROSPERO database (CRD42022339653).

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.

COVID-19 Reflections on Restorative Treatments of Permanent First Molars

BACKGROUND AND AIM

It is important to provide appropriate dental care for newly erupted permanent first molars (PFMs) since they are susceptible to caries. As the coronavirus disease 2019 (COVID-19) pandemic has led to significant changes in the way dental services are provided to patients, the purpose of this study is to examine the procedure records assigned to PFMs of 6-15 year-olds during the pandemic and analyze the restorative material preferences of the residents of public dental hospitals.

MATERIALS AND METHODS

Procedure records of patients aged between 6-15 years were extracted from the Public Oral and Dental Health Center, Bursa, Türkiye. All teeth groups except PFMs were excluded, while extracted, survived (restorative/endodontic/prosthetic procedures), and prevented (fissure sealant application) PFMs were analyzed retrospectively. Furthermore, restorative material preferences were analyzed by arch location, cavity surfaces, and dentition types.

RESULTS

Strong positive correlation was seen between age and PFM extraction (r=0.973; p<0.001) and age and PFM restorative treatments (r= 0.966; p<0.001); a negative correlation was detected between age and fissure sealants (r= -0.984; p<0,001) performed on PFMs of 8-15-year-olds. Amalgam was most often preferred as the restorative material (p<0.05).

CONCLUSION

The distribution of treatments and dental restorations can vary based on many factors, and the pandemic conditions may have changed treatment preferences to favor preventive dentistry. The excess of multi-surface restorations may be related to the delay of treatment applications during COVID-19.

Effects of Rigid and Nonrigid Connections between the Miniscrew and Anchorage Tooth on Dynamics, Efficacy, and Adverse Effects of Maxillary Second Molar Protraction: A Finite Element Analysis

Introduction

Direct, rigid indirect, and nonrigid indirect absolute anchorages using temporary anchorage devices (TADs, mini-implants/miniscrews) can provide promising opportunities for challenging, yet common, orthodontic tooth movements such as molar protraction. Rigid rectangular wire and ligature wire are the most common methods of attaching a tooth to a miniscrew in indirect anchorages. We aimed to provide a comparison of the rigidity of the connecting wire in terms of stress on the miniscrew, the anchorage loss, and the risk of root resorption using finite element analysis (FEA).

Methods

The maxillary right second molar was protracted into the proximal space at a 150 g load (1) using direct absolute anchorage with a tapered miniscrew implanted between the premolar roots and using indirect absolute anchorage with the second premolar reinforced by the miniscrew through (2) a rigid stainless steel (SS) wire or (3) a nonrigid SS ligature wire (4) at different elastic moduli. Stresses and displacements of 4 models' elements were measured. The risk of external root resorption was evaluated.

Results

Connecting the tooth to the miniscrew using rigid full-size wire (model 2) compared to ligature (model 3) can give better control of the anchorage (using the ligature wire, the anchorage loss is 1.5 times larger than the rectangular wire) and may reduce the risk of root resorption of the anchorage unit. However, the risk of miniscrew failure increases with a rigid connection, although it is still lower than with direct anchorage. The miniscrew stress when using a ligature is approximately 30% of the rigid model using the rectangular wire. The miniscrew stress using the rectangular wire is approximately 82.4% of the miniscrew stress in the direct model. Parametric analysis shows that the higher the elastic modulus of the miniscrew-tooth connecting wire in the indirect anchorage, the less the anchorage loss/palatal rotation of the premolars/and the risk of root resorption of the anchorage teeth and instead the stress on the miniscrew increases.

Conclusions

Direct anchorage (followed by rigid indirect anchorage but not nonrigid) might be recommended when the premolars should not be moved or premolar root resorption is a concern. Miniscrew loosening risk might be the highest in direct anchorage and lowest in nonrigid indirect anchorage (which might be recommended for poor bone densities).

Follow-up of patients subjected to direct and indirect pulp capping of young permanent teeth. A retrospective study

OBJECTIVE

A retrospective study of the success rate of direct pulp capping (DPC) and indirect pulp capping (IPC) was carried out in children between 6-14 years-old, considering separately primary caries or caries affecting teeth with molar incisor hypomineralization (MIH).

MATERIAL AND METHODS

Data were collected in a dental public health service. Following the inclusion criteria, 232 treatments were analyzed. Success was defined by the presence of a functional tooth without clinical signs or symptoms of pulpal or periapical disease. The success rate was correlated to patient gender, the affected tooth and the indication of therapy using the chi-squared and Fisher exact test. The success time related to treatment type was evaluated through the Mann-Whitney test.

RESULTS

The IPC and DPC success rate was 99.4%, and 84.6%, respectively (p = .01). Success was significantly lower when caries affected teeth with MIH than when caries affected teeth without MIH (p = .01). The mean survival for DPC and IPC was 14.07 ± 1.30 and 15.98 ± 0.80 months, respectively (p = .07).

CONCLUSIONS

When caries were located in teeth that were not affected by MIH, IPC was significantly more successful than DPC, but did not differ significantly when caries were placed in teeth with MIH. Key points Minimally invasive therapy is a successful approach for decayed young permanent teeth. The success of IPC was greater than the success of DPC wen caries was placed in teeth not affected by MIH. In teeth not affected by MIH the success of DPC or IPC did not differ significantly.

ANALYSIS OF DENTAL CARIES IN THE PERMANENT FIRST MOLARS AND RELATED FACTORS WITH CHILDREN AGED 10–12 YEARS IN SOUTHERN CHINA

In order to investigate and analyze the caries status of permanent first molars (PFMs) in children aged 10 to 12 years in Southern China and to analyze the related factors, from January to August 2019, a multi-stage, stratified, cluster, and random sampling method had been used to select 6208 children from 22 schools in Guangzhou city for oral health examinations and questionnaires. The total caries rate of the PFMs was 39.40%, total DMFT score was [Formula: see text], the filling rate of caries was 3.38%, and the rate of fissure sealant was 5.89%. The percentage of PFM caries was statistically significant between female and boys, urban and rural areas, only-children and non-only children, and between ethnic minorities and Han ethnic groups ([Formula: see text]). The difference between urban and rural areas was statistically significant ([Formula: see text]). Multivariate logistic regression analysis showed that the number of daily toothbrushes, the number of desserts eaten, milk drinking before bedtime, being the only-child, and the parents’ level of education were the independents influencing the factors of for developing dental caries. The incidence of dental caries in the PFMs of children aged 10–12 years in Southern China is high, and the rate of fissure sealant and the rate of dental fillings are low. There are a lot of differences between urban and rural areas, where children’s oral health knowledge is poor, and poor oral hygiene behaviors and dietary habits exist.