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Masri AA, Mourad MS, Splieth CH, Krey KF, Schmoeckel J. Extraction of First Permanent Molars in Children-A Comprehensive Review of History, Aim, Space Closure and Other Consequences. J Clin Med 2025; 14:2221. [PMID: 40217671 PMCID: PMC11989315 DOI: 10.3390/jcm14072221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2025] [Revised: 03/14/2025] [Accepted: 03/19/2025] [Indexed: 04/14/2025] Open
Abstract
Compromised first permanent molars (FPMs) in children pose major challenges for dentists and patients even in low-caries-risk populations. Whether due to caries or Molar Incisor Hypomineralization (MIH), compromised FPMs at an early age require careful treatment planning and timing of extraction, if necessary, to eventually have good space closure with healthy dentition. This comprehensive review explains the concept of early extraction of the FPMs in children and lists the results of published studies and systematic reviews regarding spontaneous or orthodontical space closure after the extraction of an FPM, including its consequences in the long term. In general, the majority of the studies confirm that spontaneous space closure after the early extraction of the maxillary FPM could be achieved if the extraction is performed before the eruption of the second permanent molar (SPM). On the other hand, space closure in the mandible is possible in case of optimal timing of extraction and supporting co-factors, but in practice, it would most probably require orthodontic treatment. The decision to retain or extract compromised FPMs must always be made on an individual basis, taking into account all relevant factors and the long-term effects on the entire stomatognathic system. Early prophylaxis to prevent caries and early management of MIH-affected FPMs should, however, be the first-line approach.
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Affiliation(s)
- Ahmad Al Masri
- Department of Pediatric Dentistry, University Medicine Greifswald, Walther-Rathenau-Str 42a, 17489 Greifswald, Germany; (A.A.M.); (M.S.M.); (C.H.S.)
- Department of Orthodontics, University Medicine Greifswald, Walther-Rathenau-Str 42a, 17489 Greifswald, Germany;
| | - Mhd Said Mourad
- Department of Pediatric Dentistry, University Medicine Greifswald, Walther-Rathenau-Str 42a, 17489 Greifswald, Germany; (A.A.M.); (M.S.M.); (C.H.S.)
- Department of Orthodontics, University Medicine Greifswald, Walther-Rathenau-Str 42a, 17489 Greifswald, Germany;
| | - Christian H. Splieth
- Department of Pediatric Dentistry, University Medicine Greifswald, Walther-Rathenau-Str 42a, 17489 Greifswald, Germany; (A.A.M.); (M.S.M.); (C.H.S.)
| | - Karl-Friedrich Krey
- Department of Orthodontics, University Medicine Greifswald, Walther-Rathenau-Str 42a, 17489 Greifswald, Germany;
| | - Julian Schmoeckel
- Department of Pediatric Dentistry, University Medicine Greifswald, Walther-Rathenau-Str 42a, 17489 Greifswald, Germany; (A.A.M.); (M.S.M.); (C.H.S.)
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Al-Nerabieah Z, AlKhouli M, Dashash M. Navigating the Complexities of Molar Incisor Hypomineralization: Challenges and Strategies in Pediatric Dentistry. Int J Dent 2025; 2025:9329492. [PMID: 39811496 PMCID: PMC11732276 DOI: 10.1155/ijod/9329492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 11/03/2024] [Accepted: 12/09/2024] [Indexed: 01/16/2025] Open
Abstract
Background: Molar incisor hypomineralization (MIH) presents a multifaceted challenge in pediatric dentistry, impacting diagnostics, clinical management, resource accessibility, and psychosocial care. The condition's complexity is exacerbated by diagnostic variability, overlapping clinical symptoms, and the need for tailored treatment approaches. Objectives: This study aims to explore the key challenges associated with the management of MIH in pediatric dentistry, including diagnostic precision, clinical management, resource limitations, interdisciplinary care, long-term follow-up, and psychosocial impact, and to propose strategies for overcoming these obstacles. Methods: A comprehensive literature review was conducted to identify and synthesize existing evidence on MIH's etiology, diagnosis, treatment, and prognosis. The review highlighted the barriers encountered in providing optimal care, particularly in resource-constrained settings, and explored potential solutions through clinical and interdisciplinary approaches. Results: The key findings included the need for standardized diagnostic criteria, the role of individualized treatment plans, and the importance of resource allocation. Limited access to specialized equipment and education hampers care, especially in under-resourced areas. Long-term management complexities were further compounded by the necessity for interdisciplinary collaboration and attention to psychosocial factors affecting pediatric patients. Conclusion: Effective MIH management requires standardized diagnostic protocols, resource advocacy, interdisciplinary collaboration, and holistic patient care. Advancements in research, education, and policy are essential to improve outcomes in pediatric patients. By addressing both clinical and psychosocial challenges, the overall well-being of MIH-affected children can be enhanced.
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Affiliation(s)
- Zuhair Al-Nerabieah
- Pediatric Dentistry Department, Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Muaaz AlKhouli
- Pediatric Dentistry Department, Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Mayssoon Dashash
- Pediatric Dentistry Department, Faculty of Dentistry, Damascus University, Damascus, Syria
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Yap LC, Williams L, Stinton N, Malik G. Management of oral manifestations of a child with Heimler Syndrome-2. BMJ Case Rep 2024; 17:e257354. [PMID: 38663901 PMCID: PMC11043732 DOI: 10.1136/bcr-2023-257354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Heimler Syndrome 2 (HS-2) is a rare, autosomal recessive mild form of a peroxisomal biogenesis disorder. Though knowledge regarding the disorder is limited, emerging research has found that sensorineural hearing loss, occasional or late onset pigmentation, amelogenesis imperfecta and nail abnormalities are clinical characteristics representative of HS-2.A school-aged male presented to the dental department with a chief complaint of a lack of enamel on multiple teeth. The patient's medical history was significant for patent ductus arteriosus, bilateral sensorineural hearing loss and biallelic mutation of the PEX6 gene. The clinical exam revealed dental crowding, hypoplasia, hypo-calcification of multiple teeth and enlarged pulp chambers of maxillary molars. This case report details the clinical findings associated with HS-2, the comprehensive dental treatment to be rendered to the patient, and critical information to paediatric dentists and general dentists so that they can make proper referrals to medical specialties.
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Affiliation(s)
- Lauren C Yap
- Pediatric Dentistry, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Lacey Williams
- Pediatric Dentistry, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Natalie Stinton
- Pediatric Dentistry, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Gayatri Malik
- Pediatric Dentistry, Geisinger Medical Center, Danville, Pennsylvania, USA
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Butera A, Maiorani C, Morandini A, Simonini M, Morittu S, Barbieri S, Bruni A, Sinesi A, Ricci M, Trombini J, Aina E, Piloni D, Fusaro B, Colnaghi A, Pepe E, Cimarossa R, Scribante A. Assessment of Genetical, Pre, Peri and Post Natal Risk Factors of Deciduous Molar Hypomineralization (DMH), Hypomineralized Second Primary Molar (HSPM) and Molar Incisor Hypomineralization (MIH): A Narrative Review. CHILDREN-BASEL 2021; 8:children8060432. [PMID: 34064138 PMCID: PMC8224286 DOI: 10.3390/children8060432] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 11/16/2022]
Abstract
Objectives: Analyze defects in the state of maturation of the enamel result in an adequate volume of enamel, but in an insufficient mineralization, which can affect both deciduous teeth and permanent teeth. Among the most common defects, we recognize Deciduous Molar Hypominerlization (DMH), Hypomineralized Second Primary Molar (HSPM), and Molar Incisor Hypomineralization (MIH). These, in fact, affect the first deciduous molars, the second deciduous molars and molars, and permanent incisors, respectively, but their etiology remains unclear. The objective of the paper is to review studies that focus on investigating possible associations between genetic factors or prenatal, perinatal, and postnatal causes and these enamel defects. Materials and methods: A comprehensive and bibliometric search for publications until January 2021 was conducted. The research question was formulated following the Population, Intervention, Comparison, Outcome strategy. Case-control, cross-sectional, cohort studies, and clinical trials investigating genetic and environmental etiological factors of enamel defects were included. Results: Twenty-five articles are included. For genetic factors, there is a statistical relevance for SNPs expressed in the secretion or maturation stage of amelogenesis (16% of studies and 80% of studies that investigated these factors). For prenatal, perinatal, and postnatal causes, there is a statistical relevance for postnatal factors, such as the breastfeeding period (2%), asthma (16%), high fever episodes (20%), infections/illnesses (20%), chickenpox (12%), antibiotic intake (8%), diarrhea (4%), and pneumonia (4%). Conclusions: The results are in agreement with the multifactorial idea of the dental enamel defects etiology, but to prove this, further studies enrolling larger, well-diagnosed, and different ethnic populations are necessary to expand the investigation of the genetic and environmental factors that might influence the occurrence of DMH, HPSM, and MIH.
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Affiliation(s)
- Andrea Butera
- Unit of Dental Hygiene, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
- Correspondence:
| | - Carolina Maiorani
- Unit of Dental Hygiene, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Annalaura Morandini
- Member Association: “ Mamme & Igieniste”, 24125 Bergamo, Italy; (A.M.); (M.S.); (S.M.); (S.B.); (A.B.); (A.S.); (M.R.); (J.T.); (E.A.); (D.P.); (B.F.); (A.C.); (E.P.); (R.C.)
| | - Manuela Simonini
- Member Association: “ Mamme & Igieniste”, 24125 Bergamo, Italy; (A.M.); (M.S.); (S.M.); (S.B.); (A.B.); (A.S.); (M.R.); (J.T.); (E.A.); (D.P.); (B.F.); (A.C.); (E.P.); (R.C.)
| | - Stefania Morittu
- Member Association: “ Mamme & Igieniste”, 24125 Bergamo, Italy; (A.M.); (M.S.); (S.M.); (S.B.); (A.B.); (A.S.); (M.R.); (J.T.); (E.A.); (D.P.); (B.F.); (A.C.); (E.P.); (R.C.)
| | - Stefania Barbieri
- Member Association: “ Mamme & Igieniste”, 24125 Bergamo, Italy; (A.M.); (M.S.); (S.M.); (S.B.); (A.B.); (A.S.); (M.R.); (J.T.); (E.A.); (D.P.); (B.F.); (A.C.); (E.P.); (R.C.)
| | - Ambra Bruni
- Member Association: “ Mamme & Igieniste”, 24125 Bergamo, Italy; (A.M.); (M.S.); (S.M.); (S.B.); (A.B.); (A.S.); (M.R.); (J.T.); (E.A.); (D.P.); (B.F.); (A.C.); (E.P.); (R.C.)
| | - Antonia Sinesi
- Member Association: “ Mamme & Igieniste”, 24125 Bergamo, Italy; (A.M.); (M.S.); (S.M.); (S.B.); (A.B.); (A.S.); (M.R.); (J.T.); (E.A.); (D.P.); (B.F.); (A.C.); (E.P.); (R.C.)
| | - Maria Ricci
- Member Association: “ Mamme & Igieniste”, 24125 Bergamo, Italy; (A.M.); (M.S.); (S.M.); (S.B.); (A.B.); (A.S.); (M.R.); (J.T.); (E.A.); (D.P.); (B.F.); (A.C.); (E.P.); (R.C.)
| | - Julia Trombini
- Member Association: “ Mamme & Igieniste”, 24125 Bergamo, Italy; (A.M.); (M.S.); (S.M.); (S.B.); (A.B.); (A.S.); (M.R.); (J.T.); (E.A.); (D.P.); (B.F.); (A.C.); (E.P.); (R.C.)
| | - Elisa Aina
- Member Association: “ Mamme & Igieniste”, 24125 Bergamo, Italy; (A.M.); (M.S.); (S.M.); (S.B.); (A.B.); (A.S.); (M.R.); (J.T.); (E.A.); (D.P.); (B.F.); (A.C.); (E.P.); (R.C.)
| | - Daniela Piloni
- Member Association: “ Mamme & Igieniste”, 24125 Bergamo, Italy; (A.M.); (M.S.); (S.M.); (S.B.); (A.B.); (A.S.); (M.R.); (J.T.); (E.A.); (D.P.); (B.F.); (A.C.); (E.P.); (R.C.)
| | - Barbara Fusaro
- Member Association: “ Mamme & Igieniste”, 24125 Bergamo, Italy; (A.M.); (M.S.); (S.M.); (S.B.); (A.B.); (A.S.); (M.R.); (J.T.); (E.A.); (D.P.); (B.F.); (A.C.); (E.P.); (R.C.)
| | - Arianna Colnaghi
- Member Association: “ Mamme & Igieniste”, 24125 Bergamo, Italy; (A.M.); (M.S.); (S.M.); (S.B.); (A.B.); (A.S.); (M.R.); (J.T.); (E.A.); (D.P.); (B.F.); (A.C.); (E.P.); (R.C.)
| | - Elisa Pepe
- Member Association: “ Mamme & Igieniste”, 24125 Bergamo, Italy; (A.M.); (M.S.); (S.M.); (S.B.); (A.B.); (A.S.); (M.R.); (J.T.); (E.A.); (D.P.); (B.F.); (A.C.); (E.P.); (R.C.)
| | - Roberta Cimarossa
- Member Association: “ Mamme & Igieniste”, 24125 Bergamo, Italy; (A.M.); (M.S.); (S.M.); (S.B.); (A.B.); (A.S.); (M.R.); (J.T.); (E.A.); (D.P.); (B.F.); (A.C.); (E.P.); (R.C.)
| | - Andrea Scribante
- Unit of Orthodontics and Pediatric Dentistry, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
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