The timing of extraction of non-restorable first permanent molars: a systematic review

Authors:

ABSTRACT

Aim

To identify the ideal timing of first permanent molar extraction to reduce the future need for orthodontic treatment.

Methods

A computerised database and subsequent manual search was performed using Medline database,
Embase and Ovid, covering the period from January 1946 to February 2013. Two reviewers (JE and ME) extracted the data
independently and evaluated if the studies matched the inclusion criteria. Inclusion criteria were specification of the follow-up with
clinical examination or analysis of models, specification of the chronological age or dental developmental stage at the time of extraction,
no treatment in between, classification of the treatment result into perfect, good, average and poor. The search was limited to human
studies and no language limitations were set.

Results

The search strategy resulted in 18 full-text articles, of which 6 met the
inclusion criteria. By pooling the data from maxillary sites, good to perfect clinical outcome was estimated in 72 (95
confidence interval 63-82). Extractions at the age of 8-10.5 years tended to show better spontaneous clinical outcomes
compared to the other age groups. By pooling the data from mandibular sites, extractions performed at the age of 8-10.5 and 10.5-11.5
years showed significantly superior spontaneous clinical outcome with a probability of 50 and 59 likelihood,
respectively, to achieve good to perfect clinical result (p<0.05) compared to the other age groups (<8 years of age: 34, >11.5 years of age: 44).

Conclusion

Prevention of complications after first permanent molars extractions is an important
issue. The overall success rate of spontaneous clinical outcome for maxillary extraction of first permanent molars was superior to
mandibular extraction. Extractions of mandibular first permanent molars should be performed between 8 and 11.5 years of age in order
to achieve a good spontaneous clinical outcome. For the extraction in the maxilla, no firm conclusions concerning the ideal extraction
timing could be drawn.

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