University College London, Paediatric Dentistry, 256 Gray's Inn Road, London, UK.
University College London, Division of Craniofacial & Development Sciences, Orthodontic Unit, 256 Gray's Inn Road, London, UK.
Br Dent J. 2019 Aug;227(3):192-195. doi: 10.1038/s41415-019-0561-7.
Treatment planning for compromised first permanent molars (FPM) can be difficult. In this paper, we present a clinical protocol to support decision-making. Interceptive loss of an FPM should be considered: where the restoration required to repair the compromised FPM is likely to be large; if the FPM is compromised because of molar-incisor hypomineralisation (MIH); where orthodontics requiring loss of tooth units is planned; or if third permanent molars (TPM) are present. Planning requires careful assessment of the prognosis of the FPM and 8-10 years is the ideal age to do this. If the prognosis is uncertain, the decision of whether or not to extract can be influenced by the presence or absence of the TPM. If the decision to extract the FPM is made, timing is dependent on whether or not extractions will be required as part of orthodontic treatment.
治疗受损第一恒磨牙（FPM）可能具有挑战性。本文提出了一个临床方案来支持决策。应考虑预防性拔除 FPM：需要修复受损 FPM 的牙体预备量较大；如果 FPM 因磨牙-切牙釉质发育不全（MIH）而受损；计划进行需要拔牙的正畸治疗；或者第三恒磨牙（TPM）存在。治疗计划需要仔细评估 FPM 的预后，理想的评估年龄为 8-10 岁。如果预后不确定，是否拔牙的决定可以受 TPM 的存在与否影响。如果决定拔除 FPM，则拔牙时机取决于正畸治疗是否需要拔牙。
