Masri Ahmad Al, Mourad Mhd Said, Splieth Christian H, Krey Karl-Friedrich, Schmoeckel Julian
Department of Pediatric Dentistry, University Medicine Greifswald, Walther-Rathenau-Str 42a, 17489 Greifswald, Germany.
Department of Orthodontics, University Medicine Greifswald, Walther-Rathenau-Str 42a, 17489 Greifswald, Germany.
J Clin Med. 2025 Mar 25;14(7):2221. doi: 10.3390/jcm14072221.
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.
即使在低患龋风险人群中，儿童第一恒磨牙（FPMs）受损也给牙医和患者带来了重大挑战。无论是由于龋齿还是磨牙切牙矿化不全（MIH），早期受损的FPMs都需要仔细的治疗计划以及必要时拔牙的时机选择，以便最终能利用健康的牙列实现良好的间隙关闭。这篇综述解释了儿童FPMs早期拔牙的概念，并列出了已发表的研究结果以及关于FPMs拔除后自发或正畸间隙关闭的系统评价，包括其长期后果。总体而言，大多数研究证实，如果在上颌第二恒磨牙（SPM）萌出之前进行拔牙，上颌FPMs早期拔除后可实现自发间隙关闭。另一方面，在下颌，拔牙时机和辅助因素合适时间隙关闭是可能的，但在实际操作中，很可能需要正畸治疗。保留或拔除受损FPMs的决定必须始终基于个体情况，考虑所有相关因素以及对整个口颌系统的长期影响。然而，预防龋齿的早期预防措施和对受MIH影响的FPMs的早期管理应作为一线方法。
