Ilyas Nurfarhana, Sinniah Saraswathy Devi, Bakar Norashikin Abu
Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia.
Ministry of Health, Kompleks E, Pusat Pentadbiran Kerajaan Persekutuan, Putrajaya, Malaysia.
J Int Soc Prev Community Dent. 2025 Apr 30;15(2):101-113. doi: 10.4103/jispcd.jispcd_234_24. eCollection 2025 Mar-Apr.
Managing the first permanent molar (FPM) with a poor prognosis can be challenging as it depends on several modifying factors that must be considered, and each approach has potential implications and clinical outcomes.
This review aimed to systematically review the assessment factors that should be considered prior to managing FPM with poor prognosis in children.
A computerized database search was conducted using Cochrane, PubMed, and Scopus with predefined search terms related to "management, treatment, extraction, restoration, endodontic, and orthodontic" involving the "FPM." The search included studies published in English between 1990 and 2024. Two reviewers independently extracted data and assessed whether the studies met the inclusion criteria. The inclusion criteria specified management approaches for FPM with poor prognosis in children aged 6-16. Any disagreement between reviewers was resolved through discussion.
A total of 1815 studies were screened, and 37 full-text articles were retrieved. Seven retrospective observational studies met the inclusion criteria. All the included studies focused on orthodontic assessment factors, such as the presence of a third molar and angulation of the second permanent molar, aimed at achieving spontaneous space closure following FPM extraction. However, no studies have addressed restorative perspectives on managing this problem, particularly in pediatric patients.
This review highlights a lack of well-established and robust studies on managing poor prognosis in FPM. The absence of research on long-term functional outcomes, patient-reported experiences, and the role of restorative alternatives, especially in children, reveals significant gaps in the current literature. Incorporating these findings into clinical practice could lead to more personalized and effective treatment strategies that focus on both immediate and long-term oral health outcomes for children. Given the complexity of FPM management, a multidisciplinary approach combining restorative, orthodontic, and preventive strategies is crucial. Therefore, further studies with stronger evidence are needed to explore a comprehensive clinical approach that could enhance treatment outcomes.
处理预后不良的第一恒磨牙（FPM）具有挑战性，因为这取决于几个必须考虑的影响因素，且每种方法都有潜在的影响和临床结果。
本综述旨在系统回顾在处理儿童预后不良的FPM之前应考虑的评估因素。
使用Cochrane、PubMed和Scopus进行计算机化数据库检索，使用与“管理、治疗、拔除、修复、牙髓治疗和正畸”相关的预定义检索词，涉及“FPM”。检索包括1990年至2024年期间以英文发表的研究。两名评审员独立提取数据并评估研究是否符合纳入标准。纳入标准规定了6至16岁儿童预后不良的FPM的管理方法。评审员之间的任何分歧都通过讨论解决。
共筛选了1815项研究，检索到37篇全文文章。七项回顾性观察性研究符合纳入标准。所有纳入研究都集中在正畸评估因素上，如第三磨牙的存在和第二恒磨牙的角度，旨在在FPM拔除后实现自发的间隙关闭。然而，没有研究涉及处理这个问题的修复观点，特别是在儿科患者中。
本综述强调缺乏关于处理FPM预后不良的成熟且有力的研究。缺乏关于长期功能结果、患者报告的经历以及修复替代方案的作用的研究，尤其是在儿童中，揭示了当前文献中的重大差距。将这些发现纳入临床实践可能会产生更个性化和有效的治疗策略，这些策略关注儿童的即时和长期口腔健康结果。鉴于FPM管理的复杂性，结合修复、正畸和预防策略的多学科方法至关重要。因此，需要进一步的更有证据的研究来探索一种可以改善治疗结果的综合临床方法。
