First permanent molars: consequences of early loss


Globally between 60 to 90% of school children have dental caries. The first permanent molar (FPM) emerging around the age of six is prone to dental caries and potential loss before the age of 15. A range of factors influence the management of badly decayed FPMs with early extraction of those with a poor prognosis being favoured by some clinicians.

The aim of this review was to determine the effects and sequelae of early extraction of FPMs in relation to the skeletal and dental development of children aged 5 to 15 years.


Searches were conducted in the Medline, Scopus and Science Direct databases. Clinical trials, case-control, cross-sectional or cohort studies in children aged 5 to 15 years were considered. 3 independent reviewers assessed papers for inclusion abstracted data and evaluated study quality. The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist   was used to assess study quality. A meta-analysis was carried out to compare the frequency of spontaneous space closure following FPM extraction in the maxilla with that of the mandible.


  • 11 studies (8 cross-sectional, 2 case-controlled, 1 prospective observational) are were included period.
  • Studies reported effects on; post-extraction space, development and eruption of the second and the third permanent molar, caries and fillings in adjacent teeth, incisor relationships and skeletal development.
  • The consequences reported were decrease in post extraction space, accelerated development and eruption of second permanents molars (SPMs) and third molars, a decrease in caries and/or fillings on the proximal surfaces of adjacent teeth, lingual tipping and retrusion of incisors, and counter clockwise rotation of the occlusal plane.


The authors concluded: –

There were several consequences of early extraction of FPMs, which were related to skeletal and dental development. Our systematic review suggests that comprehensive evaluation of the compromised FPMs should be performed before planning an extraction. The ideal time for FPM extraction is when the second permanent molar (SPM) is at the early bifurcation stage in order to achieve complete closure of the extraction space by the SPM. Benefits should be weighed over the risks to decrease the risk of unfavorable outcomes as much as possible. However, due to the limited evidence on the outcomes and variables that influence them, high-quality prospective studies are needed.


This review searched 3 major databases and did not restrict to English language studies so is likely to have identified the bulk of the relevant literature. However: has the authors notes none of the studies reported sample size or power calculations and only one provided a clear and description of the study design used. With many of the included studies being considered as cross-sectional and few of the studies being prospective the findings of the review should be interpreted cautiously. And as are and more high-quality well conducted and reported Studies are needed. A study protocol for a randomised controlled trial on this question has been reported  ( Innes et al ) however this particular study was terminated early due to poor recruitment.


Primary Paper

Saber AM, Altoukhi DH, Horaib MF, El-Housseiny AA, Alamoudi NM, Sabbagh HJ. Consequences of early extraction of compromised first permanent molar: a systematic review. BMC Oral Health. 2018 Apr 5;18(1):59. doi: 10.1186/s12903-018-0516-4. PubMed PMID: 29622000.

Other references

Original review protocol on PROSPERO

Innes N, Borrie F, Bearn D, Evans D, Rauchhaus P, McSwiggan S, Page LF,Hogarth F. Should I eXtract Every Six dental trial (SIXES): study protocol for a randomized controlled trial. Trials. 2013 Feb 27;14:59. doi: 10.1186/1745-6215-14-59. PubMed PMID: 23442547; PubMed Central PMCID: PMC3602236






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