Systematic Review of Enforced Extraction of the First Permanent Molars

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Table of Contents

Introduction
Material and Methods
References

Introduction

Dental caries is the most common disease in the world, affecting people’s health (Ozdemir, 2014). At the same time, the first permanent molars (FPM) are the teeth that are the most impacted by this condition in the permanent dentition. It happens because an FPM is the first from the permanent teeth erupted in the mouth (Saber et al., 2018). In addition to caries, molar incisor hypomineralization (MIH) is another condition that influences teeth, and especially it affects children. The MIH “varies in clinical severity and can result in early loss of the permanent 6-year molars” (Mathu-Muju & Wright, 2006, p. 604).

Thus, the impact of dental caries and MIH on the FPMs can result in their enforced extraction. Furthermore, the removal of the FPMs can be justified by the need to relieve the crowding and create space in the mouth (Ong & Bleakley, 2010). Additional factors include hypoplastic, preapical pathoses, skeletal malocclusions, and anterior open bite malocclusion (Ong & Bleakley, 2010). It demonstrates that many cases can lead to the necessity to extract the FPMs.

Even though the information above proves that the FPMs extraction is obligatory in some cases, Saber et al. (2018) argue that it is necessary to consider a few factors before this intervention. They include pulp maturation, the attitude of the child’s parents, pain severity, the level of tooth destruction, the ability to withstand local anesthesia, and others (Saber et al., 2018). Thus, the purpose of this study is to investigate the existing literature on the enforced extraction of the first permanent molars and its outcomes. The present research focuses on scholarly articles, including recent ones that present exhaustive information on the phenomenon under consideration.

Material and Methods

Eligibility Criteria

To begin with, one should mention that the present research has analyzed ten scholarly articles on the topic. Nine of them focus on the FPMs and their extraction, and the study by Ozdemir (2014) deals with dental caries and its consequences, which is necessary for presenting background information for the research. The articles were selected according to the credibility of data, while no significant attention was drawn to the year of publication.

It has resulted in the fact that a few remote articles are included. It refers to the works by Abu Aihaija, McSheny, and Richardson (2000) and Richardson (1979). Even though the two studies are considered outdated, they present useful information. Thus, Richardson (1979) investigated 43 cases to emphasize “a tendency for the overbite and overjet to increase with associated retroclination of lower and proclination of upper incisors” (p. 85). At the same time, the study by Abu Aihaija et al. (2000) is essential for the research because the scholars carefully analyze the consequences of the extraction for the position of the other teeth.

Data Collection

The Rayyan website was the primary resource for the collection of data. Initially, it offered 4,627 articles on enforced extraction of the FPM. Among them, 4,596 items were excluded because of various reasons, including animal studies, wrong study designs, duplicates, and others. As for the other 31 works, 22 of them were included, and they were carefully read to determine whether they are suitable for the given research. Consequently, the Rayyan website has provided this research with five open-access studies. It refers to the works by Ashley, Derrick, and Teo (2015), Booji et al. (2011), Jälevik and Möller (2007), Richardson (1979), and Teo, Ashley, Parekh, and Noar (2013).

At the same time, the other five articles were found with the help of Google Scholar. The website generated more than 21,000 results, and a crucial task was to find suitable articles among them. That is why the studies were assessed individually to determine whether they meet the research requirements. This approach has brought the studies by Abu Aihaija et al. (2000), Mathu-Muju and Wright (2006), Ong and Bleakley (2010), Ozdemir (2014), and Saber et al. (2018). As a result, ten credible articles were included among approximately 25,627 variants.

Source of Material

All the articles above have been selected via two large databases. The search through the Rayyan website was conducted in 2018, while Google Scholar has been monitored in 2020. That is why it is not a surprise that the studies cover a significant lifespan and represent an essential portion of the research. While most articles have been created in the 21^st century, one study was published in 1979 (Richardson, 1979). This fact indicates that the given research focuses on the literature that presents 40 years of investigation on the extraction of the FPMs and its possible effects.

Risk of Bias in Individual Studies

In general, every individual study implies a danger because its author or authors can be biased by their own opinions concerning the issue or separate examples. Thus, scholars need to do their best to avoid or overcome such biases. One of the best variants to achieve it is to focus on large samples since it allows to identify a more balanced and reliable picture. If scientists consider a relatively small number of examples, there exists a risk that these examples support a particular point of view, rather than present a common situation.

Thus, the articles by Abu Aihaija et al. (2000) and Jälevik and Möller (2007) are said to have a higher risk of bias because they consider 28 and 27 patients, correspondingly. Consequently, the risk is the lowest in the study by Booji et al. (2011) with 100 patient records. Numerous participants of the study denote that its results tend to reflect the actual state of affairs. Consequently, the other articles also imply a bias of an appropriate level that depends on the materials that they use.

Information Sources

In addition to that, the given articles are worth considering because they are based on credible and reliable information sources. Each of the studies focuses on a literature review on the topic. In general, the information comes from primary sources represented by peer-reviewed journal articles. It is so because these sources of data are regularly created by specialists who want to distribute their knowledge among their colleagues. Most of them are timely, while a few outdated studies are still significant because they offer essential information on the phenomenon. Thus, the given state of affairs shows that the present research is based on information that comes from primary sources.

Search Strategy

Finally, it is necessary to comment on the search strategy that has led to the current results. The Rayyan website was used to search for articles that would discuss the enforced extraction of the FPMs and its effects. The titles of studies were the primary indicators that described the content of works. Then, it was reasonable to read abstracts to determine whether the article was suitable for the given research. The preference was given to those articles that offered open access. At the same time, the absence of abstracts and the unavailability of full texts resulted in the fact that four initially identified studies were excluded. Thus, the flow chart below demonstrates how ten credible articles have been found.

References

Abu Aihaija, E. S., McSheny, P. F., & Richardson, A. (2000). A cephalometric study of the effect of extraction of lower first permanent molars. Journal of Clinical Pediatric Dentistry, 24(3), 195-198.

Ashley, P. F., Derrick, D., & Teo, T. K.-Y. (2015). Lower first permanent molars: Developing better predictors of spontaneous space closure. The European Journal of Orthodontics, 38(1), 1-6.

Booji, J. W., Goeke, J., Bronkhorst E. M., Pancherz, H., Ruf, S., & Katsaros, C. (2011). Overjet correction and space closure mechanisms for Class II treatment by extracting the maxillary first molars. Journal of Orofacial Orthopedics, 72(3), 196-203.

Jälevik, B., & Möller, M. (2007). Evaluation of spontaneous space closure and development of permanent dentition after extraction of hypomineralized permanent first molars. International Journal of Pediatric Dentistry, 17(5), 328-335.

Mathu-Muju, K., & Wright, J. T. (2006). Diagnosis and treatment of molar incisor hypomineralization. Compendium of Continuing Education in Dentistry, 27(11), 604-610.

Ong, D. V., & Bleakley, J. E. (2010). Compromised first permanent molars: an orthodontic perspective. Australian Dental Journal, 55(1), 2-14.

Ozdemir, D. (2014). Dental caries: The most common disease worldwide and preventive strategies. Journal of Educational and Instructional Studies in the World, 4(4), 20-24.

Richardson, A. (1979). Spontaneous changes in the incisor relationship following extraction of lower first permanent molars. British Journal of Orthodontics, 6(2), 85-90.

Saber, A. M., Altoukhi, D. H., Horaib, M. F., El-Housseiny, A. A., Alamoudi, N. M., & Sabbagh, H. J. (2018). Consequences of early extraction of compromised first permanent molar: A systematic review. BMC Oral Health, 18(1). Web.

Teo, T. K., Ashley, P. F., Parekh, S., & Noar, J. (2013). The evaluation of spontaneous space closure after the extraction of first permanent molars. European Archives of Pediatric Dentistry, 14(4), 207-212.

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