elective extractions of first permanent molars: a review

Permanent first molar teeth possess a key role in the setting-up of the occlusion, contribute significantly to the chewing function and serve as a guide for other teeth. However, it is frequently encountered that permanent first molar teeth are extracted due to the predicted negative prognoses of caries or developmental defects. As a result of the uncontrolled extraction of the permanent first molar teeth during the growth and development period, drifting of adjacent teeth, continued eruption of the opposing teeth and displacements can be seen. Furthermore, following one-sided extraction, midline deviations, oppositional tooth eruption, skeletal and dental asymmetry, unilateral chewing habits, and temporo-mandibular joint disorders may occur. To prevent these pathological conditions and to maintain the stability of the occlusal relation, it is necessary to do compensation and balancing extractions of the permanent first molar teeth on the opposite/symmetric arc, assuming mesial drag of the permanent second and third molar teeth. With such controlled-extractions, especially in Class I cases, orthodontic or prosthetic treatments, which may require extra time, cost and effort, could be prevented and a conceivable occlusion can be established.