{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:04:07Z","timestamp":1792789447506,"version":"4.5.0"},"reference-count":49,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T00:00:00Z","timestamp":1742860800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine Greifswald, Germany"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/jcm14072221","type":"journal-article","created":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T10:48:58Z","timestamp":1742899738000},"page":"2221","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Extraction of First Permanent Molars in Children\u2014A Comprehensive Review of History, Aim, Space Closure and Other Consequences"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0020-1518","authenticated-orcid":false,"given":"Ahmad Al","family":"Masri","sequence":"first","affiliation":[{"name":"Department of Pediatric Dentistry, University Medicine Greifswald, Walther-Rathenau-Str 42a, 17489 Greifswald, Germany"},{"name":"Department of Orthodontics, University Medicine Greifswald, Walther-Rathenau-Str 42a, 17489 Greifswald, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mhd Said","family":"Mourad","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dentistry, University Medicine Greifswald, Walther-Rathenau-Str 42a, 17489 Greifswald, Germany"},{"name":"Department of Orthodontics, University Medicine Greifswald, Walther-Rathenau-Str 42a, 17489 Greifswald, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian H.","family":"Splieth","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dentistry, University Medicine Greifswald, Walther-Rathenau-Str 42a, 17489 Greifswald, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl-Friedrich","family":"Krey","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, University Medicine Greifswald, Walther-Rathenau-Str 42a, 17489 Greifswald, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2436-3001","authenticated-orcid":false,"given":"Julian","family":"Schmoeckel","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dentistry, University Medicine Greifswald, Walther-Rathenau-Str 42a, 17489 Greifswald, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,25]]},"reference":[{"key":"ref_1","unstructured":"(2024, June 25). W.H.O.: WHO\/Europe Calls for Urgent Action on Oral Disease as Highest Rates Globally Are Recorded in European Region. Available online: https:\/\/www.who.int\/europe\/news\/item\/20-04-2023-who-europe-calls-for-urgent-action-on-oral-disease-as-highest-rates-globally-are-recorded-in-european-region#:~:text=The%20report%20outlines%20progress%20in,teeth%20in%20this%20age%20group."},{"key":"ref_2","first-page":"391068","article-title":"Prevalence of first permanent molar caries in and its relationship to the dental knowledge of 9\u201312-year olds from jeddah, kingdom of saudi arabia","volume":"2012","author":"Ahmad","year":"2012","journal-title":"ISRN Dent."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/1472-6831-4-2","article-title":"Grouping of tooth surfaces by susceptibility to caries: A study in 5\u201316 year-old children","volume":"4","author":"Batchelor","year":"2004","journal-title":"BMC Oral. Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1111\/j.1600-0528.1990.tb00653.x","article-title":"Dental caries status and treatment needs of the permanent dentition of 6\u201312-year-olds in Hong Kong","volume":"18","author":"Lo","year":"1990","journal-title":"Community Dent. Oral. Epidemiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1111\/j.1365-263X.2007.00849.x","article-title":"Evaluation of spontaneous space closure and development of permanent dentition after extraction of hypomineralized permanent first molars","volume":"17","author":"Jalevik","year":"2007","journal-title":"Int. J. Paediatr. Dent."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1055\/s-0039-1695756","article-title":"Morphological Differences between the First and Second Permanent Upper Molars","volume":"36","author":"Genaro","year":"2019","journal-title":"J. Morphol. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S23","DOI":"10.4103\/jpbs.JPBS_744_20","article-title":"First Molars in Permanent Dentition and their Malformations in Various Pathologies: A Review","volume":"13","author":"Yamunadevi","year":"2021","journal-title":"J. Pharm. Bioallied Sci."},{"key":"ref_8","unstructured":"Bathia, S., and Leighton, B. (1993). A Manual of Facial Growth of Longitudinal Cephalometric Growth Data, Oxford University Press."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/S0002-9416(72)90268-0","article-title":"The six keys to normal occlusion","volume":"62","author":"Andrews","year":"1972","journal-title":"Am. J. Orthod"},{"key":"ref_10","unstructured":"Slavicek, R. (2000). Das Kauorgan: Funktion und Dysfunktion, Klosterneuburg, Gamma, Med.-Wiss. Fortbildungs-Ges."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1186\/1472-6831-14-124","article-title":"Identification and adjustment of experimental occlusal interference using functional magnetic resonance imaging","volume":"14","author":"Oda","year":"2014","journal-title":"BMC Oral Health"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1016\/j.ajodo.2020.05.022","article-title":"Occlusal stress distribution in the human skull with permanent maxillary first molar extraction: A 3-dimensional finite element study","volume":"160","author":"Sana","year":"2021","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_13","first-page":"112","article-title":"Understanding and improving care: Use of routine data","volume":"1","author":"Walter","year":"2019","journal-title":"Dtsch. Zahnarztl. Z. Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1111\/iej.13999","article-title":"Treatment outcomes of regenerative endodontic therapy in immature permanent teeth with pulpal necrosis: A systematic review and network meta-analysis","volume":"57","author":"Sabeti","year":"2024","journal-title":"Int. Endod. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1111\/joor.12058","article-title":"Success rates of prosthetic restorations on endodontically treated teeth; a systematic review after 6 years","volume":"40","author":"Ploumaki","year":"2013","journal-title":"J. Oral Rehabil."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.jdent.2017.05.020","article-title":"Managing molars with severe molar-incisor hypomineralization: A cost-effectiveness analysis within German healthcare","volume":"63","author":"Elhennawy","year":"2017","journal-title":"J. Dent."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1111\/cdoe.12751","article-title":"Should compromised first permanent molar teeth in children be routinely removed? A health economics analysis","volume":"51","author":"Sanghvi","year":"2023","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_18","first-page":"106","article-title":"Improved Forceps, &c","volume":"7","year":"1857","journal-title":"Am. J. Dent. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"78","DOI":"10.22514\/jocpd.2024.010","article-title":"Timing for extraction of permanent first molars in school aged children: A pilot study","volume":"48","author":"Bakkal","year":"2024","journal-title":"J. Clin. Pediatr. Dent."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1007\/s40368-021-00647-w","article-title":"Extraction of first permanent molars severely affected by molar incisor hypomineralisation: A retrospective audit","volume":"23","author":"Brusevold","year":"2022","journal-title":"Eur. Arch. Paediatr. Dent."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.4103\/njcp.njcp_606_20","article-title":"Spontaneous space closure following the extraction of the first permanent mandibular molar","volume":"24","author":"Ciftci","year":"2021","journal-title":"Niger. J. Clin. Pract."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"331","DOI":"10.7126\/cumudj.793013","article-title":"Ideal Spontaneous Space Closure After Late Extraction of Permanent First Molar Teeth","volume":"23","author":"Demir","year":"2020","journal-title":"Cumhur. Dent. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s40368-013-0042-7","article-title":"The evaluation of spontaneous space closure after the extraction of first permanent molars","volume":"14","author":"Teo","year":"2013","journal-title":"Eur. Arch. Paediatr. Dent."},{"key":"ref_24","first-page":"123","article-title":"Radiographic Evaluation of Permanent Second Molar Substitution After Extraction of Permanent First Molar: Identifying Predictors for Spontaneous Space Closure","volume":"44","author":"Nordeen","year":"2022","journal-title":"Pediatr. Dent."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1016\/j.ajodo.2016.09.018","article-title":"Radiographic prognostic factors determining spontaneous space closure after loss of the permanent first molar","volume":"151","author":"Patel","year":"2017","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e18276","DOI":"10.7717\/peerj.18276","article-title":"Spontaneous space closure after extraction of young first permanent molar. Retrospective cohort study","volume":"12","author":"Sabbagh","year":"2024","journal-title":"PeerJ"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"936","DOI":"10.4103\/njcp.njcp_52_19","article-title":"Effects of first permanent molar extracton on space changes observed in the dental arch using data mining method","volume":"22","author":"Serindere","year":"2019","journal-title":"Niger. J. Clin. Pract."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1093\/ejo\/cjv029","article-title":"Lower first permanent molars: Developing better predictors of spontaneous space closure","volume":"38","author":"Teo","year":"2016","journal-title":"Eur. J. Orthod."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Elhussein, M., and Jamal, H. (2020). Molar Incisor Hypomineralisation-To Extract or to Restore beyond the Optimal Age?. Children, 7.","DOI":"10.3390\/children7080091"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1016\/j.ajodo.2020.09.024","article-title":"Multidisciplinary management of permanent first molar extractions","volume":"159","author":"Sabri","year":"2021","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1186\/s12903-018-0516-4","article-title":"Consequences of early extraction of compromised first permanent molar: A systematic review","volume":"18","author":"Saber","year":"2018","journal-title":"BMC Oral. Health"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"cjae054","DOI":"10.1093\/ejo\/cjae054","article-title":"Spontaneous space closure after extraction of permanent first molars in children and adolescents: A systematic review and meta-analysis","volume":"46","author":"Hamza","year":"2024","journal-title":"Eur. J. Orthod."},{"key":"ref_33","first-page":"272","article-title":"The timing of extraction of non-restorable first permanent molars: A systematic review","volume":"16","author":"Eichenberger","year":"2015","journal-title":"Eur. J. Paediatr. Dent."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Alqanas, S., Alsahiem, J., Aljami, A., Alsudairi, N., Ahmad, S., Sharma, S., Rajinder, S., Alamri, A., Alhazmi, H., and Hegazi, F. (Int. J. Paediatr. Dent., 2024). Factors related to spontaneous space closure following early first permanent molar extraction: A systematic review, Int. J. Paediatr. Dent., early view.","DOI":"10.1111\/ipd.13273"},{"key":"ref_35","first-page":"261","article-title":"Problems in orthodontic space closure after loss of first permanent molars","volume":"5","author":"Wehrbein","year":"1991","journal-title":"Prakt. Kieferorthop."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1007\/s00056-010-0007-y","article-title":"Orthodontic space closure after first molar extraction without skeletal anchorage","volume":"72","author":"Jacobs","year":"2011","journal-title":"J. Orofac. Orthop. Fortschritte Kieferorthopadie"},{"key":"ref_37","first-page":"4206435","article-title":"Orthodontic Replacement of Lost Permanent Molar with Neighbor Molar: A Six-Year Follow-Up","volume":"2017","author":"Raveli","year":"2017","journal-title":"Case Rep. Dent."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s40510-022-00427-2","article-title":"The impact of the loss of first permanent molars on the duration of treatment in patients treated with orthodontic space closure and without skeletal anchorage","volume":"23","author":"Cardoso","year":"2022","journal-title":"Prog. Orthod."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Langer, L.J., Pandis, N., Mang de la Rosa, M.R., Jost-Brinkmann, P.G., and Bartzela, T.N. (2023). Eruption Pattern of Third Molars in Orthodontic Patients Treated with First Permanent Molar Extraction: A Longitudinal Retrospective Evaluation. J. Clin. Med., 12.","DOI":"10.3390\/jcm12031060"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.physbeh.2006.01.025","article-title":"Oral physiology and mastication","volume":"89","author":"Engelen","year":"2006","journal-title":"Physiol. Behav."},{"key":"ref_41","first-page":"499","article-title":"Masticatory efficiency in children with primary dentition","volume":"23","author":"Gaviao","year":"2001","journal-title":"Pediatr. Dent."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1093\/ejo\/cji080","article-title":"Masticatory performance in children and adolescents with Class I and II malocclusions","volume":"28","author":"Toro","year":"2006","journal-title":"Eur. J. Orthod."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1111\/j.1600-0528.2004.00149.x","article-title":"Assessing the impact of oral health on the life quality of children: Implications for research and practice","volume":"32","author":"McGrath","year":"2004","journal-title":"Community Dent. Oral. Epidemiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1111\/joor.13066","article-title":"Four-dimensional oral health-related quality of life impact in children: A systematic review","volume":"48","author":"Omara","year":"2021","journal-title":"J. Oral. Rehabil."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1111\/jphd.12390","article-title":"Preschool oral health-related quality of life: A practical guide to measurement tools","volume":"81","author":"Culler","year":"2021","journal-title":"J. Public. Health Dent."},{"key":"ref_46","first-page":"109","article-title":"Quality Appraisal of Child Oral Health-Related Quality of Life Measures: A Scoping Review","volume":"5","author":"Yang","year":"2020","journal-title":"JDR Clin. Trans. Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1097\/MLR.0b013e318268aaff","article-title":"The use of patient-reported outcomes (PRO) within comparative effectiveness research: Implications for clinical practice and health care policy","volume":"50","author":"Ahmed","year":"2012","journal-title":"Med. Care"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1056\/NEJMp0911494","article-title":"The missing voice of patients in drug-safety reporting","volume":"362","author":"Basch","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1038\/nrclinonc.2017.109","article-title":"Outcomes research: Integrating PROs into the clinic\u2014Overall survival benefit or not, it\u2019s worth the trouble","volume":"14","author":"Sperti","year":"2017","journal-title":"Nat. Rev. Clin. Oncol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/7\/2221\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:59:44Z","timestamp":1760029184000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/7\/2221"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,25]]},"references-count":49,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["jcm14072221"],"URL":"https:\/\/doi.org\/10.3390\/jcm14072221","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,25]]}}}