First permanent molars of poor prognosis

First permanent molars of poor prognosis

Description: Teeth with moderate to severe molar incisor hypomineralisation (MIH), advanced or unrestorable caries, pulpitis with reversible or irreversible symptoms, dental infection, pulpal involvement radiographically or periradicular pathology.

Image shows a first permanent molar of poor prognosis.

Aims: To ensure all relevant factors are considered when deciding how to manage first permanent molars (FPMs) of poor prognosis and to optimise the timing of extraction, if extraction is indicated, to enable the second permanent molar(s) (SPM) to occupy the FPM(s) spaces or to maintain the FPM(s) so that they can be extracted later as part of a comprehensive orthodontic treatment plan.

The Royal College of Surgeons of England 2023 Guideline for the Extraction of First Permanent Molars in Children guideline provides more detailed advice on planned extraction of first permanent molars.