08 April 2020

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Premature loss of primary molar: space changes analysis

Alessandra Abbà

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Many times primary teeth are given less importance as they are believed to shed automatically. Quite the opposite, primary teeth help in chewing, speech, are important for aesthetics and also they represent a “rail” for permanent teeth that should reach the right position in the dental arch. In fact the premature loss of primary molars leads to space reduction, resulting in malocclusion of permanent teeth unless a space maintainer. The early loss of primary teeth may have as side effect even crowding, rotation and impaction in the permanent teeth.

The aim of this study published on Journal of Dental Science on March 2017 was to monitor the long term space changes in children with premature loss of a primary maxillary first molar.      

Matherials&Methods:  
19 cases with unilateral premature loss of a primary maxillary first molar were evaluated for this study but only nine participants (mean age 6.0 ± 0.42 years) were available for the last follow up. Examination of the cases were done on dental casts after 2 or 3 days after the tooth extraction and then at a follow up visit after, on average, 81 months. Controlateral molars act as control. No space maintainer were used with any patient during the whole period.
Five lines of dental arch were measured according to designed reference points:
- Arch width and length,
- Intercanine width and length,    
- Arch perimeter.
Paired t-test was used to compare the measurements between the initial and 81-month follow-up examinations.    

Results
At 81-month follow-up, the examinations registered the following data:
- 88.9% of the cases didn’t show neither crowing of permanent successors nor canine impaction at the extraction site;
- 1\9 case exhibit more crowded permanent dentition at the control site compared with the extraction site,
- significantly greater arch width, arch length, intercanine width, and intercanine length compared with the initial parameters (P < 0.05);
 - no significant difference in the arch perimeter (P = 0.071).

Conclusions
Increases of the dental arch dimension recorded in this study may call into question the use of space maintainers. Moreover, the variety of the results suggests that multiple factors affect the space changes in developing arches. Nevertheless more studies are needed to draw a certain conclusion.      

For additional information:  a long-term space changes after premature loss of a primary maxillary first molar