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Guide to extraction of first permanent molars |
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1. The best age for extraction is between 8 1/2 and 10 1/2 years ( Commencement of calcification of bifurcation of lower 7’s, as seen on radiograph). Nearer 8 1/2 if space closure required. Lower molars not before 8 years old if at all possible (Drift of lower 5’s)
2. Verify presence of all other permanent teeth
3. No evidence of hypoplasia of unerupted teeth |
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Tooth or teeth to be extracted |
CLASS I No Crowding |
CLASS I Crowding |
CLASS II |
CLASS III |
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One Lower First Permanent Molar |
Extract upper 6 on the same side ONLY |
Extract all 6’s if upper 6’s doubtful, if not leave and extract nearer crowding later |
Extract other lower 6 unless it is sound and there is no crowding |
If no over crowding leave other lower 6. DO NOT remove upper 6’s if good prognosis |
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One Upper First Permanent Molar |
Leave lower 6 of good prognosis |
Leave other 6’s if good prognosis and extract nearer crowding later |
Extract other upper 6’s if good prognosis |
Leave other 6’s. Ortho referral essential |
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Both Lower First Permanent Molars |
Extract all 6’s |
Leave other 6’s if good prognosis and extract nearer crowding later |
Leave other 6’s if good prognosis but over eruption a disadvantage, premolar extraction a greater advantage |
Leave other 6’s if good prognosis |
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Both Upper First Permanent Molars |
Leave other 6’s if sound or well restored |
Leave other 6’s if sould or well restored. Extract all 6’s if prognosis doubtful |
Leave other 6’s if sound or well restored |
Leave other 6’s. Ortho referral essential |