Description
Poor prognosis permanent teeth
“Poor prognosis permanent teeth can include teeth with severe dental caries, periodontitis, deep restorations with likely pulp pathology or localised conditions such as molar-incisor hypomineralisation.”
– Ashley and Noar 2019
Poor prognosis teeth are a significant consideration in a developing or developed dentition as they may require extractions or may complicate orthodontic treatment.
First permanent molars are often the most affected teeth due to caries and conditions such as a molar-incisor hypomineralisation. Extractions of the first molars should be cautioned and a specialist orthodontic consult prior to their removal is recommended. The first molar space should be assessed for its use in any future comprehensive orthodontic treatment, and the timing of the second and third molars development need to be confirmed before any extractions are performed.
Ideally, premature loss of the first permanent molars should be followed by eruption of the second molars into the space and the third molars to follow thereafter.
Non-ideal extractions of first permanent molars or premature loss of anterior teeth can lead to significant occlusal complications and aesthetic changes.
Early loss of permanent teeth can lead to:
- Residual spaces of the arch
- Ectopic premolars and rotation of molars
- Retroclination of the incisors, increased overbite and overbite
- Atrophy of edentulous ridges
