It was with disappointment that I read the article by Peter Ngan and colleagues titled "Management of Space Problems in the Primary and Mixed Dentitions" (September JADA).
During this very comprehensive analysis, the authors never present second-molar replacement as an option for severe crowding.
Over the past 50 years, the successful extraction of second molars, with third-molar replacement, has been well-documented in the literature.1–4
While taught extensively in European orthodontic programs, this procedure receives little support from graduate programs in the United States.
A growing number of practitioners in the United States are now seeing the value of finishing orthodontic treatment with 28 functioning teeth, as opposed to the 24 found in most traditional premolar and third-molar extraction cases.
The common misbelief that third molars are too unpredictable has been addressed by Quinn,5 who showed that if the second molars are extracted when the third-molar roots are immature, the maxillary thirds commonly erupt unaided into good occlusion, while the lower thirds require uprighting in about 25 percent of the cases. (Uprighting a third molar involves the same mechanics Dr. Ngan describes for uprooting any ectopically erupting molar.)
While bicuspid extraction has definite indications in orthodontic treatment, I would urge the author to include the removal of second molars in his treatment planning alternatives.
TOP
REFERENCES
