Clinical and radiographic evaluation of the extraction of permanent first molars in mixed dentition in Konya

The first permanent molar (FPM) is the tooth with the highest incidence of caries during both mixed and permanent dentition, and is the most commonly restored and extracted permanent tooth. When extraction is necessary, it should be considered that the second permanent molar (SPM) and second premolar (SP) may drift into the extraction space under appropriate conditions. Therefore, the long-term prognosis of FPMs must be carefully evaluated. This study aimed to assess the clinical and radiographic outcomes of FPM loss during the mixed dentition period. Ninety pediatric patients aged 7–12 years, who presented to the Selçuk University Faculty of Dentistry between 2017 and 2022 and had at least one extracted FPM, were included. A total of 35 maxillary and 95 mandibular extracted FPMs were retrospectively analyzed. Extraction age, number of extracted teeth, and extraction sites were recorded. Radiographic evaluations included SPM bifurcation development, third molar (TPM) presence, SPM vertical position, and angular changes of SPMs and SPs. Spontaneous space closure and temporomandibular joint (TMJ) symptoms were assessed using clinical records. A significant relationship was found between the SPM bifurcation development stage and spontaneous space closure success (p<0.05), with higher closure rates at Demirjian stages D and E. Space closure success was also significantly associated with extraction age (p<0.05), with better results when extraction occurred between 8–11 years. Closure was more successful in the maxilla (81.8% Grade 1 closure) compared to the mandible (33.7%). Limited angular changes were observed in successful cases, while greater mesial tipping of SPMs was noted in unsuccessful cases. SPs exhibited mild distal tipping, particularly limited in the mandible. No significant relationship was found between TPM presence or SPM vertical position and space closure. TMJ symptoms were observed in some patients but were not statistically linked to extractions. In conclusion, successful spontaneous space closure after FPM extraction depends not only on chronological age but also on dental developmental stages and other factors. Early diagnosis and proper timing are crucial to achieving optimal occlusal and functional outcomes.