Article Data

  • Views 1803
  • Dowloads 307

Original Research

Open Access

Timing for extraction of permanent first molars in school aged children: a pilot study

  • Meltem Bakkal1,*,
  • Berza Yilmaz2
  • Mustafa Sarp Kaya1
  • Tugba Unver3
  • Pinar Kinay Taran1
  • Serife Ozdemir1

1Department of Pediatric Dentistry, Bezmialem Vakif University, 34083 Istanbul, Turkey

2Department of Orthodontics, Bezmialem Vakif University, 34083 Istanbul, Turkey

3Department of Oral and Maxillofacial Radiology, Istanbul Galata University, 34430 Istanbul, Turkey

DOI: 10.22514/jocpd.2024.010 Vol.48,Issue 1,January 2024 pp.78-84

Submitted: 26 April 2023 Accepted: 29 June 2023

Published: 03 January 2024

*Corresponding Author(s): Meltem Bakkal E-mail:


Extraction of permanent first molars (P1Ms) could create gaps, tipping and/or rotating of neighboring teeth, which depend on the extraction timing. This study evaluated the outcomes of P1Ms extraction in children who were classified based on their permanent second molar’s (P2Ms) dental calcification at the time of extraction. In this retrospective study, the evaluations were made for 406 panoramic radiographs (PRs) of children aged 7–14 years who had single P1M extracted. Twenty-nine children having pre- and post-treatment PRs were selected based on the inclusion criteria. First, 2 groups were formed based on the extraction time by using the pre-treatment PRs; Early extraction group (EE)(n = 15) including Nolla Grades 5–6–7, and late extraction group (LE) (n = 14) including Nolla Grades 8–9–10 for P2Ms. Then, the inclination degrees of neighbouring teeth on extraction side and contralateral quadrant (non-extraction) side were measured by using the post-extraction PRs. Mann-Whitney U test was employed, and the statistical significance was set at p < 0.05. The mesial tipping tendency of P2M was significant towards the extraction side both at EE or LE calcification grades of P2Ms (p > 0.05). The mesial inclination degrees of maxillary P2Ms showed no statistically significant difference between the two sides of LE group. The ideal extraction time should be determined according to the dental age to plan an appropriate occlusal maintenance.


Dental age; Calcification grades; Molar extraction; Permanent first molars; Nolla’s method

Cite and Share

Meltem Bakkal,Berza Yilmaz,Mustafa Sarp Kaya,Tugba Unver,Pinar Kinay Taran,Serife Ozdemir. Timing for extraction of permanent first molars in school aged children: a pilot study. Journal of Clinical Pediatric Dentistry. 2024. 48(1);78-84.


[1] Moca AE, Vaida LL, Negrutiu BM, Moca RT, Todor BI. The influence of age on the development of dental caries in children. A radiographic study. Journal of Clinical Medicine. 2021; 10: 1702.

[2] Suzuki S, Sugihara N, Kamijo H, Morita M, Kawato T, Tsuneishi M, et al. Reasons for tooth extractions in Japan: the second nationwide survey. International Dental Journal. 2022; 72: 366–372.

[3] Ali D. Reasons for extraction of permanent teeth in a university dental clinic setting. Clinical, Cosmetic and Investigational Dentistry. 2021; 13: 51–57.

[4] Halicioglu K, Celikoglu M, Caglaroglu M, Buyuk SK, Akkas I, Sekerci AE. Effects of early bilateral mandibular first molar extraction on condylar and ramal vertical asymmetry. Clinical Oral Investigations. 2013; 17: 1557–1561.

[5] Mosharrafian S, Baghalian A, Hamrah MH, Kargar M. Clinical evaluation for space maintainer after unilateral loss of primary first molar in the early mixed dentition stage. International Journal of Dentistry. 2021; 2021: 3967164.

[6] Abu Aihaija ES, McSheny PF, Richardson A. A cephalometric study of the effect of extraction of lower first permanent molars. Journal of Clinical Pediatric Dentistry. 2000; 24: 195–198.

[7] Almahdi HM, Alabdrabulridha Z, AlAbbas J, Saad AA, Alarka I, Alghatm S, et al. Permanent first mandibular molar: loss prevalence and pattern among Saudis in Al-Ahsa. To be published in European Journal of Dentistry. 2022. [Preprint].

[8] Saber AM, Altoukhi DH, Horaib MF, El-Housseiny AA, Alamoudi NM, Sabbagh HJ. Consequences of early extraction of compromised first permanent molar: a systematic review. BMC Oral Health. 2018; 18: 59.

[9] Brusevold IJ, Kleivene K, Grimsøen B, Skaare AB. Extraction of first permanent molars severely affected by molar incisor hypomineralisation: a retrospective audit. European Archives of Paediatric Dentistry. 2022; 23: 89–95.

[10] Yavuz I, Baydaş B, İkbal A, Dağsuyu IM, Ceylan I. Effects of early loss of permanent first molars on the development of third molars. American Journal of Orthodontics and Dentofacial Orthopedics. 2006; 130: 634–638.

[11] Gill DS, Lee RT, Tredwin CJ. Treatment planning for the loss of first permanent molars. Dental Update. 2001; 28: 304–308.

[12] Eichenberger M, Erb J, Zwahlen M, Schatzle M. The timing of extraction of non-restorable first permanent molars: a systematic review. European Journal of Paediatric Dentistry. 2015; 16: 272–278.

[13] Teo TKY, Ashley PF, Parekh S, Noar J. The evaluation of spontaneous space closure after the extraction of first permanent molars. European Archives of Paediatric Dentistry. 2013; 14: 207–212.

[14] Cobourne MT, Williams A, Harrison M. National clinical guidelines for the extraction of first permanent molars in children. British Dental Journal. 2014; 217: 643–648.

[15] Nur B, Kusgoz A, Bayram M, Celikoglu M, Nur M, Kayipmaz S, et al. Validity of demirjian and nolla methods for dental age estimation for Northeastern Turkish children aged 5–16 years old. Medicina Oral Patología Oral Cirugia Bucal. 2012; 17: e871–e877.

[16] Wen D, Ding Z, Tian Z, Wu W, Qu W, He W, et al. Comparing the accuracy of Demirjian and Nolla methods and establishing a new method for dental age estimation in northeastern Chinese children. Forensic Sciences Research. 2022; 7: 685–693.

[17] Rocha CA, Almeida RRD, Henriques JFC, Flores-Mir C, Almeida MRD. Evaluation of long-term stability of mesiodistal axial inclinations of maxillary molars through panoramic radiographs in subjects treated with Pendulum appliance. Dental Press Journal of Orthodontics. 2016; 21: 67–74.

[18] Que L, Jia M, You Z, Jiang LC, Yang CG, Quaresma AAD, et al. Prevalence of dental caries in the first permanent molar and associated risk factors among sixth-grade students in Sao Tome Island. BMC Oral Health. 2021; 21: 483.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Scopus: CiteScore 1.8 (2023) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Submission Turnaround Time