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© Borgis - New Medicine 3/2019, s. 96-104 | DOI: 10.25121/NewMed.2019.23.3.96
Angelika Kobylińska1, Paula Piekoszewska-Ziętek1, Dariusz Gozdowski2, Anna Turska-Szybka1, *Dorota Olczak-Kowalczyk1
Spatial changes in the dental arch after premature extraction of the first primary molar – a 12-month observational study
Przestrzenne zmiany w łuku zębowym po jednostronnej przedwczesnej ekstrakcji pierwszego trzonowego zęba mlecznego ? obserwacje 12-miesięczne
1Department of Paediatric Dentistry, Medical University of Warsaw, Poland
Head of Department: Professor Dorota Olczak-Kowalczyk, MD, PhD
2Department of Experimental Design and Bioinformatics, Warsaw University of Life Sciences, Poland
Head of Department: Professor Wiesław Mądry, PhD
Streszczenie
Wstęp. Przedwczesna utrata pierwszego zęba trzonowego mlecznego może prowadzić do wady zgryzu lub zaburzenia procesu wyrzynania zębów stałych.
Cel pracy. Celem pracy była ocena przestrzennych zmian w łuku zębowym po jednostronnej przedwczesnej ekstrakcji pierwszego zęba trzonowego mlecznego.
Materiał i metody. U pacjentów w wieku od 5. do 7. roku życia spełniających kryteria włączenia na podstawie wywiadu, badania klinicznego i pantomograficznego pobierano wyciski anatomiczne masą alginatową podczas wstępnego badania kwalifikującego w okresie do 14 dni przed ekstrakcją lub w dniu ekstrakcji przed jej przeprowadzeniem oraz podczas badań kontrolnych (1, 3, 6 i 12 miesięcy od ekstrakcji). Na modelach gipsowych zmierzono obwód łuku, tylną i międzykłową szerokość łuku, tylną i międzykłową długość łuku, odległości międzyzębowe: IIID-VM, IIID-VD po stronie ekstrakcji i przeciwnej stronie łuku. Dane poddano analizie statystycznej (Statistica 10, Statsoft, p < 0,05).
Wyniki. U 27 dzieci (średni wiek w latach ± SD = 6,64 ± 1,01; 15 chłopców i 12 dziewcząt) usunięto 14 zębów w żuchwie i 16 w szczęce. Zaobserwowano istotną utratę odległości międzyzębowych IIID-VM oraz IIID-VD pomiędzy stroną badaną i kontrolną na skutek dystalizacji kła i mezjalizacji II zęba trzonowego mlecznego. Istotnie mniej znaczące przemieszczenia tych zębów występowały w przypadku obecności w jamie ustnej I zęba trzonowego stałego w momencie ekstrakcji I zęba trzonowego mlecznego.
Wnioski. Przedwczesna utrata pierwszych zębów trzonowych mlecznych prowadzi do zmniejszenia odległości międzyzębowych w stopniu nieutrudniającym wyrzynania stałego następcy. Nie ma potrzeby stosowania utrzymywaczy przestrzeni.
Summary
Introduction. Premature loss of the first primary molar may cause malocclusion or impair permanent tooth eruption.
Aim. The aim of the study was to assess spatial changes in the dental arch after unilateral premature extraction of the first primary molar.
Material and methods. The alginate impressions were taken in patients aged between 5 and 7 years who met the inclusion criteria based on medical history, clinical examination and panoramic x-ray during a preliminary qualifying examination 14 days before or on the day of extraction (before the procedure), as well as during follow up (at months 1, 3, 6 and 12 after extraction). Gypsum models were used to measure the circumference of the arch, the posterior and intercanine width, as well as the interdental distance: IIID-VM, IIID-VD on the side of extraction and the opposite side of the arch. The data were analysed statistically (Statistica 10, Statsoft, p < 0.05).
Results. A total of 14 mandibular and 16 maxillary teeth were extracted in 27 children aged between 5 and 7 years (mean age ± SD = 6.64 ± 1.01; 15 boys and 12 girls). A significant loss of interdental spaces for IIID-VM and IIID-VD between the study vs. control side due to distalisation of canine and mesialisation of the second primary molar was observed. Much less significant displacement of these teeth was noted in the case of the presence of the first permanent molar at the time of first primary molar extraction.
Conclusions. Premature loss of first primary molars results in reduced interdental distances which does not hinder the eruption of their permanent successors. There is no need for space maintainers.
Introduction
Premature loss of the first primary molar may result in adverse dental arch spatial changes and, consequently, malocclusion or impaired permanent tooth eruption.
It leads to distalisation of primary canine or mesialisation of the second primary molar, especially in the period of first permanent molar eruption (1).
These displacements may cause the first permanent molar to tilt towards the gap, as well as crowding of mixed and permanent dentition and arrested eruption of the permanent successors (2-5).
The opinions of doctors on the use of space maintainers in the case of the loss of the first primary molars before physiological tooth replacement are divergent (6). Literature contains both data supporting and negating the need for space maintainers. In a systematic review, Tunison et al. showed that the majority of studies on the subject fail to meet the quality criteria for methodology (7).
Aim
The aim of the study was to assess spatial changes in the dental arch after unilateral premature extraction of the first primary molar.
Material and methods
Patients aged between 5 and 7 years, with indications for extraction of a single first primary molar, no loss of other teeth in the dental arch, whose parents resigned from space maintainers, were included in the study. A written consent of parents/legal guardians for the child’s participation in the study and child’s cooperation were the inclusion criteria. Children with growth disorders, malocclusions, and confirmed congenital absence of tooth/teeth or the presence of supernumerary teeth were excluded from the study. The preliminary qualification examination (0) included medical history (information about chronic diseases, oral pain, parafunctions, orthodontic treatment); clinical dental examination for the presence of first primary molars with indications for extraction (e.g. tooth damage to an extent preventing conservative reconstruction, pulpopathies with inflamed peri-root tissue); an assessment of malocclusions (occlusion of dental arches in the transverse (midline, position of the lateral teeth), anteroposterior (horizontal bite, inter-arch tooth alignment, Angle’s class), or vertical direction (vertical bite, lateral teeth contact)); radiological assessment for the presence of permanent tooth buds/supernumerary teeth based on panoramic radiography. Alginate impressions were collected from patients meeting the inclusion criteria during the preliminary examination which took place in the period of 14 days before or on the day of extraction (before the procedure). During follow-up (at 1, 3, 6 and 12 months after extraction), dental assessment was performed for the presence of teeth with indications for extraction or the loss of teeth since previous visit, as well as alginate impressions of the evaluated dental arch were taken. Alginate impressions were used to prepare gypsum models. The models were used to assess dental arch spatial changes by measuring the circumference of the arch, the posterior and intercanine width and length, as well as the interdental distance: distal surface of primary canine to mesial surface of second primary molar (IIID-VM) and distal surface of primary canine to distal surface of second primary molar (IIID-VD) on the side of extraction and the opposite side of the arch (fig. 1).
Fig. 1. Dental arch measurements: A ? posterior and B ? intercanine arch width, C ? posterior and D ? intercanine arch length, interdental distance: E ? IIID-VM, F ? IIID-VD
The data were analysed statistically (Statistica 10, Statsoft, p < 0.05; t-test, Mann-Whitney U test, Spearman’s rank correlation). The study was approved by the Bioethics Committee of the Medical University of Warsaw (KB/47/2014).
Results
Among 44 patients qualified for the study based on the indication for a single molar extraction, 7 patients were excluded due to malocclusion (n = 4), lack of second premolar buds on examination (n = 1) and the presence of mesiodens (n = 2). A total of 37 patients meeting the inclusion criteria were enrolled in the study; however, 10 children were excluded during the 12-month follow-up due to further extractions. The final group included 27 children aged between 4.66 and 8.73 (mean age in years ± SD = 6.64 ± 1.01), including 15 boys and 12 girls. A total of 14 mandibular and 16 maxillary teeth were extracted in the study group.
Interdental distances
The mean interdental distances were higher on the control side at each examination. We found negative correlations between IIID-VM in the study quadrant and the maxillary intercanine length and width, and a positive correlation between IIID-VD in the study quadrant and posterior mandibular length. There were significant differences in the mean IIID-VM in both arches between the study and the control side, except for the baseline measurement in the mandible (tab. 1). There were significant differences in the mean maxillary IIID-VD between the study and the control side at each examination, and only at months 6 and 12 in the case of the mandible.
Tab. 1. Mean interdental distances
MeasurementArchMean IIID-VM [mm]DifferencePMean IIID-VD [mm]DifferenceP
0upperB 7.156 -0.375 0.029*B 15.594-0.3440.011*
K 7.531K 15.938
lowerB 7.929 -0.321 0.133B 17.250-0.1070.596
K 8.250K 17.357
1upperB 7.031 -0.438 0.006*B 15.438-0.5000.006*
K 7.469K 15.938
lowerB 7.679 -0.571 0.048*B 17.143-0.1790.336
K 8.250K 17.321
3upperB 6.750 -0.719 0.000*B 15.344-0.5630.005*
K 7.469K 15.906
lowerB 7.429 -0.786 0.020*B 17.036-0.2500.355
K 8.214K 17.286
6upperB 6.563 -0.844 0.000*B 15.188-0.7500.000*
K 7.406K 15.938
lowerB 7.071 -0.929 0.008*B 16.643-0.5710.033*
K 8.000K 17.214
12upperB 6.281 -1.156 0.003*B 14.938-0.9690.010*
K 7.438K 15.906
lowerB 6.964 -1.000 0.016*B 16.393-0.7500.037*
K 7.964K 17.143
*statistically significant
The mean loss of maxillary IIID-VM distance was 0.88 (± 1.19) mm on the study side and 0.09 (± 0.64) mm on the control side during the follow-up period; the mean loss of mandibular IIID-VM distance was 0.96 (± 0.97) and 0.29 (± 0.47) mm, respectively. The mean loss of maxillary IIID-VD distance was 0.66 (± 1.34) mm on the side of extraction and 0.03 (± 0.56) mm on the opposing side; the same loss was 0.86 (± 1.25) and 0.21 (± 0.51) mm, respectively, for the mandible. Significantly different mean differences in the IIID-VM distance between the study and the control side on examinations 1-0, 3-0, 6-0 for the mandible and 3-0 and 6-0 for the maxilla were noted. Significantly different mean differences in the IIID-VD distance between the study and the control side on examination 6-0 for both arches were observed (tab. 2).
Tab. 2. Interdental distances (S ? study side; C ? control side)
MeasurementDental archIIID-VM [mm]IIID-VD [mm]
MeanDifferencePMeanDifferenceP
1-0 Smaxilla-0.125 (± 0.22)-0.063 0.333-0.156 (± 0.44) -0.156 0.264
1-0 C-0.063 (± 0.25)0.000 (± 0.32)
1-0 Smandible-0.250 (± 0.38) -0.250 0.029*-0.107 (± 0.21) -0.071 0.165
1-0 C0.000-0.036 (± 0.13)
3-0 Smaxilla-0.406 (± 0.42) -0.344 0.029*-0.250 (± 0.52) -0.219 0.186
3-0 C-0.063 (± 0.6)-0.031 (± 0,34)
3-0 Smandible-0.5 (± 0.52) -0.464 0.009*-0.214 (± 0.67) -0.143 0.365
3-0 C-0.036 (± 0.24)-0.071 (± 0.27)
6-0 Smaxilla-0.594 (± 0.49) -0.469 0.023*-0.406 (± 0.55) -0.406 0.018*
6-0 C-0.125 (± 0.76)0.000 (± 0.45)
6-0 Smandible-0.857 (± 0.79) -0.607 0.003*-0.607 -0.464 0.017*
6-0 C-0.250 (± 0.38)-0.143
12-0 Smaxilla-0.875 (± 1.19)-0.7810.052-0.66 (± 1.34)-0.6250.083
12-0 C-0.094 (± 0.64)-0.03 (± 0.56)
12-0 Smandible-0.964 (± 0.97)-0.6790.014-0.86 (± 1.25)-0.6430.073
12-0 C-0.286 (± 0.47)-0.21 (± 0.51)
12-1 Smaxilla-0.750 (± 1.21) -0.719 0.062-0.500 (± 1.17) -0.469 0.173
12-1 C-0.031 (± 0.46)-0.031 (± 0.46)
12-1 Smandible-0.714 (± 0.85) -0.429 0.075-0.750 (± 1.2) -0.571 0.084
12-1 C-0.286 (± 0,47)-0.179 (± 0.46)
12-3 Smaxilla-0.469 (± 1.19) -0.438 0.150-0.406 (± 0.9) -0.406 0.103
12-3 C-0.031 (± 0.22)0.000 (± 0.32)
12-3 Smandible-0.464 (± 0.66) -0.214 0.321-0.643 (± 0.97) -0.500 0.084
12-3 C-0.250 (± 0.47)-0.143 (± 0.31)
12-6 Smaxilla-0.281 (± 1.05) -0.313 0.244-0.250 (± 0.98) -0.219 0.387
12-6 C0.031 (± 0.22)-0.031 (± 0.22)
12-6 Smandible-0.107 (± 0.53) -0.071 0.671-0.250 (± 0.75) -0.179 0.418
12-6 C-0.036 (± 0.31)-0.071 (± 0.18)
*statistically significant
Eruption of a permanent successor was observed in 7 patients on the study side and in none of patients on the control side.

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Piśmiennictwo
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otrzymano: 2019-08-30
zaakceptowano do druku: 2019-09-20

Adres do korespondencji:
*Dorota Olczak-Kowalczyk
Zakład Stomatologii Dziecięcej Warszawski Uniwersytet Medyczny
ul. Binieckiego 6, 02-091 Warszawa
tel.: +48 (22) 116 64 24
do-k@o2.pl

New Medicine 3/2019
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