Australian Dental Journal

The official journal of the Australian Dental Association

Australian Dental Journal 2019; 0: 1–10

doi: 10.1111/adj.12716

The extraction of first, second or third permanent molar

teeth and its effect on the dentofacial complex
A Hatami, C Dreyer
Department of Orthodontics, School of Dentistry, The University of Adelaide, Adelaide, South Australia, Australia.

ABSTRACT
The extraction of permanent molar teeth was first introduced in 1976 as a substitution for premolar extraction in cases
with mild crowding. Since then, a number of studies have investigated the effect of permanent molar extraction on
dentofacial harmony. Undertaking the procedure of molar extraction is most commonly recommended in response to
factors such as: gross caries, large restorations and root-filled teeth, along with its application in the management of
anterior open bite and reduction in crowding in facial regions. It has been indicated, however, that before undertaking
the extraction of molar teeth it is important to investigate the potential influence of the procedure on other molars, with
particular consideration of their eruption path. This is due to the doubt as to the effect of the exact molar teeth extrac-
tion and their consequences. In light of this, This review was undertaken to investigate and compare the effect of first,
second and the third molar teeth extraction and their subsequent dentofacial complex changes.
Keywords: dentofacial complex, extraction, first permanent molar, second permanent molar, third permanent molar.
Abbreviations and acronyms: CAI = condylar asymmetry index; TMD = temporal mandibular disorder; TMJ = temporomandibular
joint.
(Accepted for publication 12 August 2019.)

arise from the undertaking of the first, second and

INTRODUCTION
Tooth extraction is an important issue related to the
management of the dentofacial complex and its sym-
metry, with the extraction rate in orthodontic patients
found to be about 25–80%.1–5 The loss of permanent
teeth most often occurs due to caries or for the treat-
ment and management of periodontal disease6–9 with
molar teeth playing an important role in normal
occlusion.10,11 The first molar extraction in 1976 was
mentioned in an article by Williams, however, the
technique of extraction of permanent molar teeth as
the substitution for premolar extraction was first
introduced for the second molar by Richardson in
1996.12,13
Numerous studies have indicated various
approaches for molar teeth extraction in recent years,
however, the use of extraction is still controversial, as
there are no clear indications for the use of this
approach. The purpose of this article is to investigate
and compare the dentofacial complex changes which
© 2019 Australian Dental Association
third molar extraction.
FIRST MOLAR EXTRACTION
Chronology and dimensions
The movement of a tooth from its development site in
alveolar bone to the occlusal plane is termed a tooth
eruption.14 This path of eruption is not reliant on pres-
sure from the tooth itself and is instead considered a
genetic phenomena. The timing of the eruption of perma-
nent teeth is specifically dependent on the loss of antece-
dent teeth.15–17 There are numerous factors which might
affect permanent teeth eruption and their chronology
such as hyperdontia, trauma and cysts, all of which are
pathologic conditions affecting eruption by commanding
space. Additionally, the presence of general factors could
be important in eruption including genetic influences,
gender, social and economic conditions, the geographic
region and the consumption of fluoride.18–23
1
A Hatami and C Dreyer
First evidence of calcification At birth
Enamel completed 3–4 years
Eruption 6 years
Root completed 9–10 years
Mandibular first Maxillary first
molar (mm) molar (mm)
Overall length 20.9 20.1
Crown length 7.7 7.5
Root length 14.0 M root 12.9 MB root
13.0 D 12.2 DB
13.7 L
Crown width Mesio-Distal 11.4 10.4
Crown width Bucco-Lingual 10.2 11.5
Root to crown ratio 1.83 1.72
Advantages and indications of first molar extraction
Losing the first molar for any reason can be a challenge
for the developing occlusion especially in the mixed den-
tition stage24 as the first molar is an important tooth in
the development of normal occlusion of both arches.10 It
has been indicated that the first molar tooth is more
often exposed to caries which can lead to early extrac-
tion of the tooth25–28, however, overall the development
of caries in children and adolescents has decreased since
1980.29–31 The most common indications for the extrac-
tion of this tooth are caries, endodontic problems, and
cases of hypomineralization.32
First molar extraction advantages and indications:
(a) Management of impaction. It has been indicated
that due to the lack of space the third molar
could become impacted and that this tooth shows
the highest impaction rate of all teeth. In a study
carried out by Ay et al., it was suggested that
mandibular third molar eruption could be facili-
tated by mandibular first molar extraction.33
(b) Management of molar incisor hypomineralization.
This condition which is estimated to involve about
25% of European children and 3.6–19% in other
populations34–38 is defined as inadequate mineral-
ization in molar teeth34 resulting in a painful sen-
sation when brushing or breathing cold air in
which can require complex treatment.38,39 Jalevik
et al. evaluated 27 children with hypomineralized
teeth, and found that extraction of the first per-
manent molar could be beneficial. The study also
found that the patient’s permanent dentition posi-
tioning and the reduction of the space did not
cause particular concerns.40 Regardless of other
conditions restorative treatment of hypomineral-
ized molars caused practitioners a variety of man-
agement problems.41–44
(c) First molar extraction as part of orthodontic treat-
ment. In 2010, Ong et al. suggested first molar
extraction and its advantages and disadvantages
2 © 2019 Australian Dental Association
were based on endodontic and restorative treat-
ment need.45 Practitioners prefer extraction of this
tooth to premolars because of its high rate of car-
ies, root-fillings and its effect on relieving crowd-
ing.32,46 Bayram and colleagues showed that the
extraction of the first molar could be useful as the
space for third molar eruption is increased, the
effects of which are more favourable for upper
third molars in comparison with the lower.47
Disadvantages and contraindications of first molar
extraction
Additional studies have investigated the disadvantages
of the first molar extraction26,48. These include:
(a) Tipping of adjacent teeth towards the extraction
site;
(b) Shifting of the dental midline towards the site of
the extraction;
(c) Change in chewing habits;
(d) Periodontal and temporomandibular joint prob-
lems.
Of particular concern is the potential of the first
molar extraction to negatively impact on dentofacial
symmetry. This is defined as the similarity in shape
and volume of both sides of the face, however, the
exact equilibrium is theoretical.49–51 Caglaroglu and
colleagues demonstrated, by using postero-anterior
radiographs in 25 patients with maxillary permanent
first molar extraction, 26 mandibular permanent first
molar extraction and 30 controls, that patients who
had early molar extraction could be faced with dental
and skeletal asymmetry. This finding was also sup-
ported by Farkas and Hewitt amongst others.52,53
Halicioglu investigated bilateral mandibular first
molar extraction and its effect on asymmetry in adult
patients. In this study, the Condylar asymmetry index
(CAI), ramal asymmetry index and condylar plus ramal
asymmetry index were measured. The study found that
the CAI was increased in both cases and control groups,
however that there was no significant difference
between the groups.54,55 By considering these studies, it
can be suggested that the extraction of the first molar at
mixed dentition stage could be important in dentofacial
asymmetry but when this extraction happens in the
adult there is no evidence of asymmetry. Furthermore,
asymmetrical extractions when considered have to be
evaluated carefully to prevent the side effect of asym-
metry such as midline shift, temporal mandibular disor-
der (TMD) and cross bite.
Timing for first molar extraction
The differences in mandibular and maxillary first
molar eruption could play an important role in

extraction timing.56 There are limited studies on this
subject. Conway et al. in an evaluation of three cases
showed that maxillary Molar extraction results were
favourable in two children who were aged more than
11 years in comparison with one child at 8 years.57
Additionally, Jalvek’s study showed that the result of the
maxillary first molar extraction in patients older than
8 years could be more promising in comparison with
those under 8 years.40 The mandibular first molar
extraction was also investigated in studies by Conway
and Jalevik. In the Conway study, a mandibular first
molar extraction was performed in two patients aged 11
and 12 years, however, the results of the extractions
were inconclusive. However, in Jalevik’s study the
mandibular extraction in 12 patients showed favourable
results despite the differences in their age.40,57 Consider-
ing the limited number of studies there is not enough evi-
dence to determine a definite conclusion, however,
based on current literature, it is suggested that the
extraction of the first molar is favourable in orthodontic
treatment of patients older than 8 years old. Ay et al.
noted that the early extraction of the first molar could
cause dentofacial asymmetry, premature contacts and
uncontrolled tipping.58
Other molar position changes after first molar
extraction
The loss of a permanent maxillary first molar is
commonly followed by a mesial drift of the second
(a)
(b)
Fig. 1 In this patient the first molar extraction effect on the third molar
development is illustrated. This panoramic radiograph shows third molar
development acceleration in the maxillary (a) and mandibular (b) where
extraction of the first molar has occurred.61
© 2019 Australian Dental Association
Molar extractions
molar, which along with the extraction of the first
molar can provide a favouable space for third molar
eruption into the second molar site.47 Additionally,
the extraction of the second molar might trigger this
shift by better positioning the third molar at the
time of its eruption.59,60 Halicioglu et al. investi-
gated permanent first molar extraction effects on the
third molar development and showed that the
extraction of the first molar can have beneficial
effect on developmental acceleration of the third
molar on the mandibular and maxillary extracted
side (Fig. 1).61 In addition, first molar extraction
can also provide a greater vertical angulation of
third molar (Table 1).33,47
Angle’s classification in first molar extraction
Angle’s classification is a common method for the
evaluation of malocclusion of teeth.62 Teo et al. inves-
tigated the Angle’s classification in patients with first
molar extraction and the position of the second molar
after 5 years. They could not show any significant
association between Angle’s classes and space closure.
Even by considering any significant relationship most
of the cases with upper first molar extraction led to
adequate space closure.59
SECOND MOLAR EXTRACTION
A permanent second molar is the tooth located dis-
tally from the first molars and mesial from the third
molars.63 The first molar tooth might be sacrificed
during orthodontic extraction26 however, the special
anatomical position of the second molar and the
outcome of extraction modalities has been the focus
of attention for some time in the Western
world.63,64 Recently, second molar extraction has
become a topic of interest and controversy among
dental professionals.65
There is discordance in the scientific literature on
the conditions of the adjacent second molar associ-
ated with the extraction of neighbouring molars.
Retrospective studies have reported relatively high
residual periodontal defects at the distal aspect of
the second molar after third molar extraction.66–69
However, some prospective studies have shown dif-
ferent clinical outcomes with relative periodontal
improvements.67,70,71 Studies have shown different
results of improvement, unchanged or even deterio-
ration of periodontal status.67 Orthodontic treatment
involving the extraction of the second molar compa-
rably takes significantly shorter time for periodontal
ligament to heal than with non-extraction methods
of treatment.72
3
A Hatami and C Dreyer

Table 1. Important studies in this field and their Intended conclusion

Author Year Conclusion Patients number Mean age Ref

Yavoz 2006 The extraction of the first permanent molar can induce third molar 165 15.35  2.53 122

eruption in early ages

33
Ay 2006 First molar extraction increases the third molar space, aids in better 107 patients with 25.69
development, eruption and better movement into the space. Also unilateral mandibular
increase in vertically angulated third molars first-molar extractions
40
Jalevik 2007 Extraction of first molar is an appropriate alternative in patients with 27 8.2
hypomineralization.The permanent dentition positioning and dental
development in these patients was suitable without any intervention
49
Caglaroglu 2008 Early unilateral first molar extraction can lead to dental and skeletal 25 maxillary/26 18.25
asymmetries mandibular/30 control
47
Bayram 2009 First molar extraction increases the third molar eruption space and 41 16.6
increases the maxillary third molar angulation more than the
mandibular
59
Teo 2013 There was no statistically significant association between Angle’s 63 8.9
classes and space closure
Halicioglu 2013 Condylar asymmetry index were increased but there were no 30 and 25 control 18.24  1.17 54

statistical significant difference in asymmetry between these groups

61
Halicioglu 2014 The first molar extraction caused increased third molar eruption 2925 panoramic 13–20 years
acceleration in both maxilla and mandible radiographs

3.1 Chronology and dimensions73–75 (a) The minimal impact on the anterior profile of the
face due to the lack of visiblity.73,81,82
(b) Significantly shorter time to heal compared to the
First evidence of calcification 2.5–3 years non-extraction approach of orthodontic treat-
Enamel completed 7–8 years
Eruption 11–13 years ment.72
Root completed 14–15 years (c) Facilitation of treatment using removable appli-
Mandibular second Maxillary second ances.
molar (mm) molar (mm) (d) Disimpaction and faster eruption of third molars.
Overall length 20.6 20.0 (e) Prevention of ‘late’ incisor imbrication, fewer
Crown length 7.7 7.6
Root length 13.9 M root 12.9 MB root ‘residual’ spaces at the end of orthodontic treat-
13.0 D 12.1 DB ment.
13.5 L (f) Less likelihood of relapse.
Crown width MD 10.8 9.8
Crown width BL 9.9 11.4 (g) Favourable functional occlusion and mandibular
Root to crown ratio 1.82 1.70 arch formation.72,83

Disadvantages and contraindications of second molar

Advantages and indications of second molar
extraction
Second molar extraction has been recommended as an
orthodontic treatment option.77 The indications for
the extraction of the second molars include:
(a) Presence of severe caries.
(b) Ectopically erupted or severely rotated molars.76–79
(c) Existence of mild-to-moderate arch length defi-
ciencies with concurrent good facial profiles.
(d) Crowding in the tuberosity area with a need to
facilitate first molar distal movement.57
(e) Relief of malocclusions developed from the erup-
tion forces of permanent molars.80
(f) Facilitate the eruption of the third molars, thus
avoiding the need for surgical extraction.
Other advantages and considerations of second
molar extraction include:
4 © 2019 Australian Dental Association
extraction
Various authors have reported some drawbacks
regarding extraction of the second molar tooth,
including the 84
(a) Tipping and drifting of the adjacent teeth, usually
followed by missing mandibular second molars.
(b) Supraeruption of unopposed teeth.
(c) Poor gingival contours.
(d) Poor interproximal contacts.
(e) Reduced inter-radicular bone and pseudopockets.85
(f) Late lower arch crowding when extracted in the
presence of a developing third molar with insuffi-
cient space.86
(g) The development of cervicofacial subcutaneous
infections which might follow incomplete second
molar extraction.64,87
 Molar extractions

Other disadvantages of second molar removal as
reported by several authors include:
(a) Frequent undesirable positions of erupted third
molars resulting in a second late stage of fixed
appliance therapy.
(b) That the extraction site is located far from the
area of concern in moderate-to-severe anterior
crowding.11,60,65,72,81
A comparative study by Staggers et al., demon-
strated that the maxillary and mandibular first molars
were protracted a greater amount in the second molar
compared to pre-molar extraction group. There
appeared no change in facial profile after extraction
of second-molars.83 In another study, the maxillary
first molars were found to have moved distally an
average of 1.2 mm following the maxillary second
molar extraction.72,80,94,95

Timing for second molar extraction

THIRD MOLAR EXTRACTION
It is believed by many orthodontists that the optimum
The third molar tooth (M3) is the last to appear and
age for second molar extraction as a therapeutic
is the most variable tooth affected by morphology,
method is between 12 and 14 years, with the impor-
eruption period and oligodontia/hypodontia.96 The
tance of the position of the third molar is equally
M3 is of interest to scientists when estimating the
highlighted allowing the fill-in of space left by the sec-
chronological age of youngsters, to assess develop-
ond molar.80,88
ment, to select treatment, to establish diagnosis and
The consensus of several reports is that the optimal
to resolve legal issues and immigration.97
time of extraction of the second molar is as early as it
Wisdom teeth are the most likely to undergo impaction
erupts, provided that the third molar crown is com-
(incomplete eruption in the presence of a fully grown
plete but before any reliable evidence of root forma-
root), which occurs when there is inadequate space in the
tion. The axial alignment and angulation of the third
mouth, if there is an impediment by another tooth or if the
molar bud plays an essential role in the extraction
tooth has developed in an abnormal position. The
decision, especially if indicated at a later age.79,83,89,90
impacted tooth is generally trouble free and covered
totally or partially by soft tissue, bone or a combination of
Changes in other molar position after second molar the two.98 The development of the M3 is not without risks,
extraction however, with Mortazavi et al.99 finding with their system-
atic review an association between an impacted third
It is noted that the loss of permanent molars is closely
molar and 10 different types of cysts and tumours.
followed by drift of the neighbouring teeth.91 This
shift also could be triggered by the extraction of the
second molar which might provide the third molar a Chronology and dimensions
better position and hasten the time of the erup-
The chronology of M3 varies widely across races but
tion.59,60 In relation to the drift following extraction,
generally it is found that females experience M3 devel-
Wieslander reported that the third molars usually
opment earlier than their male counterpart. The earliest
assume a downward and forward orientation,80 with
chronology of human dentition by Schour and Massler,
Richardson et al reporting slight distal movement of
that is modified from Kronfeld’s table, provides an esti-
the first molars and a decrease in crowding.88
mate of M3 chronology with maxillary dentition in the
It is a common belief among dental professionals
lead. The M3 is similar to second molar being heart-
that in the long-term perspective, unopposed molars
shaped but has a smaller crown and shorter root com-
tend to over erupt following the extraction of the
pared to the second molar tooth.100
molars. Livas et al found insignificant changes in the
eruptive movement of unopposed mandibular second
molars.92 However, according to Breakspear: First evidence of calcification 7–9 years
Enamel completed 12–16 years
(a) Path of eruption of the third molar could be Eruption 17–21 years
Root completed 18–25 years
affected by the over eruption of the opposing sec-
ond molar. Mandibular third Maxillary third
molar (mm) molar (mm)
(b) Distal migration of the first molar when there is miss- Overall length 18.2 17.5
ing second molar and premolar crowding could also Crown length 7.5 7.2
effect path of eruption of the third molar. Root length 11.8 M root 10.8 MB root
10.8 D 10.1 DB
(c) Following the second molar extraction a residual 11.2 L
space is created which is usually spontaneously Crown width MD 11.3 9.2
closed by distal movement of the first molars and Crown width BL 10.1 10.4
Root to crown ratio 1.57 1.49
to some extent by spontaneous migration of the
third molars.63,80,83,93
© 2019 Australian Dental Association 5
A Hatami and C Dreyer

The development and eruption of the third molar is
enigmatic in orthodontics, especially the mandibular
third molar.101 It’s been indicated that the early erup-
tion of the M3 is associated with the angulation of
the developing third molar, mandibular growth and
the extraction of other teeth in the erupting
area.101,102
The eruption of M3, like other permanent teeth, is
dependent on a number of factors, including:
(a) Genetic diseases such as Amelogenesis Imper-
fecta, Down syndrome, Neurofibromatosis etc.
(b) Gender.
(c) Socioeconomic status (conflicting data on higher
vs. lower socioeconomic status).103
(d) Nutrition (malnutrition extending into early
adulthood delayed dental eruption).
(e) Systemic diseases (renal failure, anaemia and vita-
min D-resistant rickets104).
Advantages and indications of third molar extraction
Despite its common use, the surgical removal, and the
timing of the surgical removal, of asymptomatic M3
as prophylaxis to prevent related health complications
is a controversial topic among health practitioners as
well as public and health insurance companies103,105.
As concluded by Costa et al. in their systematic
review the notion of M3 extraction as a prophylaxis
is null and void due to lack of sufficient evidence.106
However, a number of benefits exist for M3 extrac-
tion and studies have unanimously pointed to an ear-
lier age of extraction to correlate favourably with
lesser morbidity.107 The circumstances remaining in
which extraction of the M3 is indicated, include:
(a) Impaction associated with dental caries (in-
tractable carious lesion).
(b) Periodontal defects close to the preceding
molar.108
(c) Pericoronitis.
(d) Odontogenic cyst.109
(e) Dental tumours.105
(f) Prophylactic removal of impacted M3 is also indi-
cated for root resorption, crowding of lower inci-
sors and damage to the adjacent tooth.98
The M3 also plays a role as a method for evaluating a
young adult age. Chronological evidence from all other
bony tissues has been completed by the mid-adolescence,
with the M3 having the benefit of its phase of crown-root
mineralization able to be easily surveyed in a non-invasive
manner from a dental radiograph. This technique is also
useful in determining age in forensic science96 as well as in
the evaluation of dental age to provide a vital way of moni-
toring whether adolescents are developing sequentially.97
Dental surgeons use an appraisal of M3 mineralization to
plan autologous transplant in replacing undesirable first or
second molars.109
Disadvantages of third molar extraction
A number of changes post third molar extraction have
been observed.
(a) Increase in probing depth on the distobuccal
aspect of the second molars and a reduction in
attachment level after surgical removal of
impacted mandibular third molar.110
(b) No appreciable gain in alveolar bone height after
removal of the impacted M3 of second molars
with distal bone loss due to M3 impaction.111
The extraction of M3 is a topic of ongoing contro-
versy.112 One of ten patients after surgical removal
experience associated complications that include;
intense pain, swelling, haemorrhage, infection, alveo-
lar osteitis, haematoma, lockjaw105, alveolar nerve
injury113, oroantral communication, incomplete root
removal, delayed healing, infected subperiosteal hema-
toma and bony spicule.114 Although rare, 5 in 1000
patients over 25 years of age experience mandibular
angle fracture after M3 extraction.108
Patients commonly experience anxiety with the
removal of M3, which has a significant impact on the
outcome of the surgery due to the disturbed emotional
state of the patient.115 Kim and colleagues have

Table 2. Indications, disadvantages and proposed timing for extraction of molar teeth
Tooth/condition First molar Second molar Third molar

Indications Caries, endodontic problems, Caries, ectopically eruption, severely rotated, Caries, periodontal defects, pericoronitis,
hypomineralization orthodontic treatment odontogenic cyst, dental tumours
Disadvantages Shifting of the dental midline, Drifting of the adjacent teeth, supraeruption of One of 10 patients faced with intense
change in chewing habits, unopposed teeth, poor gingival contours, poor pain, swelling, haemorrhage, alveolar
periodontal problems, interproximal contacts, reduced inter-radicular osteitis, haematoma, lockjaw, alveolar
temporomandibular joint bone, pseudopockets nerve injury
problems
Changes in Help in mandibular third Relieve malocclusions, facilitate eruption of the Relieve crowding of lower incisors
other molar molar eruption third molars, faster eruption of third molars,
position maxillary first molars could have move
distally

6 © 2019 Australian Dental Association


demonstrated a significant reduction in intraoperative
anxiety of the patients in presence of their music of
choice.116 Patients appreciated having a separate con-
sultation prior to surgical visit for M3 extraction but
it has no corralation to overal anxiety outcome.117
Timing for a third molar extraction
There is a paucity of literature on the timing for the
M3 extraction. In general, dental professionals agree
that third molars should be removed whenever there
is evidence that predicts:
(a) Cavities that cannot be restored
(b) Severe periodontal disease
(c) Infections
(d) Tumours
(e) Cysts, and/or
(f) Damage to neighbouring teeth.
In terms of tooth survival to extraction among wis-
dom teeth in the maxillary or mandibular arch, the
difference is insignificant but upper M3 survival time
to extraction carries the least prognosis.118 The pro-
phylactic M3 extraction at younger age has a more
positive prognosis.107
Changes in other molar position after third molar
extraction
In patients with second molar extraction, usually the
lower third molar erupts in an acceptable position.86
Richardson et al. recommended that the presence of
the third molar could be a cause of crowding in lower
arch during the post-adolescent period.119 However,
there is no conclusive evidence to show the role of
M3 on anterior teeth crowding. Previous studies have
pointed out that molar distalization and rotation is
unaffected by wisdom teeth eruption.
After second molar extraction, M3 usually assumes
a downward and forward orientation.80 Bayram and
co-workers stated that prophylactic extraction of the
first molar provides adequate space for M3 eruption
and results in better angulation of maxillary M3 com-
pared to the mandibular. This also decreases the
chance of impaction of M3s.120 In another study, it
was concluded that first molar extraction helps M3
occupy an optimal position but suggested if the
extraction was carried out too early, this could lead
to uncontrolled tipping of neighbouring teeth into the
extraction space.121,122
CONCLUSION
This study was carried out to evaluate dentofacial
complex changes in first, second and third molar teeth
extraction. A number of studies were included as part
© 2019 Australian Dental Association
Molar extractions
of this review, most of which indicate that undertak-
ing the extraction of the first, second and third molars
must involve a number of considerations. These con-
siderations include and are not limited to;
(a) management of impaction
(b) molar pathologies such as gross caries, dentiger-
ous cyst etc
(c) severe hypomineralization
(d) age of patient
(e) asymmetry and malocclusion
(f) molar teeth crowding
(g) Periodontal and TMJ problems
There are some circumstances in which the indica-
tions for molar extraction are clear, such as when
there is the presence of caries affecting the teeth.
However, the studies regarding timing of planned
extractions are limited and conclusions drawn
require further investigation. When planning for
extractions the known disadvantages do need to be
considered, such as alvelolar nerve injury, intense
pain, swelling and infection, unfavourable shifting of
adjacent teeth, change in occlusion, TMJ problems.
When extraction is planned for first, second or third
molars, the patients’ age and the optimum timing
for the extraction needs to be carefully considered.
This study suggests that the approach to dental
molar extraction must include the careful considera-
tion of the effects of the extracted molar on other
molars, the faciodental complex and its symmetry
(Table 2).
CONFLICTS OF INTEREST
The authors disclose no conflicts of interest. This
research has not received any funding. All authors
have viewed and agreed to the submission.
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Address for correspondence:
Amir Hatami
38 James Street
Mount Gambier
SA 5290
Australia
Email: amh2005@gmail.com
© 2019 Australian Dental Association