Status of retained

deciduous second
molars in subjects with MOHANA SRIRAM K.L
1ST YEAR POST GRADUATE
agenesis of second DEPARTMENT OF PEDIATRIC &
PREVENTIVE DENTISTRY
premolars in relation to
age
AUTHOR’S

 M.BILINSKA

 M.ZADURSKA

 E.CZOCHROWSKA
INTRODUCTION
 Premolar agenesis, or the absence of second premolars, is a common developmental
anomaly with implications for dental health and occlusion.

 The retention of deciduous second molars (DSMs) in individuals with premolar agenesis
is of clinical interest due to its impact on orthodontic treatment and dental management.

 This study investigates the relationship between DSM retention and age in subjects with
agenesis of second premolars.

 DSM retention is influenced by genetic factors, dental morphology, eruption timing, and
environmental influences.

 Some individuals retain DSMs until late adolescence or adulthood, while others
experience early exfoliation, leading to space loss and orthodontic challenges.
 Age is a critical variable in this investigation due to its association with dental development and
eruption.

 Understanding age-related changes in DSM retention can inform orthodontic planning and
treatment timing.

 Insights from this research can contribute to more effective orthodontic interventions and long-
term dental management for individuals with premolar agenesis.

 Ultimately, this study seeks to enhance the quality of care for individuals with congenital tooth
anomalies by providing valuable insights into the dynamics of DSM retention in relation to age.
 AIM

The aim of this study was to evaluate the presence and the status of
retained deciduous second molars (DM2) in cases with a congenital
absence of second premolars (PM2) in relation to age.
 Material and methods

 The research material consisted of panoramic radiographs

 Selected from the database of the Department of Orthodontics of the Medical University of
Warsaw.

 A private orthodontic practice and a radiology center in Warsaw, Poland.

 The patients were divided into three groups according to age:

1. 10–13 years
2. 14–17 years
3. 18–22 years.
 The study group was examined for the presence and location of retained DM2

 The degree of their root resorption, the presence of fillings/ dental caries and
infraocclusion.
INCLUSION CRITERIA

 Agenesis of at least one PM2.

 If the second premolar (PM2) tooth germ wasn't seen on the

panoramic X-ray and there's no record of PM2 extraction, it was
diagnosed as missing.

 The minimum age of patients who qualified for the study was 10
years.
EXCLUSION CRITERIA

 Included patients with dentofacial deformities.

 Patients with oligodontia (excluding M3) and poor-quality

panoramic radiographs.
The study was approved by the Bioethics Committee of the Warsaw Medical University.

Root resorption of DM2 was graded from 1 to 6. they are,

 Grade 1. Roots without resorption;

 Grade 2. Roots resorbed for ¼ of the root length;
 Grade 3. Roots resorbed for ½ of the root length;
 Grade 4. Roots resorbed for ¾ of the root length;
 Grade 5. Roots completely resorbed;
 Grade 6. Missing tooth.
 Infraocclusion was identified if the distance between the occlusal line and the surface of the retained
deciduous molar was more than 2mm.

 It was graded on a scale from 0 to 1,

 where 1 indicated infraocclusion and 0 indicated its absence.

 The presence of cavities or restorations was noted as either 1 for present or 0 for a healthy deciduous
molar.
 RESULTS

 The study included 131 people

 Among them, 53 were receiving orthodontic treatment (40.5%), and the remaining 78 were
general population (59.5%).

 In most patients, the absence of one or two second premolars (PM2) was found in 80% of cases,
more commonly in the lower jaw than the upper jaw.

 Bilateral absence of PM2 in the lower jaw was most common. The absence of all PM2s was three
times more likely in females compared to males, with a ratio of 3:1.
Distribution of congenitally absent second premolars (PM2) according to gender and number of missing premolars.

Presence of retained deciduous second molars (DM2) according to the age group and gender.
 Presence of distinct infraocclusion in retained deciduous
Presence of restoration of caries in retaineddeciduous
second molars (DM2) according to the age group and
second molars (DM2) according to the age group
gender.
 DISCUSSIO
N
ROOT RESORPTION
 In almost half of cases, the degree of root resorption in persistent DM2 remained unchanged.

 Only a small percentage (7%) of DM2 were lost due to root resorption, caries, or infraocclusion.

 Studies suggest a good long-term prognosis for persistent DM2 in adults over 20 years old.

 Root resorption progresses slowly, with infraocclusion observed in a significant portion of cases.

 Evaluation of root resorption in younger patients (10-13 years old) shows lower rates compared to older
age groups.
 Root resorption increases with age, with over half of DM2 showing resorption above half of the root
length in patients aged 14-22 years.

 Progression of root resorption in older patients suggests potentially unfavorable prognoses.

 Studies indicate a positive correlation between root resorption and patient age.

 Similar findings from other studies support the observed trends in root resorption and age correlation.
CARIES

 Letten et al. (2003) found that 25% of DM2 were lost in cases with missing premolars, mainly due
to cavities or gum disease, over a 12-year period.

 None of the DM2 were lost due to root resorption.

 The survival rate of DM2 over 12 years was 86%.

 Keeping healthy DM2 might be a good option for tooth replacement in people over 40.

 In patients under 20, about half of the DM2 had fillings or cavities, potentially affecting their long-
term health.
 Hvaring et al. (2014) found that most retained primary molars without successors (78.4%) had no
fillings.

 Fillings didn't significantly affect the prognosis of these molars.

 In Poland, where dental problems are common, high rates of cavities in children were found in studies
from 2016.

 In the study sample, over half of DM2 had cavities or fillings.

 Older patients had more filled DM2, suggesting differences in cavity risk between populations.
 INFRAOCCLUSION
 Infraocclusion, where teeth sit lower than normal, impacts the long-term survival of retained deciduous
teeth.

 Kokich (2005) suggests removing ankylosed deciduous molars to avoid issues during future implantation
procedures.

 Thilander et al. (2001) recommend extraction only for severe infraocclusion cases.

 In Hvaring et al.'s study (2014), nearly 44% of persistent deciduous molars showed infraocclusion, with
around 19% having advanced infraocclusion.

 Root resorption was found to be positively correlated with the extent of infraocclusion.
 Garib et al. (2014) found higher infraocclusion rates with increasing age in orthodontic patients from Brazil.

 In the present study, infraocclusion rates were lower than in Garib et al.'s study, with older age groups
showing less infraocclusion.

 Infraocclusion was not observed in the 18-22 age group in the present study, though caution is advised due to
the small sample size.
 Bjerklin and Bennett (2000) reported infraocclusion ranging from 0.5 to 4.5 mm in deciduous molars without
permanent successors at 19 years of age.

 Rune and Sarnäs (1984) found higher rates of severe root resorption leading to deciduous molar loss
compared to the present study.
CONCLUSION

 Missing second premolar teeth (PM2) were three times more common in the lower jaw than the upper jaw.
About one-third of these sites had retained deciduous molars (DM2), especially in younger people.

 Half of the DM2 in places where PM2 were missing had cavities or fillings, making their future uncertain,
especially for younger individuals. Root resorption and infraocclusion getting worse over time were
common.

 For older patients, if a retained deciduous molar (DM2) is healthy and doesn't show significant
infraocclusion or extensive root resorption, the outlook is good.
 Agenesis of mandibular second premolars with retained primary molars. A
longitudinal radiographic study of 99 subjects from 12 years of age to adulthood
Krister Bjerklin , Midea Al-Najjar , Henrik Kårestedt and Anders Andrén
Department of Orthodontics, Institute for Postgraduate Dental Education, Jönköping , Orthodontic Clinic, Public Dental Service, Växjö , and Orthodontic Clinics,
Trollhättan and Mariestad, Sweden

SUMMARY In subjects with agenesis of the second mandibular premolar teeth, the primary molar may be left in
situ. The long-term prognosis of a retained primary molar has not been established in any study that included
large number of patients.
The aim of this investigation was to monitor the survival of retained mandibular second primary molars, from
12 – 13 years of age to adulthood.
The material comprised the radiographs of 99 subjects, 37 males and 62 females, with retained primary
molars and agenesis of 149 mandibular second premolars. In subjects with bilateral agenesis, only one
randomly selected primary molar was included to ensure that all primary molars were statistically independent
units. Three variables were recorded on intraoral radiographs at 11 registration stages starting at 12 – 13 years
of age: the distance between the permanent molar and the premolar abutting the retained primary molar,
infraocclusion of the primary molar, and resorption of the primary molar roots. The mean age at the fi nal
registration was 24 years 7 months, [standard deviation (SD) 5.3 3 years, range 18.25 – 45.44 years]. Paired t-
tests were used to analyse changes in the variables and intraclass correlation coefficient (ICC) to determine
whether all primary molars could be included in the analyses. During the observation period, only seven of the
99 primary molars were lost due to extensive root resorption, infraocclusion, or caries. Long-term survival
may be expected in more than 90 per cent of patients with retained primary molars with agenesis of
mandibular second premolars.
 The long-term survival of lower second primary molars in
subjects with agenesis of the premolars
K Bjerklin , J Bennett
This study investigated 41 subjects, 13 male and 28 female, with agenesis of one or both lower second
premolars, and with retained lower second primary molars.
Intra-oral radiographs of 59 primary teeth were examined to judge the resorption of the mesial and distal roots,
and were measured to record infra-occlusion of the primary teeth and tipping of the adjacent permanent teeth.
The study commenced at 11-12 years of age. The mean age at the last measurement was 20 years 6 months
(SD 3.62, range 13.6-31.8 years). During the observation period, only two of the 59 primary teeth were
exfoliated. Five were extracted, two of which were replaced by upper third molar transplants. Beyond the age
of 20 years no teeth were lost. Root resorption varied widely between individuals, but was slow. There was no
typical pattern for development of infra-occlusion. Mean infra-occlusion was 0.47 mm (SD 1.13) at 11-12
years, increasing by less than 1.0 to 1.43 mm (SD 1.13) at age 17-18 years. At age 19-20 years, 55 per cent of
teeth showed infra-occlusion between 0.5 and 4.5 mm, but 45 per cent showed no infra-occlusion. The space
between the first molar and first premolar was a mean of 10.35 mm (SD 0.76) at age 10-12 years compared
with the mean width of the second primary molar of 10.53 mm (SD 0.51). The space reduced by less than 0.5
mm to 9.95 mm (SD 1.50) at age 17-18 years
. If primary molars are present at 20 years of age they appear to have a good prognosis for long-term
survival.
 PERSISTENCE OF DECIDUOUS MOLARS IN SUBJECT WITH
AGENISIS OF SECOND PREMOLARS
KIRSTEN ITH-HANSEN AND INGER KJAER

 The purpose of the present study was to investigate persistent primary second molars in a group of young
people in their late twenties with agenesis of one or two second premolars.
 In 1982-83 it was decided, in connection with the orthodontic evaluation of 25 patients, to allow 35 primary
molars (one or two in each patient) to remain in situ. All patients had mixed dentitions and agenesis of one or
two premolars. The primary teeth were generally in good condition, although root resorption and infra-
occlusion (compensated by occlusal composite onlays) occurred. In 1997, 18 of the 25 patients with a total of
26 retained primary molars were reexamined, comprising a clinical examination for exfoliation, extraction,
loosening, and ankylosis, and a radiographic examination for root resorption, tooth morphology (crown and
root), and alveolar bone contour. The examination showed that the degree of root resorption was unaltered in
20 of the 26 primary molars. In the permanent dentitions, where these primary molars persisted, there were no
morphological deviations. Three of the six remaining primary molars had been extracted and three showed
extensive resorption. In three of the 26 primary molars the infra-occlusion had worsened.
 The present study shows that persistence of primary second molars in subjects with agenesis of one or two
premolars, and normal morphology of the permanent dentition can be an acceptable, semi-permanent solution
for the patient.
CRITICAL APPRAISAL

TITLE – INCOMPLETED BETTER IF MENTIONED THE TYPE OF THE STUDY

AIM – EXPLAINED PROPERLY
STUDY SETTING – INADEQUATE
ABSTRACT – GIVEN
METHODOLOGY – GIVEN
INCLUSION AND EXCLUSION CRITERIA – GIVEN
RESULTS – GIVEN
TABLES AND CHARTS – GIVEN
GIST OF WHOLE TEXT – WELL EXPLAINED
 REFERENCE
 jerklin K, Bennett J. Long term survival of lower second deciduous molars in subjects with agenesis
of the premolars. Eur J Orthod 2000;22(3):245–255.
 Borzabadi– Farahani A. Orthodontic considerations in restorative management of hypodontia
patients with endosseous implants. J Oral Implantol 2012;38(6):779–791.
 Dhamo B, Vucic S, Kuijpers MA, Jaddoe VW, Hofman A, Wolvius EB, Ongkosuwito E. The
association between hypodontia and dental development. Clin Oral Investig 2016;20(6):1347–1354.
 Garib DG, de Medeiros Alves AC, Janson G, Salles RB, Ferreira DG. Correlation of root resorption
and infraocclusion in mandibular deciduous second molars without succedaneous permanent teeth. J
of the World Federation Orthodont 2014;3(3):110-113.
 Grzesiak I, Kaczmarek U. Caries location in primary teeth in children aged 18-36 months living in
Wrocław city. Dent Med Probl 2006;43(2):215-221.
 Haselden K, Hobkirk JA, Goodman JR, Jones SP, Hemmings KW. Root resorption in retained
deciduous canine and molar teeth without permanent successors in patients with severe hypodontia.
Int J Paediatr Dent 2001;11(3):171–178.
THANK YOU