Interceptive extractions for first permanent molars: a clinical protocol

Treatment planning for compromised first permanent molars (FPM) can be difficult. In this paper, we present a clinical protocol to support decision-making. Interceptive loss of an FPM should be considered: where the restoration required to repair the compromised FPM is likely to be large; if the FPM is compromised because of molar-incisor hypomineralisation (MIH); where orthodontics requiring loss of tooth units is planned; or if third permanent molars (TPM) are present. Planning requires careful assessment of the prognosis of the FPM and 8-10 years is the ideal age to do this. If the prognosis is uncertain, the decision of whether or not to extract can be influenced by the presence or absence of the TPM. If the decision to extract the FPM is made, timing is dependent on whether or not extractions will be required as part of orthodontic treatment.