MIH First Molar Extraction — ORE Part 1 MCQ

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HardPaediatric DentistryMIH First Molar ExtractionORE Part 1

A 12-year-old child presents with a lower left first permanent molar that has extensive MIH-related breakdown. The tooth has recurrent symptoms despite attempts at restoration. The second premolar is present. The second molar is in its crypt with early root formation. What is the most appropriate management?

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Correct answer: B — Extract the first molar and monitor for second molar eruption into the extraction space

Extraction with monitoring is the correct management because the clinical context indicates multiple factors supporting interceptive extraction: (1) extensive MIH-related breakdown with recurrent symptoms despite restorative attempts indicates the tooth has a poor prognosis; (2) the second molar is in the crypt at early root formation (Demirjian stage E or earlier), which is optimal timing for space closure—extraction at this stage maximises the chance that the second molar will erupt into the space and the third molar will complete the molar dentition; (3) for a lower molar, while some cases require subsequent orthodontic treatment for space closure, extraction at the correct timing results in little additional treatment in the majority. Option E (preformed crown) is inappropriate because restorations have already failed and the tooth shows extensive breakdown. Option D (endodontics) prolongs an unsalvageable situation and adds treatment burden. Option C (immediate implant) is contraindicated in a growing child—implants prevent natural second molar eruption and require skeletal maturity. Option A (bridge) commits healthy adjacent teeth to invasive preparation and interferes with second molar eruption. The RCS FDS guidance supports interceptive extraction when properly timed, and recent systematic reviews confirm this approach yields good long-term occlusal outcomes.

Reference: Royal College of Surgeons Faculty of Dental Surgery. A Guideline for the Extraction of First Permanent Molars in Children. https://www.rcseng.ac.uk/-/media/fds/guidance-for-the-extraction-of-first-permanent-molars-in-children.pdf; Somani C et al. Spontaneous space closure after extraction of permanent first molars in children and adolescents: a systematic review and meta-analysis. *International Journal of Paediatric Dentistry*, 2024;34(6):1163–1174. https://pubmed.ncbi.nlm.nih.gov/39380531/