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Primary Molar Space Loss — ORE Part 1 MCQ

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ModeratePaediatric DentistryPrimary Molar Space LossORE Part 1

A 6-year-old child requires extraction of a carious lower left first primary molar. Radiographic assessment confirms that the lower left first premolar is present with early root formation. Mixed-dentition analysis shows severe crowding of 4 mm in that quadrant. What is the most appropriate space-management consideration?

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Correct answer: C — Consider a band-and-loop space maintainer after extraction

**A is correct.** Premature loss of a primary molar can permit mesial drift of teeth posterior to the space and contribute to displacement of the permanent successors. UK Faculty of Dental Surgery guidance states that space maintenance is most valuable after loss of a primary first molar when crowding is severe—defined as more than 3.5 mm per quadrant. This child has 4 mm of crowding, so a space maintainer should be considered; for a single missing tooth, a band-and-loop is the usual design. Extraction of the canine or second primary molar is not justified merely to manage this space. Observation alone risks further loss of an already deficient space. A removable appliance is not the preferred choice for a single-tooth space and relies on compliance.

Reference: Royal College of Surgeons of England, Faculty of Dental Surgery. Extraction of Primary Teeth – Balance and Compensation, sections 2.5 and 2.5.1, 2000. https://www.rcseng.ac.uk/-/media/Files/RCS/FDS/Publications/extractp.pdf