Compensating Extraction Plan — ORE Part 1 MCQ

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ModeratePaediatric DentistryCompensating Extraction PlanORE Part 1

A 7-year-old child has symptomatic post-eruptive breakdown affecting all four first permanent molars due to molar-incisor hypomineralisation. Following paediatric dental and orthodontic assessment, extraction of all four first permanent molars is planned. How is this extraction pattern best described?

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Correct answer: A — Balancing and compensating extractions

The correct answer is **A. Balancing and compensating extractions**. In UK terminology, a compensating extraction removes the corresponding first permanent molar in the opposing arch, whereas a balancing extraction removes the contralateral first permanent molar in the same arch. Planned removal of all four first permanent molars therefore incorporates both patterns. The child’s severe MIH, symptoms and multidisciplinary assessment support a planned interceptive extraction strategy rather than an acute intervention. Serial extraction is a staged orthodontic approach involving sequential removal of selected primary and permanent teeth to manage crowding; it does not describe this four-molar plan. “Therapeutic” describes the indication for extraction, not the occlusal extraction pattern. Emergency and prophylactic extraction are also inconsistent with the planned, assessment-led management described.

Reference: Royal College of Surgeons of England, Faculty of Dental Surgery. A Guideline for the Extraction of First Permanent Molars in Children, section: “Balancing and compensating extractions”, 2014. https://www.rcseng.ac.uk/-/media/Files/RCS/FDS/Publications/A-Guideline-for-the-Extraction-of-First-Permanent-Molars-in-Children-rev-Sept-2014.pdf