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Title Implant Restorations For Congenitally Missing Second Premolars In The Growing Patient
Clinical Question Should space closure be the preferred orthodontic/restorative treatment option if a primary second molar is prematurely lost in a congenitally missing second premolar patient?
Clinical Bottom Line Implant placement should be a viable treatment option in a congenitally missing second premolar patient. Alveolar ridge width does not significantly resorb after a primary second molar is lost prematurely. The alveolar ridge width decreases approximately 25% over a 3-year period after extraction of the primary second molar. Ridge resorption slows over the next 4 years so that there is an additional 4% loss of ridge width. The final ridge width was only slightly less than the width across the first premolar space. The narrowest portion was usually located near the mandibular lingual concavity. Therefore most of the patients in this study had adequate ridge width for larger diameter implants. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 8126668Ostler/1994stone casts and radiographs of 35 edentulous sites on 22 patientsRetrospective
Key resultsThe findings indicate that ridge width decreases 25% within 3 years after primary molar extraction. The rate of decrease diminishes to 4% over the next 3 years. The change in ridge width had a weak association with the age of the patient at the time of the extraction but a small predictive value. No correlation was found between changes in ridge width and height and the time since the extraction or the age of the patient at the time of extraction.
Evidence Search ("alveolar process"[MeSH] OR "alveolar ridge"[All Fields]) AND ("Changes"[Journal] OR "changes"[All Fields]) AND congenitally[All Fields] AND missing[All Fields] AND second[All Fields] AND ("bicuspid"[MeSH Terms] OR "bicuspid"[All Fields] OR "premolar"[All Fields])
Comments on
The Evidence
Alveolar ridge changes are not significant enough to rule out implant placement if a primary second molar is prematurely lost in a congenitally missing second premolar patient.
Applicability Symmetry in a dental arch can be maintained in the orthodontic patient if there is only one congenitally missing second premolar. Symmetry can be maintained by restoring the edentulous site with a dental implant, thus not requiring contra-lateral extraction of a second premolar.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Orthodontics) (Pediatric Dentistry) (Prosthodontics) (Restorative Dentistry)
Keywords Congenitally missing premolar, alveolar ridge change, implants
ID# 740
Date of submission: 11/12/2010spacer
E-mail riveraj7@uthscsa.edu
Author Jaime Rivera, DDS
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Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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None available
Comments and Evidence-Based Updates on the CAT
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by Meredith Key, DDS & Blake Hoedebecke, DDS (San Antonio, TX) on 08/08/2013
We conducted a PubMed search on this topic in August 2013 and found a more recent publication: Kokich VG published in 2006 (PubMed ID 17045142 ). This Case Series covers multiple options to treat congenitally missing second premolars. The evidence is not very strong due to limited patient number, 5. The discussion section reveals not all patients should be treated alike, that each needs its own analysis and treatment planning. We searched Trip Database and found the following article: "Guideline Summary: Guideline on management of the developing dentition and occlusion in pediatric dentistry" published by American Academy of Pediatric Dentistry. The guideline supported the conclusion of this CAT.

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