Title: Orthodontic management of space following compromised molar extraction: When to close and when to maintain the space?
Abstract:
Background: The extraction of a compromised permanent molar may be unavoidable for endodontic or periodontal reasons. Therefore, the resulting space may either be orthodontically closed or maintained and, when necessary, redistributed for prosthetic rehabilitation. Choosing between these strategies can substantially influence occlusal outcomes, treatment complexity, treatment duration, anchorage requirements, and long-term stability.
Objective: This presentation highlights the main clinical and biomechanical factors that guide the decision between orthodontic space closure and space maintenance following extraction of a compromised permanent molar. Clinical cases illustrate how these criteria can be integrated into individualized treatment planning.
Methods: A review of the orthodontic literature was conducted focusing on the management of spaces resulting from permanent molar extraction. Particular attention was given to factors influencing the feasibility and predictability of orthodontic space closure versus space maintenance or redistribution.
Results: Major determinants such as type and severity of the malocclusion, sagittal and vertical skeletal pattern, amount and location of crowding, periodontal considerations, and many other factors should be considered for structured decision-making. The feasibility of anchorage control and the biomechanical consequences of extensive molar protraction must also be considered.
Conclusion: Management of an imposed molar extraction should be considered within the overall orthodontic treatment plan rather than as an isolated space problem. The choice between space closure and space maintenance requires a multifactorial assessment.
