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ISSN 0970 - 4388

Loss of space and changes in the dental arch after premature loss of the
lower primary molar: A longitudinal study
PADMA KUMARI B.a, RETNAKUMARI N.b

Abstract
The purpose of the study was to evaluate the space changes, dental arch width, arch length and arch perimeter, after the
unilateral extraction of lower first primary molar in the mixed dentition period. A longitudinal study was conducted among forty
children in the age group of 6-9 years, who reported for extraction of lower first primary molar in the department of Pedodontics,
Govt. Dental College, Trivandrum. Study models were made from alginate impression taken before extraction and after extrac
tion at the periodical intervals of two months, four months, six months and eight months. The mesiodistal width of lower first
primary molar of the non-extracted side was taken as the control. The results of the study showed statistically significant space
loss in the extraction side (P value <0.01) and no significant space loss in the control side (P value > 0.05). The rate of loss was
greatest in the first four months. The arch width, arch length and arch perimeter had no significant change from initial to eight
months follow up. The present study challenges the use of a space maintenance under the circumstances of premature loss of
mandibular primary molar for preventing space loss.
Key words: Arch length, arch perimeter, arch width, space loss

Introduction

migration of the posterior teeth than distal migration of

the anterior teeth, especially in the mandible. In majority of
children, the occlusion and space would be influenced by
premature extraction of primary molars and canines.

Pedodontists have traditionally accepted active supervision

of the developing dentition as major responsibility. Man
agement of space problems associated with the transitional
stages from primary to permanent dentition is a routine
component of pedodontic practice. The change from pri
mary dentition to the permanent dentition is a complex phe
nomenon, which is composed of a variety of physiological
adaptations of occlusion during this period. The exfoliation
of the primary teeth, the permanent teeth eruption and the
occlusion through independent, occur in a harmonious se
quence.[1,2] There are many morphogenetic and environmen
tal influences, which manage the occlusal development and
a disorder or deviation in any of these elements may influ
ence the occlusion. Among these elements, there is the im
portance of the primary teeth because when they are physi
ologically exfoliated, there is a favourable alveolar growth
and space for a better accommodation of the successor per
manent teeth.[3] The permanent teeth dislocation occurs in
the eruptive, pre functional and functional periods of the
eruption, that are within the primary arch and in the mixed
dentition stage.[4-7]

Growth and development and drifting patterns of teeth are

closely interdependent. In the field of pediatric dentistry
much emphasis should be put on these factors in order to
secure the optimal benefit of systematic dental care for the
child. It is well known that after early loss of deciduous
molars dental arch crowding arises in some cases, while in
other cases it does not. It has been suggested that large
jaws with normal spacing or over spacing are not influenced
by the premature loss of the deciduous teeth. A tendency
towards small jaws and space deficiency in the deciduous
arch, on the other hand, will probably cause closure of the
extraction gap resulting in crowding in the permanent den
tition.[10] Premature loss of a primary tooth is of concern not
only because of the loss of function, but also because of the
increased possibility that the other teeth may drift. It would
be useful in determining the treatment, if the dentist could
predict the sequel of premature loss of primary teeth.
As the premature loss of primary teeth is still a very com
mon situation within the population, this study was under
taken using longitudinal cast data to investigate the changes
after unilateral premature extraction of the mandibular first
primary molar in the mixed dentition stage.

[8]

Richardson observed that the most severe space problems

happen when the primary teeth, in particular the first pri
mary molars are exfoliated before the eruption of the per
manent molar. The premature loss of the primary molars
that results in mesial positioning of the first permanent molar
is of a great concern during the mixed dentition. Love and
Adams[9] found a greater percentage of space loss by mesial

Aim and Objectives

1. To evaluate the space changes in the extracted site.
2. To determine the changes in dental arch width.
3. To observe changes in the dental arch width.

Senior Lecturer, Dept. of Pedodontics, bProf. and Head, Dept. of

Pedodontics, Govt. Dental College, Trivandrum, India
J Indian Soc Pedod Prev Dent - June 2006

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Loss of space and changes in the dental arch

4. To evaluate the changes in the dental arch perimeter.

Materials and Methods

Forty children for the study. The patients were in the age
group of 6-9 years, who had reported for extraction of lower
first primary molar in the Department of Pedodontics, Govt.
Dental college, Thiruvananthapuram for an evaluation of
thirteen months. The selected patients were made as ho
mogenous as possible. In the final stage of the study, the
number of patients decreased to 30, as ten children did not
come for further follow up and they were excluded from the
study.
All the cases complied with the following criteria
1. The first permanent molars have erupted.
2. Patients indicated for unilateral extraction of mandibu
lar first primary molar due to extensive decay and hav
ing an intact anterior tooth.
3. The anteroposterior and lateral arch relationships were
acceptable.
4. Premature loss of the primary molar was defined as hav
ing an unerupted permanent predecessor for at least
two years after extraction of the deciduous first molar.
5. Parents and guardians who were willing to overweigh
the effects of not maintaining the extraction space.

2
Figures 1 and 2: Representative scheme of the dental arch
with the referent extraction space

Recordings
At the start of the study, the children were subjected to a
clinical examination and the medical and dental history of
the child was taken. Mandibular study models were prepared
from alginate impressions before extraction and immedi
ately after the impression procedure, the decayed first mo
lar was extracted. No space maintaining appliance was ad
vocated. Longitudinally, the procedure was repeated at each
follow up after two, four, six and eight months after extrac
tion. Thus each patient was subjected to evaluation at five
stages. The opposite non-extraction side was taken as the
control. Two dental arch models of each patient prior to
extraction and four models after the extraction of lower first
primary molar were used for the study.

Figure 3: Representative scheme of the dental arch width

measurement

Arch width
The arch width was measured between the central fossae
on the occlusal surface of two second primary molars [Fig
ure 3].

Measurements on the casts

Four measurements concerning dental arch development
were performed on the extraction space, arch width, arch
length and arch perimeter using a measuring gauge.

Arch length

Extraction space

The arch length was determined by the orthogonal distance

of the median point between the central incisors until the
tangent line to the distal face of the second primary molars
or mesial surface of the first permanent molars [Figure 4].

The referent space was determined by measuring the dis

tance between the mesial midpoint of the second decidu
ous molar and the distal midpoint of the primary canine
[Figures 1 and 2].

Arch perimeter
The arch perimeter was the measurement of the arc from
91

J Indian Soc Pedod Prev Dent - June 2006

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Loss of space and changes in the dental arch

three times using different caliper from which an average

value of the measurement in millimeter was recorded and
analysed [Figure 5].
Statistical analysis
The analysis was done with Statistical Package for Social
Science Soft ware (SPSS) programme. Paired t test was used
for the comparison of measurement of all parameters.

Results
The present study, was undertaken to evaluate the loss of
space and change in the dental arch after premature loss of
lower first primary molar among thirty children in the age
group of 6-9 years brought the results. The measurement of
the mesiodistal width of lower first primary molar on both
control and extraction side, before extraction and following
2, 4, 6 and 8 months after extraction are shown in table. It
was observed that there was a space loss in the extraction
side and no space in the control side. It was also noted that
space loss was maximum during the first four months and
consequently space loss was minimum during the period of
six to eight months. The result showed statistically signifi
cant space loss in the extraction side (P < 0.01) compared to
the control side, which is not statistically significant (P >0.05).

Figure 4: Representative scheme of the dental arch length

measurement

Comparison of the space changes of the lower first primary

molar between the initial and follow up examinations dur
ing 2 months, 4 months, 6 months and 8 months in both
control and extraction side are shown in Table 2 and Figure
6a-6e. The first primary molar space of the extraction side
during the follow up examinations after 2 months (7.72
0.56), 4 months (7.03 0.56), 6 months (6.62 0.56)
and 8months (6.64 0.44), were significantly lesser than
the control side. There are statistically significant difference
between the initial and the follow up examination in the
extraction side. No significant difference is noted between
the control side and the extraction side in the initial first
primary molar space.

Figure 5: Representative scheme of the dental arch perimeter

measurement
(c)

(a)
(d)

Quantity of space loss in millimeter after the premature loss

of lower first primary molar is shown in Table 3. Space re
duction in the analyzed dental arch were measured to be
1.31 mm, 1.69 mm, 1.41 mm and 1.22 mm during the moni
toring in 2 months, 4 months, 6 months and 8 months re
spectively. Shows the mean changes of space reduction in
control side and extraction side during the period from ini
tial to eight months.

(e)

(b)
Figure 6: (a) Lower cast pre extraction, (b) Study model
second month, (c) Study model - fourth month, (d) Study model
- sixth month, (e) Study model - eighth month.

Measurements of arch width were analysed and the results

showed no significant change in the arch width between
the initial and the follow up examinations at 2, 4, 6 and 8
months intervals.

the mesial midpoint of the first permanent molar, through

the cusp tip of the first permanent molars. It was measured
by the brass wire method. Measurements were repeated
J Indian Soc Pedod Prev Dent - June 2006

The measurements of arch length from initial and follow up

92

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Loss of space and changes in the dental arch

Table 1: Space changes in (mm) from initial to follow up examination - control side and extraction side
Case

Control side

Extraction side

Initial

2nd
month

4th
month

6th
month

8th
month

Initial

2nd
month

4th
month

6th
month

8th
month

9
8
8
7
8
9
8.5
8
8.5
8
8.5
8
9
9
9
8
8.5
8
7
9
9
9
8.5
8.5
8
7.5
9
8.5
8
9
8.31

9
8
8
7
8
9
8.5
8
8.5
8
8.5
8
9
9
9
8
8.5
8
7
9
9
9
8.5
8.5
8
7
9
8
8
9
8.32
0.62

9
8
8
7
8
9
8
8
8.5
8
8.5
8
9
9
9
8
8.5
8
7
9
9
9
8.5
8.5
8
7
9
8
8
9
8.33
0.62

9
8
8
7
8
9
8
8
8.5
8
8.5
8
9
9
9
8
8.5
8
7
9
9
9
8
8.5
8
7
9
8
8
9
8.28
0.58

9
8
8
7
8
9
8
8
8.5
8
8.5
8
9
9
9
8
8.5
8
7
9
9
9
8
8.5
8
7
9
8
8
9
8.23
0.55

9
8.5
8
8
8.5
8.5
7
8.5
9
9
8
8
9
8.5
8
8
7.5
7
7
8
8
9
8
8.5
8.5
8.5
8.5
8
8
9
7.72

7
7.2
8
8
8
8
6
8
8
8.5
8
7
8
8
8
7
7
6.5
7
7.5
8
8
8
8
8.5
8
8
7
7
8.5
7.03
0.56

6.5
6.5
7.5
7.5
7.5
7
6
8
7
8
7.5
6.5
7
7.5
7.5
7
7
6
6.5
7
7
7.5
7.5
7.5
8
8
7
6.5
6.5
8
6.62
0.71

6-5
6
7
7.5
7.5
7
6
7.5
6
7
6
6
6
7
7
6.5
6.6
6
6
7
6
7
7
7
7.5
7
7
6
6
7
6.4
0.56

6
6
6
7
7
6.5
6
7
6
6.5
6
6
6
7
7
6
6
6
6

0.44

0.21

0.32

0.22

0.57

0.001

0.001

0.001

0.001

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Mean
SD
P value

6
6.5
7
7
7
7
6.5
6
6
6

Table 2: Comparisons of the space changes of lower first primary molar in different intervals - control side and extraction
side
Period
Initial
2 months
4 months
6 months
8 months

Control side
8.31 0.52
8.33 0.62
8.32 0.62
8.33 0.58
8.28 0.55

P value
0.05**
0.21**
0.32**
0.22**
0.57**

Extraction side
8.23 0.52
7.77 0.56
7.03 0.56
6.62 0.56
6.4 0.44

P value
0.021
0.001
0.001
0.001
0.001

examinations reveal no statistically significant change.

Table 3: Quantity of space loss from Initial to eight months

- extraction side

No statistically significant changes observed in the arch pe

rimeter in the initial examination to follow up examinations.

Discussion

Period between the

2 months
4 months
6 months
8 months

Research dealing with space changes in the dental arch is

difficult to perform accurately because of the multifactorial
variance influencing the results. Most of the reports of re-

search studies were based on cross sectional data, limited

sample size and crude methodology that had led to miscon

ceptions of space changes of the dental arch in maxillary or

93

Mean
1.31 mm
1.69 mm
1.41 mm
-1.22 mm

Percentage measurements
39
50
42
36

J Indian Soc Pedod Prev Dent - June 2006

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Loss of space and changes in the dental arch

Table 4: Changes in arch width (mm) from the initial to follow up examinations
Case no.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Mean
SD

Initial
38
34
33
36
34
36
33
34
32
34
34
34
33
36
38
35
35
33
34
36
33
38
33
34
34
36
33
35
38
36
34.73
1.72
P Value

2 months
38
34
33
36
34
36
33
34
33
33
33
43
35
37
38
34
35
33
33
36
33
37
33
35
34
36
33
34
37
36
. 34.67
1.64
0.88

4 months
39
35.5
32.5
35
35
37
32
33
33
32
33
35.5
36
38
39
34
34
33
33
35
32
37
33
35
33
35
33
34
37
35
34.35
2.02
0.71

6 months
39.5
35.5
32.5
35
35
38
32
32
34
32
32
33
36
38
39
33
34
32
32
35
31
36
33
36
32
35
32
34
37
35
34.35
2.33
0.47

8 months
39.5
36
32
34
34
38.5
32
32
35
32
32
33
36
39
39
33
33
32
32
35
31
35
32
36
31
34
32
34
36
33
34.1
2.49
0.26

6 months
19
19
19
19
17
22
17
19
19
20
18
18
19
19
21
17
21
17
17
21
20
17
19
21
16
16.5
16.5
18
20
19
18.47
1.56
0.31

8 months
19
19.5
20
20
17
22
17
19
19
20
18
18
19
19
21
17
21
17
17
22
21
18
19
21
16
16.5
16.5
18
20
19
18.9
1.68
0.67

Table 5: Changes in arch length (mm) from initial to follow up examinations

Case no.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Mean
SD

Initial
22
20
21
18
18
18
19
19.5
21
17.5
20.5
20
18
22
19
18
19
18
17.5
19
21
16
19
19
18
16
17.5
19
22
20
19.08
1.62
P Value

J Indian Soc Pedod Prev Dent - June 2006

2 months
21
19
20
18
18
19
19
19.5
21
18
19
19.5
19
20
20
18
19
17.5
17
20
20
16
20
20
17
16.5
17
19
21
21
18.97
1.4
0.77

4 months
20
22
20
18
18
20
18
19
20
19
19
19
19.5
19
20
17.5
20
17
17
20
20
17
19
21
17
16.5
17
18
21
20
18.92
1.45
0.68
94

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Loss of space and changes in the dental arch

mandibular arch. The present study tried to minimize the

errors conducting a longitudinal study by using strict ho
mogenous samples and focusing on unilateral extraction of
the mandibular first primary molar.

The mean changes of space loss in the present study are

1.31 mm after 2 months, 1.69 mm after 4 months, 1.41 mm
after 6 months and 1.22 mm after 8 months. It is noted that
space loss is maximum during the first four months and
minimum is last four months. Concerning the rate of space
change, the greatest space loss occurred in the first four
months. The study reveals significant space loss during the
average eight months of experimental period.

The present study was carried out to find out the space loss
due to the unilateral premature extraction of the lower first
primary molar. There is statistically significant space loss in
the extraction side (P value<0.01) and no significant space
loss in the control side (P value>0.05). The space changes
in the extraction side measured by the first primary molar
space after eight months (6.4 0.44 mm) have shown sig
nificant space loss compared to the initial first primary mo
lar space (8.23 0.52 mm) and the control side (8.31
0.52 mm).

It appears in the present study that the space loss in the

mandible is mostly due to distal movement of primary cus
pid during the following eight months. The possible expla
nation is that the erupting anterior incisors pushed the pri
mary cuspid towards the distal more than the erupting first
permanent molar did on the second primary molar towards
the mesial. The findings of the present study support the
findings to Johnsen[15] that the space changes occurred mainly
by the distal migration of primary cuspid in the intial stage.

The result of the present study confirm with the conclusion

of the studies of Helm, Owen and Yng-Tzer J, Lin and LiChing Chang.[11,12,14] They reported that space loss was more
common in the mandibular arch after the premature loss of
first primary molar. The results of the present study partly
support the conclusions that space in the mandible is lost
by both mesial migration of posterior teeth and distal move
ment of anterior teeth as reported by Osmar Aparecide
Cuoghi et al.[13]

The present study also investigated the changes in the arch

width, arch length and arch perimeter. No significant change
in the arch width, arch length and arch perimeter from ini
tial and the follow up examinations at 2 months, 4 months,
6 months and 8 months was observed. Lundstrom[16] em
phasized the importance of inheritance of dental arch, the

Table 6: Changes of arch perimeter (mm) from initial to follow up examination

Case no.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Mean
SD
P value

Initial
85
72
84
75
76
76
78
75
74
72
79
72
70
75
80
71
73
71
75
73
74
73
71
74
75
75
74
72
71
74
74.63
3.58

2 months
83
74
83
75
76
76
77
75
75
72
78
72
72
76
80
70
72
70
75
73
73
72
72
73
76
75
76
74
70
75
74.67
3.27
0.97

4 months
82
74
82
74
74
77
75
77
74
73
78
70
73
77
79
68
72
69
76
72
72
71
73
73
76
74
77
74
69
77
74.4
3.4
0.8

95

6 months
82
75
82
75
74
77
75
77
73
73
77
69
74
78
78
68
71
68
76
72
72
70
75
72
77
77
77
75
69
76
74.5
3.62
0.89

8 months
82
75
83
75
75
78
75
77
72
72
77
70
74
78
78
68
70
68
76
72
72
70
76
72
77
78
78
75
68
78
74.5
3.89
0.94

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Loss of space and changes in the dental arch

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exfoliation period, occlusal developmental stages and influ

ences in the dental arch perimeter.
Briefly, the space loss is mainly, by movement of the pri
mary cuspids distally and by a lesser degree by movement
of the first permanent molar and second primary molar
mesially, depending on the period of the referred tooth ab
sence.
The following conclusions are drawn from the present study
1. The premature loss of the lower first primary molar in
the mixed dentition resulted in statistically significant
space loss in the extraction side than in the control side.
2. The early space change of the mandibular dental arch
after premature loss of the mandibular primary first
molar is mostly by distal movement of the primary cus
pid towards the extraction space.
3. There is significant space change during the average
eight months of experimental period. The greatest space
loss is observed in the first four months after the pre
mature extraction.
4. There is no significant space change in arch width, arch
length and arch perimeter in the mandibular arch after
premature loss of the primary first molar during the ex
perimental period of eight months after extraction.
The present study challenges the use of a space mainte
nance under the circumstances of premature loss of man
dibular primary molar for preventing space loss.
Further studies are needed to be done, regarding not only
on space problems of primary first molars, but also involv
ing the second primary molars in either the maxillary or
mandibular arch.

References
1.

Reprint requests to:

B. Padma Kumari,
Dept. of Pedodontics
Govt. Dental College, Trivandrum, India

Foster TD, Hamilton MC. Occlusion in primary dentitions. Br Dent

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