Assessment Factors for Managing First Permanent Molars in Children with Poor Prognosis: A Systematic Mapping of Clinical Evidence.

Background: Managing the first permanent molar (FPM) with a poor prognosis can be challenging as it depends on several modifying factors that must be considered, and each approach has potential implications and clinical outcomes. Aim: This review aimed to systematically review the assessment factors that should be considered prior to managing FPM with poor prognosis in children. Methods: A computerized database search was conducted using Cochrane, PubMed, and Scopus with predefined search terms related to "management, treatment, extraction, restoration, endodontic, and orthodontic" involving the "FPM." The search included studies published in English between 1990 and 2024. Two reviewers independently extracted data and assessed whether the studies met the inclusion criteria. The inclusion criteria specified management approaches for FPM with poor prognosis in children aged 6-16. Any disagreement between reviewers was resolved through discussion. Results: A total of 1815 studies were screened, and 37 full-text articles were retrieved. Seven retrospective observational studies met the inclusion criteria. All the included studies focused on orthodontic assessment factors, such as the presence of a third molar and angulation of the second permanent molar, aimed at achieving spontaneous space closure following FPM extraction. However, no studies have addressed restorative perspectives on managing this problem, particularly in pediatric patients. Conclusion: This review highlights a lack of well-established and robust studies on managing poor prognosis in FPM. The absence of research on long-term functional outcomes, patient-reported experiences, and the role of restorative alternatives, especially in children, reveals significant gaps in the current literature. Incorporating these findings into clinical practice could lead to more personalized and effective treatment strategies that focus on both immediate and long-term oral health outcomes for children. Given the complexity of FPM management, a multidisciplinary approach combining restorative, orthodontic, and preventive strategies is crucial. Therefore, further studies with stronger evidence are needed to explore a comprehensive clinical approach that could enhance treatment outcomes.