Therapeutic management of primary molar infraocclusion: a systematic review.

purposeInfraocclusion is an occlusal anomaly characterised by an abnormally low position of the occlusal surface of a tooth relative to the occlusal plane. Although this condition can affect permanent teeth, it primarily involves the primary teeth. This pathology can impact adjacent teeth, occlusion, and in the presence of a permanent tooth germ, its development. This systematic review aimed to evaluate the clinical consequences of the early loss of infraoccluded primary molars and to compare different therapeutic strategies to optimise occlusal development and prevent complications. MATERIALS AND

methodsFollowing PRISMA guidelines, a systematic search was conducted in MEDLINE/PubMed and SCOPUS databases, with registration on PROSPERO (CRD42023481712). Inclusion criteria targeted studies on patients with infraocclusion of primary molars, assessing various management options (monitoring, extraction, occlusal restoration, etc.). The risk of bias was evaluated using the JBI Critical Appraisal Tools.

resultsOut of 246 identified studies, 37 met the inclusion criteria. The selected articles were classified and qualitatively analysed, and the results of the included studies were synthesised in a summary table. The review highlighted that management strategies depended largely on the presence or absence of a permanent successor, the severity of infraocclusion, and patient-specific factors. Monitoring was preferred in mild cases with a permanent successor, whereas extraction or restoration may be necessary in severe cases or in the absence of a successor. Preservation of infraoccluded molars without successors could maintain alveolar bone volume and facilitate future prosthetic rehabilitation. DISCUSSION: Management of infraoccluded primary molars requires an early, personalised, and multidisciplinary approach. Conservative treatment is often favoured in mild infraocclusions, whilst severe cases may require surgical or restorative solutions. However, evidence is limited by the predominance of case reports and the lack of long-term follow-up studies. The review emphasises the need for individualised treatment plans and highlights the absence of a clear consensus in the literature.