Oral health–related quality of life after early extraction of primary second molars in children with congenitally missing second premolars: a randomized controlled trial with matched controls

BACKGROUND: Extraction of mandibular primary second molars in patients with congenitally missing second premolars may influence oral health-related quality of life (OHRQoL), yet this has not been previously investigated. OBJECTIVE: To assess the impact of mandibular primary second molar extraction on OHRQoL compared with an age- and gender-matched control group without dental agenesis. DESIGN: Prospective, randomized, longitudinal split-mouth study. METHODS: Patients were recruited from nine public dental clinics in the Skaraborg region, Sweden (2017-2020) with bilateral congenitally missing second mandibular premolars. Each mandibular side was randomly assigned to extraction or hemisection. At the 4-year follow-up, the intervention group underwent a clinical examination and completed the Child Perceptions Questionnaire (CPQ11-14) along with a treatment recall and perception questionnaire, whereas the control group underwent a clinical examination and completed the CPQ11-14. RESULTS: The study included 80 patients, divided equally between the intervention group (n = 40) and the control group (n = 40). There was no significant difference in total CPQ scores between the intervention group (mean 8.5, SD 5.6) and the control group (mean 6.9, SD 5.6; P = 0.218), nor were any differences observed between sexes. The intervention group scored significantly higher in emotional (P = 0.018) and social well-being (P = 0.045). Hemisection was recalled as more painful than conventional extraction (P < 0.001). Despite 65% reported awareness of residual spaces, 82.5% were not interested in further treatment. CONCLUSION: Extraction of mandibular primary second molars in patients with congenitally missing second premolars did not adversely affect overall OHRQoL 4 years post-treatment. Hemisection was recalled as more painful than conventional extraction. Most patients were satisfied without additional treatment, indicating good long-term acceptance of residual spaces following interceptive extraction. TRIAL REGISTRATION: The trial was registered with https://www.researchweb.org/is/sverige, registration number: 967125.