Improvement of Comprehensive Treatment Methods AImed at Preserving and Ensuring the Functional Status of First Permanent Molars With Incompletely Formed Roots

First permanent molars (teeth 16, 26, 36 and 46) erupt at about six years of age, while their roots continue to form for a further three to four years. During this period the teeth are highly susceptible to caries, and deep lesions rapidly involve the wide, well-vascularised pulp. Loss of a first permanent molar in childhood leads to tipping and drifting of neighbouring teeth, overeruption of antagonists, reduced masticatory efficiency and malocclusion. The aim of this article is to review current evidence and to propose an improved comprehensive approach to the management of first permanent molars with incompletely formed roots, combining prevention, minimally invasive caries management, vital pulp therapy with calcium silicate-based materials, apexification and regenerative endodontic procedures, and structured long-term follow-up. A stage-based clinical algorithm is presented that links the choice of treatment to the stage of root development and to the condition of the pulp. The approach is intended for use in paediatric dental practice, including municipal children’s dental polyclinics.