To Treat or to Extract Necrotic First Permanent Molars Between 8 and 12 Years of Age: A Retrospective Cohort Study

<b>Background:</b> First permanent molars (FPM) are highly susceptible to decay before the age of 15. When they are severely affected, the decision between conservation and extraction arises, particularly considering the potential for the second permanent molar (SPM) to replace the FPM. This cohort study aimed to evaluate clinical practices regarding FPM pulp necrosis treatment in children aged eight to twelve in two hospital departments in the Paris region. A second objective was to evaluate the one-year outcomes of the two therapies. <b>Methods:</b> A retrospective analysis was conducted using computerized billing software to identify patients aged eight to twelve who underwent either extraction or root canal treatment (RCT). Data collected included sex, age, arch involved, number of decayed surfaces, presence of Molar Incisor Hypomineralization (MIH), presence of infection, and treatment type. <b>Results:</b> A total of 66 patients were included, representing 61 extracted teeth and 23 RCT. Three main decision criteria were identified: presence of MIH (<i>p</i> < 0.005), extent of decay (<i>p</i> < 0.05), and SPM Nolla's stage. A total of 48% of the patients were seen at one year. A total of 16 of the 32 extractions and five of the nine RCTs had favorable evolution (<i>p</i> = 1). <b>Conclusions:</b> The question of whether to perform RCT or extraction of necrotic FPM in children aged eight to twelve is difficult to assess. It appears that five criteria need to be considered before the decision: possibility of long-term sealed coronal reconstruction, SPM Nolla's stage, follow-up possibilities, arch concerned, and presence of third permanent molar.