Identification of assessment factors for managing poor prognosis first permanent molars in children: a multi-phase consensus study

The management of poor prognosis first permanent molar (FPM) in children can be challenging because it depends on several modifying factors that must be considered, and each treatment approach has its own implications and clinical outcomes. With the current updates of scientific evidence, there are numerous options of treatment approaches for poor prognosis FPM, including preservation of the tooth by restorative or endodontic treatment or elective extraction followed by orthodontic management. The existing guidelines on the management of poor prognosis FPM predominantly focus on specific perspectives, such as orthodontics, which impedes comprehensive evaluation and assessment in managing these cases with minimal adverse outcomes in paediatric patients. To ascertain the optimal treatment approach for young patients, it is essential to evaluate the factors that influence treatment outcomes. Achieving the best treatment outcome with a holistic approach requires expert healthcare providers to share their understanding and experiences pertaining to this matter. A comprehensive assessment of the management of poor prognosis in FPM should also encompass orthodontic, restorative, and paediatric dentistry points of view. To date, there is no available checklist that can be used especially for dental frontliners to facilitate their management. Therefore, this study aimed to identify and structure assessment factors to support the future development of a clinical decision-making tool for managing poor prognosis FPMs in paediatric patients. A three-phase approach was employed: a scoping review to identify relevant factors from the literature, followed by focus group discussions (FGDs) with paediatric dentists, orthodontists, and restorative specialists to explore and refine these factors, and finally, a Delphi consensus process involving paediatric dentists to achieve agreement on item inclusion. The initial 35 items identified were reviewed over two Delphi rounds, resulting in 34 items reaching expert consensus. These items were categorized into three domains: tooth-related, child- related, and treatment-related factors. Although this study provides a structured foundation for a potential assessment checklist, the tool has not been piloted or tested in clinical settings, particularly with general dental practitioners. Future research should focus on validating its practical usability and integration into routine care. Upon validation, this tool could standardize clinical assessment, enhance referral decision- making, and improve interdisciplinary treatment planning for children with compromised FPMs.