Mostafa: he was a little boy, now he is taller than me, and his molar is still there five years later
Mostafa is the son of my friend Dr. Islam. He came as a child with a broken-down first permanent molar. Instead of extracting it, we did root canal treatment and a direct composite overlay. About five years later, at 16–17, the tooth is still working.
The height difference
Mostafa is the son of my friend Dr. Islam, and he has been with me since he was four. Look at the two photos: the first time he barely reached my shoulder, and today he is taller than me!
He grew up in front of me at the clinic, year after year, and the tooth we saved grew up with him.
The tooth
He came with a broken-down first permanent molar. Many would see extraction at this age as the easy answer, letting the second molar take its place.
Instead we did root canal treatment, then restored the tooth with a direct composite overlay. Today, about five years later, at 16–17, the tooth is still working and his overall condition is better.
Does it have to last forever?
Of course not. If a problem comes later, there are options: repair, retreatment, or a different restorative approach, depending on the situation at the time.
But we bought the tooth years of function at a very important age.
Not every treatment needs to be the final treatment. It needs to be the right treatment for this stage of life.
Clinical details for dentists
1 Before: severely broken-down upper first permanent molar 
2 Pre-operative radiograph 
3 After root canal treatment: direct composite overlay 
4 Radiograph: root canal treatment and overlay 5 About 5-year follow-up
Case summary
Patient: the son of a colleague, followed since early childhood. Tooth: upper first permanent molar, severely broken down, in the mixed dentition.
Treatment
- Root canal treatment.
- Direct composite overlay (cuspal coverage).
Follow-up
About 5 years; patient now 16–17. Tooth functioning, overall condition improved.
Discussion
- Extraction of a compromised first permanent molar in the mixed dentition is often the default, based on orthodontic concepts or older guidelines.
- If extraction is always the default, clinicians never build the restorative skills needed to save these teeth. At some point, you have to start.
- A restoration does not have to last forever: repair, retreatment or a change of approach remain available. What matters is buying years of function at a critical age.
Take-home message
We don't need every treatment to be the final treatment. We need it to be the right treatment for this stage of life.
Book a Consultation
Leave your details and our team will contact you to arrange your visit — whether you live in Egypt or are travelling in for treatment.
