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Second molar replacement therapy (SMRT) can be a very controversial issue. There are three types of wisdom: 1. There is the wisdom of God (the one true living God) 2. There is the wisdom of the world 3. There is the wisdom of the devil. Believe it or not, agree with it or not, like it or not, there is a real supernatural being called the devil. He is our adversary. He is a liar and a deceiver. He does not want you to know the truth. He does not want you to know what is right and best for you. His goal is to destroy. He has great power and influence over the world system (including health care) as we know it today, but only as God allows.

True wisdom is from God. He is our creator. He designed and made each one of us. He knows us well individually and collectively. He wants you to know the truth. He wants you to know and do what is right and best for you. He is for you and not against you. He will give us wisdom if we ask for it, but we must believe in Him and trust in Him when He answers us and not waiver or doubt when He answers us (James 1:5-8).
When the benefits of SMRT are carefully and logically considered, we believe that the proper decision should be as the worldly saying goes, "a no brainer."

Second molar replacement therapy (SMRT) is the process of removing the permanent (adult) second molars and allowing the third molars ("wisdom" teeth) to erupt or grow into the second molar places. There are normally four second molars that are removed (one in each corner of the mouth) and four third molars ("wisdom" teeth) that take their place. Under normal circumstances, the "wisdom" teeth will drift forward in due time and take the place of the second molar.

The "wisdom" teeth normally erupt between 18 and 28 years of age. SMRT will allow the "wisdom" teeth to erupt earlier and better. With SMRT, "wisdom" teeth will typically erupt around 16 years of age. We have had one female patient whose "wisdom" teeth began erupting at 14 years of age! One of the primary reasons that "wisdom" teeth become impacted is because they have no place to go as they try to develop and erupt. The roots become all twisted and turned as the tooth is locked between the second molar and the surrounding bone of the upper and lower jaws. It is even more of a problem in the lower jaw. This process frees up the "wisdom" teeth or third molars and allows them to develop as they should without hindrance or restriction.

See the dramatic difference in results of second molar extractions over traditional pre-molar extractions!

WHAT IS THE SUCCESS RATE?

Under normal circumstances and with proper case selection, the "success" rate of SMRT in our personal experience with our own patients is about 95 - 98 %. That is an excellent "success" rate! What do we mean by "success"? We mean that the "wisdom" teeth or third molars essentially came in and took the place of the second molars without any significant complications. When dealing with the human body, nothing is guaranteed. However, the predictability of SMRT is very good, especially when certain criteria are met. You can see the benefit of this technique from the unfinished and finished case illustrations of our own patients in this monograph and web site.

1. It provides immediate space to work with and fewer teeth to move when uncrowding teeth or correcting an over-bite and/or over-jet situation. This is a direct and stark contrast to the process of removing permanent premolars to make space which has been an inherent part of "traditional" orthodontics for decades and even still today (see our monograph and web page on "Functional Orthodontics vs. Traditional Orthodontics").

3. It frees up the "wisdom" teeth so that they can develop normally without becoming impacted or causing recrowding of the other teeth.

5. A bigger, broader smile compared to "traditional" orthodontics which has removed premolars over the decades (see our monograph on "Functional Orthodontics vs. Traditional Orthodontics")

6. A healthier TMJ (temporomandibular joint or "jaw joint") compared to "traditional" orthodontics (see our monograph as referenced in point #5 above). SMRT in conjunction with "functional" orthodontics develops the upper and lower jaws forward, relieving the TMJ. Removal of premolars in "traditional" orthodontics results in just the opposite. When the premolar spaces are closed, the upper and lower jaws are constrained or retarded (under developed), retruded (brought back), or restricted. This is not good for the TMJ. It causes an unhealthy situation for the TMJ by causing it to be jammed when eating or clenching or grinding the teeth. This effect of "traditional" orthodontics either causes or aggravates TMJ problems!

7. SMRT removes only four teeth rather than eight teeth (four premolars and four "wisdom" teeth) as in the case of "traditional" orthodontics.

WHAT ARE THE PRACTICAL & FINANCIAL BENEFITS OF SECOND MOLAR REPLACEMENT THERAPY (SMRT)?

1. Simple extractions vs. complicated, surgical extractions
2. Less potential for post-op problems (pain, swelling, dry socket, etc.)
3. Less cost
4. Quicker recovery and healing (because the patient is much younger)

To get the best results, the following criteria should be satisfied:
1. There need to be "wisdom" teeth or third molars to replace the second molars. Without "wisdom" teeth to replace the second molars, we obviously do not remove the second molars. The technique works best when there are four second molars and four "wisdom" teeth to work with (one of each in each corner of the mouth). This results in a better, balanced bite. However, we still get good results even if one or more "wisdom" teeth are missing. It may not be the best case scenario, but it is still better than the alternative.
2. We do not remove the second molars until they are erupted enough to gain access to them for simple extraction or removal. This avoids having to make an incision in the gums for a more complicated surgical removal. The second molars normally erupt around 12 years of age. They are often called "12 year molars." The timing of SMRT for orthodontic patients is normally between Phase II (removable functional appliances) and Phase III (brackets and wires or "braces").
3. Under normal and ideal circumstances, we get the best result when the "wisdom" teeth are not very well developed. The best time is usually when the "wisdom" teeth have good crown development and very little or no root development. This is best determined with a panoramic radiograph ("xray"). The timing of SMRT for non-orthodontic patients is typically sometime after the second molars have erupted (sometime after 12 years of age).

We still get good results and benefit with older patients who have more developed "wisdom" teeth. These cases just take longer to "finish" and are less predictable and less perfect. However, the results are still better than the alternative.

1. Those who satisfy the above criteria.
2. Orthodontic patients with crowded teeth and/or over-bite/over-jet.
SMRT is an inherent part of our "Full Face Functional Orthodontics." Potential orthodontic patients should not even consider doing orthodontics with us without commitment to second molar removal and replacement. Don't start a project without counting the cost. Don't start to cross a strong river unless you plan to go to the other side. You can't stop mid-stream without problems.
3. Non-orthodontic patients with potential for impacted "wisdom" teeth.
Criteria for potential for impacted "wisdom" teeth:
A. Panoramic radiograph analysis
B. One or both parents with a history of impacted "wisdom" teeth

1. The older patient with fully developed and /or poorly positioned or impacted "wisdom" teeth with a poor prognosis for replacement of the second molars by the "wisdom" teeth. (However, we have seen some amazing results with patients who were not very good candidates for SMRT for various reasons but still decided to opt for SMRT).
2. Those who are more comfortable with traditional or conventional treatment modes.
3. Those who are not convinced that this is a better way.

There are some lay people as well as professionals who are antagonistic and vehemently opposed to second molar replacement therapy (SMRT). It amazes me how foolish some people can be when faced with the truth and factual evidence. I call it willful ignorance. Ignorance may seem like a strong word that draws strong reaction, but it simply means "without knowledge." These people simply have no working knowledge about SMRT. All they have is head knowledge. They don't know if it really works or not. They have no experience.
Change is a difficult thing for most people. There are usually two things that keep us from changing for the better - pride and "comfort zone." We don't want to think that we are not providing the best treatment possible (pride). We have always done it a certain way and we don't want to change because it's comfortable to us that way ("comfort zone"). Some people are bound and determined not to change, regardless of the proof of benefit.
Unfortunately, some of our patients or potential patients over the years have sought the counsel of these types of people and have allowed them to badly influence their decision. These are some of their arguments or the things that the "nay sayers" say:

1. "We've never heard of that."
Just because they've never heard of it, doesn't mean that it's not the best treatment.
2. "We've never done that."
Just because they've never done it, doesn't mean that it's not the best treatment.
3. "You're removing four perfectly good teeth."
Orthodontists have been removing "four perfectly good teeth" (premolars) for decades. They turn around and remove four more teeth later (four "wisdom" teeth) to try to prevent recrowding of teeth. Some orthodontists still do that today!
4. "Wisdom" teeth are not good to keep because they are so badly malformed."
"Wisdom" teeth will not be malformed if they are allowed to develop properly.

These "nay sayers" do not want to know the truth. They are bound and determined to believe a lie even in the face of obvious truth. After careful consideration of the information provided in this monograph and a careful review of the case presentations of our actual patients, we hope that you can come to the right conclusion and make the proper decision regarding SMRT. As we mentioned in the beginning of this monograph, true wisdom comes from God. We believe that what is right and proper in this matter should be obvious - a "no brainer."

This monograph was designed with the patient in mind, but other health care professionals should be able to benefit from this information also.

For even more fantastic information on SMRT from two of the most revered pioneers of functional orthodontics and SMRT, click on the image to the left view illustrative case studies and to read the terrific article "Treating to Beautiful Faces, Healthyt TM Joints, Faster Treatments, and Stable Arches" in the Journal of General Orthodontics by Dr. John WitzigDDS and Dr. Yosh Jefferson, DMD, IBO.