Pre-eruptive intra-coronal resorption of dentine: a review of aetiology, diagnosis, and management

Regenerative endodontic treatment of necrotic permanent teeth with pre-eruptive intracoronal radiolucency: a case report

Pre-eruptive intracoronal radiolucency is a rare dental anomaly with unclear aetiology, generally asymptomatic and diagnosed through routine radiographs. Failure to diagnose and treat it early can lead to rapid pulp damage, potentially compromising root development. The presented clinical report describes a mandibular second premolar with pre-eruptive intracoronal radiolucency that caused early pulp necrosis with arrest of root formation and emphasises the endodontic management using regenerative endodontic therapy.

Pre-eruptive intracoronal resorption: A report of two cases treated with Biodentine in mandibular premolars

Pre-eruptive intracoronal resorption is a rare dental anomaly marked by a radiolucent area within an unerupted tooth. This report discusses the clinical management of pre-eruptive intracoronal resorption in two mandibular premolars through vital pulp therapy using Biodentine as a sealant. Emphasising the significance of timely intervention for preserving pulp vitality and the tooth's integrity, the present case report underscores the necessity of vigilant clinical and radiographic monitoring for early detection and appropriate treatment. By presenting effective strategies for managing pre-eruptive intracoronal resorption, the report contributes to the understanding of this condition and highlights the importance of proactive measures in preserving affected teeth and ensuring favourable long-term outcomes.

Pre-eruptive intramural resorption in unerupted teeth: a cone-beam computed tomography evaluation of prevalence and related factors

OBJECTIVE

Pre-eruptive intramural resorption (PEIR) is defined as an abnormal, well-circumscribed radiolucency within the coronal dentin of the tooth, which is often overlooked in plain radiographs. This study aimed to investigate the prevalence of PEIR and its related factors using cone-beam computed tomography (CBCT).

METHODS

CBCT images of 590 unerupted teeth were evaluated for the presence of PEIR, location of PEIR, number of lesions in the affected tooth, PEIR score, tooth angulation, tooth position, and pericoronal space. Binary logistic tests were used to analyze the association between the characteristics of PEIR and the patient's demographic data and related factors.

RESULTS

The tooth prevalence of PEIR was 13.6% among unerupted teeth. However, it was noteworthy that 19.2% of the unerupted teeth with PEIR were planned to be kept. PEIR was significantly associated with transverse (p = 0.020), inverted-angulated (p = 0.035), and centrally-positioned teeth (p = 0.043). The severity of PEIR was more pronounced in teeth with distal (p = 0.019), lingual (p = 0.023), or inverted-angulated (p = 0.040) positions, and in the absence of pericoronal space (p = 0.036).

CONCLUSION

PEIR should be suspected in transverse, inverted-angulated, centrally positioned unerupted teeth, particularly in molars, with no pericoronal space. Further monitoring through CBCT is recommended in such cases.

CLINICAL RELEVANCE

The management of unerupted teeth does not always involve surgical removal. Instead, they could be utilized for artificial eruption or tooth transplantation. The present study emphasizes the significance of early detection of PEIR. Clinical recommendations for screening PEIR in unerupted teeth are also proposed, which can be applied to routine plain radiographs.

Cone-beam computed tomography-based investigation of pre-eruptive intracoronal resorption prevalence

This retrospective study aimed to investigate the prevalence of pre-eruptive intracoronal resorption (PEIR) using cone-beam computed tomography (CBCT) and to explore the mechanism and characteristics of PEIR development. CBCT images of patients aged ≤ 20 years with unerupted teeth at Hiroshima University Hospital were collected. We examined 1530 patients with 10,576 unerupted teeth. Teeth with PEIR were identified for the detailed location and size of the PEIR in the crown using multiplanar reconstruction. The subject and tooth prevalence rates of PEIR were 1.96% and 0.31%, respectively. The teeth that were the most commonly affected by PEIR were mandibular third molars (3.09%). The prevalence of PEIR was significantly higher in females than in males, and higher in the mandible than in the maxilla. No significant difference between in the position of PEIR within the crown was observed. Moreover, CBCT imaging revealed the onset of PEIR in one case. This study demonstrated the prevalence of PEIR and identified statistically significant sex- and location-based differences. Furthermore, one case of CBCT imaging supports the hypothesis that the onset of PEIR was due to resorption after completion of the crown.

Pre-eruptive intracoronal resorption of permanent dentition: A new classification and a multidisciplinary study

The aims of this study were to develop a new classification for pre-eruptive intracoronal resorption(PIR) with different resorption areas and sizes and to compare the new classification scores among observers from different specialities and professional experience. The PIR was evaluated according to the new classification by two dentomaxillofacial radiologists and two endodontists. Information regarding the patient's age, gender, systemic diseases, the number of PIR, the affected tooth area and the size of the PIR was recorded. The new classification system showed that PIR six and seven defects were the most detected. Regarding jaw regions, the highest reliability was seen in the maxillary central teeth between observers I and IV, and maxillary premolar-molar teeth between observers II and III. This study revealed that PIR can be found in both root and crown dentine. Professional experience and specialty and awareness of the PIR defect may affect the diagnosis.

Pre-eruptive intracoronal resorption in orthodontic patients: A retrospective analysis of 3,143 patients

OBJECTIVES

The aim of this retrospective study was to analyze the occurrence and characteristics of pre-eruptive intracoronal resorptions in a clinical orthodontic patient population.

MATERIALS AND METHODS

Patients treated in an orthodontic department (University of Pécs, Pécs, Hungary) were included. Unerupted teeth on panoramic radiographs were analyzed for intracoronal radiolucent lesions. For each patient, the demographic data, jaw localization, number of unerupted teeth with pre-eruptive intracoronal resorption lesions, number of lesions per tooth, size and localization of pre-eruptive intracoronal resorption defects, affected tooth's surface, pulp involvement and ectopic position of the tooth with defects were recorded.

RESULTS

In the 3,143 patients investigated, 55 teeth in 49 patients showed pre-eruptive intracoronal resorption lesions (subject incidence: 1.56%). The incidence on unerupted teeth was 0.25%. Pre-eruptive intracoronal resorption was significantly more common in mandibles (43 mandibular vs. 12 maxillary lesions) with an odds ratio of 12.84 (95% Confidence Interval: 5.19-31.74) and no gender differences were found (p = 0.746). The occurrence of pre-eruptive intracoronal resorption was highest in the youngest (7-10 years) mixed dentition status group (p < 0.001). Most of the lesions (44 of 55, or 80.0%) were localized in the dentin, occupying two-third or less of the dentin thickness. Only 12.73% (7/55) of the lesions were not localized on the occlusal surface. Of the lesions, 89.1% (49/55) showed no obvious size increase over an average follow-up of 36.4 ± 8.1 months.

CONCLUSIONS

Pre-eruptive intracoronal resorption may occur mainly in the mixed dentition stage in orthodontic patients. Careful and attentive radiographic evaluations may facilitate early detection and follow-up of the lesions' possible dimensional changes, especially when resorption influences orthodontic extraction therapy.

Pre-Eruptive Intracoronal Resorption (PEIR): A Case Report

Pre-Eruptive Intracoronal Resorption (PEIR) is a rare yet significant phenomenon in which an abnormal, well-circumscribed, radiolucent area develops in the tooth prior to eruption. This case report outlines the treatment of a 12 year old Hispanic female who was referred for endodontic evaluation of tooth #31 and subsequently diagnosed with PEIR. The patient's chief complaint was recorded as "spontaneous pain" in the lower right quadrant of her jaw. Clinical examination revealed a partially erupted tooth #31 with no visible decay. Radiographic examination, including a cone beam computed tomography scan, led to the detection of a radiolucent area surrounding the pulp chamber on the mesial aspect of tooth #31. Radiographically, the enamel appeared intact with no signs of perforation. Based on the clinical and radiographic evaluation, tooth #31 was determined to have PEIR, with the pulpal and periapical diagnosis of "Symptomatic Irreversible Pulpitis" and "Normal Apical Tissue," respectively. The Orthodontic consultation obtained for this patient recommended that tooth #31 be maintained at least until tooth #32 appeared in the oral cavity and could be used as a replacement. Therefore, a treatment plan involving vital pulp therapy and gingivectomy was selected. During the procedure, granulation tissue was excavated and sent for histological evaluation, which concluded the presence of "granulation tissue with acute and chronic inflammation". No caries were detected. Following the procedure, the tooth was found to be asymptomatic with continued root development. A positive response to Electric Pulp Test was achieved after 3.5 years of follow up.

Pre-eruptive intracoronal resorption in "high-risk" impacted third molars: A report of four cases

Pre-eruptive intracoronal resorption (PEIR) is usually an incidental finding as a radiolucent lesion within the coronal dentin of unerupted teeth. Through the four cases reported here, authors would demonstrate deeply impacted "high-risk" third molars with PEIR defects, showing an increased risk of inferior alveolar nerve (IAN) injury. However, follow-up or coronectomy may eliminate or reduce the risk of neurosensory disturbances, in case of PEIR lesions this can be contradictory due to the unpredictable reactions of the third molar's pulp. Cases show the important role of preoperative imaging in the diagnostics and management of deeply impacted PEIR third molars and highlight the need for investigations regarding coronectomy in such cases.

Pre-eruptive intracoronal radiolucencies in permanent dentition of children in Tamil Nadu-A cross-sectional study

BACKGROUND

Pre-eruptive intracoronal radiolucency (PEIR) poses a challenge to paediatric dentists as it cannot be clinically detected.

AIM

To estimate the prevalence and coexisting factors of PEIR in permanent teeth of children and adolescents in western Tamil Nadu, India.

DESIGN

This cross-sectional study assessed 5012 digital panoramic radiographs of children and adolescents below 14 years of age obtained from private digital imaging centers, dental clinics, and dental colleges located in five districts of western Tamil Nadu. The prevalence and PEIR and its coexisting factors were assessed by two independent calibrated investigators. Data were analyzed using the chi-square test.

RESULTS

The subject prevalence and tooth prevalence of PEIR were estimated to be 3.2% and 0.4%, respectively. Maxillary canines and mandibular premolars were commonly involved. Majority of the lesions were limited to less than one-third of dentin thickness (74%) and distal aspect of the crown (45.1%). Ectopic positioning (9.3%) and dental caries in the preceding primary tooth (9.9%) were the most common coexisting factors.

CONCLUSION

Pre-Eruptive Intracoronal Radiolucency defects were commonly seen in maxillary canines, mandibular premolars, and distal aspect of the crown involving less than one-third dentin thickness. Ectopic positioning and caries in primary teeth were commonly seen along with the PEIR defects.

Management of Maxillary Premolar with Pre-eruptive Intracoronal Resorption: A 5-year Follow-up Case

Aim and objective

The present article aims to describe and discuss the preventive clinical management of a pre-eruptive intracoronal resorption (PEIR) defect on a maxillary right second premolar of an 11-year, 5-month-old girl.

Background

Pre-eruptive intracoronal resorption is described as an abnormal, well-circumscribed, radiolucent area, occurring within the coronal dentinal tissue close to the dentinoenamel junction of unerupted teeth and extending into various depths of the dentin. It is a rare anomaly occurring in primary and permanent dentitions. In the past, these defects were misdiagnosed as caries, and were therefore called “pre-eruptive caries” or “hidden caries”. Currently, the most acceptable etiological hypothesis for PEIR is intracoronal resorption by the invasion of resorptive cells into the dentine through breakdowns in the enamel during crown formation. These lesions are often detected accidentally during routine dental radiographic examination.

Case description

A fissure sealant was applied to the affected tooth shortly after its eruption. Clinical and radiographical assessments were scheduled every 6 months for a period of 5 years and 5 months.

Conclusion

The preventive approach proved to be effective in preserving the tooth vital and asymptomatic with normal root development for the entire follow-up period.

Clinical significance

This article raises awareness about misdiagnosed PEIR in primary and permanent dentitions. A close inspection of radiographs, taken during routine visits and orthodontic check-ups, is important for early detection and proper management of such defects.

How to cite this article

Ambriss B, Moukarzel C, Ezzeddine M, et al. Management of Maxillary Premolar with Pre-eruptive Intracoronal Resorption: A 5-year Follow-up Case. Int J Clin Pediatr Dent 2021;14(1):161–166.