Management of pre-eruptive intracoronal radiolucency (PEIR): a case series with up to 8 years follow-up.

BACKGROUND: Pre-eruptive intra-coronal radiolucency (PEIR) is a rare dental anomaly often incidentally detected during routine radiographic examinations. This condition manifests as a radiolucent lesion beneath the enamel-dentinal junction of unerupted teeth, particularly in lower molars, posing diagnostic and management challenges due to its asymptomatic nature. The treatment of PEIR depends on the extent of the lesion and the degree of pulp involvement.

CASE SERIES: This case series reports on four patients with progressive pre-eruptive intra-coronal radiolucency. In case 1 and 2, lesions were incidentally discovered in an OPG during orthodontic planning (lower permanent 2nd molars), and additional surgical exposure to access the lesion was required as teeth were only partially erupted. Interestingly in case 3, the PEIR was not visible in earlier x-rays though the crown of the tooth was already mineralized (lower permanent 2nd molar). For case 4, the tooth presented with symptoms of reversible pulpitis (lower permanent 1st molar). All lesions were treated with indirect pulp capping using biocompatible material. The patients were followed-up for a period of up to 8 years to evaluate treatment success. Indirect pulp capping and restorations were found to be successful in all four cases in the last follow-up: 1 year (case 2), 1.4 years (case 1), 1.5 years (case 4), and 8 years (case 3).

CONCLUSION: This case series demonstrates the effectiveness of early intervention via surgical exposure and indirect pulp capping and restoration for managing severe cases of PEIR. However, further research with larger samples and long follow-up is necessary.