title: Case report: pre-eruptive intra-coronal radiolucencies revisited.
abstract: OBJECTIVE
  Pre-eruptive intra-coronal radiolucency (PEIR) describes a radiolucent lesion located in the coronal dentine, just beneath the enamel-dentine junction of unerupted teeth. The prevalence of this lesion varies depending on the type and quality of radiographic exposure and age of patients used for assessment. The aetiology of pre-eruptive intra-coronal radiolucent lesions is not fully understood, but published clinical and histological evidence suggest that these lesions are resorptive in nature. Issues around the diagnosis, treatment planning and clinical management of this lesion are explored using previously unreported cases.
  
  
  METHODS
  Case 1: A ten-year-old girl attended for a routine check-up. An intra-coronal radiolucency in the unerupted lower right second premolar was an incidental finding on orthopantomograph (OPT). The tooth erupted and removal of enamel revealed a space filled with soft red tissue, unlike carious dentine in appearance. The tooth was restored with an indirect pulp cap, resin modified glass ionomer base and composite resin. Tissue from the lesion was removed for histopathological investigation. Root development continued to completion and the tooth remained asymptomatic and vital. Case 2: A six-year-old girl attended for her first dental visit. An intra-coronal radiolucency in a lower right first permanent molar was noted on baseline bitewing radiographs. The lesion was monitored and fissured sealed upon eruption. The lesion was monitored annually radiographically. The tooth remained symptom free for 5 years. The patient presented on an emergency basis having fractured the distolingual cusp overlying the lesion. There was no pain and the tooth was vital. The softened dentine was removed and the tooth was restored using a preformed metal crown. Case 3: A 12-year-old girl was referred for restoration of mandibular left second permanent molar. Clinically there was extensive occlusal destruction. Review of a previous OPT showed that an intra-coronal radiolucency was present in tooth 37 at least one year prior to its eruption. The large mass of coronal soft tissue was removed, the remaining enamel shell was deemed to be unrestoreable and the tooth was extracted. The patient was referred back to an orthodontist for completion of orthodontic treatment.
  
  
  CONCLUSIONS
  Early detection and classification of the PEIR lesion allows an array of individualised treatments to be provided for successful outcome.
authors.affiliation: Department of Paediatric Dentistry, Leeds Dental Institute, Leeds, UK. katepcounihan@gmail.com
authors.forename: K P
authors.initials: KP
authors.lastname: Counihan
authors.forename: A C
authors.initials: AC
authors.lastname: O'Connell
mesh_terms: D001641:Bicuspid / Q000000981:diagnostic imaging; D002648:Child; D003188:Composite Resins / Q000737:chemistry; D003743:Dental Enamel / Q000473:pathology; D003764:Dental Materials / Q000737:chemistry; D003785:Dental Pulp Capping; D003793:Dental Restoration, Permanent / Q000379:methods; D003804:Dentin / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005899:Glass Ionomer Cements / Q000627:therapeutic use; D006097:Granulation Tissue / Q000473:pathology; D006801:Humans; D033162:Incidental Findings; D008963:Molar / Q000000981:diagnostic imaging; D010010:Osteoclasts / Q000473:pathology; D010895:Pit and Fissure Sealants / Q000627:therapeutic use; D011862:Radiography, Panoramic; D019279:Resin Cements / Q000627:therapeutic use; D019228:Tooth Crown / Q000000981:diagnostic imaging*; D014091:Tooth Resorption / Q000473:pathology; D014097:Tooth, Unerupted / Q000000981:diagnostic imaging*
chemical_list: D003188:Composite Resins; D003764:Dental Materials; D005899:Glass Ionomer Cements; D010895:Pit and Fissure Sealants; D019279:Resin Cements