Counihan K P, O'Connell A C
Department of Paediatric Dentistry, Leeds Dental Institute, Leeds, UK.
Eur Arch Paediatr Dent. 2012 Aug;13(4):221-6. doi: 10.1007/BF03262874.
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.
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.
Early detection and classification of the PEIR lesion allows an array of individualised treatments to be provided for successful outcome.
萌出前牙冠内透射区（PEIR）是指位于未萌出牙牙冠牙本质内、恰好在釉牙本质界下方的透射性病变。该病变的患病率因用于评估的影像学检查类型和质量以及患者年龄而异。萌出前牙冠内透射性病变的病因尚未完全明确，但已发表的临床和组织学证据表明这些病变本质上是吸收性的。本文利用此前未报道的病例探讨了该病变的诊断、治疗计划和临床管理相关问题。
病例1：一名10岁女孩前来进行常规检查。在曲面体层片（OPT）上偶然发现右下第二乳磨牙未萌出且牙冠内有透射区。牙齿萌出后，去除釉质可见一个充满柔软红色组织的腔隙，外观与龋坏牙本质不同。该牙采用间接盖髓术、树脂改性玻璃离子垫底和复合树脂进行修复。取自病变组织用于组织病理学检查。牙根发育至完成，牙齿保持无症状且活力正常。病例2：一名6岁女孩首次前来就诊。在基线咬合翼片上发现右下第一恒磨牙牙冠内有透射区。对该病变进行监测，牙齿萌出后进行窝沟封闭。每年进行影像学监测。该牙5年无症状。患者因覆盖病变的远舌尖折断前来急诊。无疼痛，牙齿活力正常。去除软化牙本质，使用预成金属冠修复该牙。病例3：一名12岁女孩因下颌左第二恒磨牙修复前来就诊。临床检查发现广泛的咬合面破坏。回顾之前的OPT显示，37号牙在萌出前至少1年就存在牙冠内透射区。去除大量牙冠软组织后，剩余的釉质壳被认为无法修复，遂拔除该牙。患者被转回正畸医生处完成正畸治疗。
对PEIR病变进行早期检测和分类，可为成功治疗提供一系列个体化治疗方案。
