Pre-Eruptive Intracoronal Resorption: The Hidden Truth

Keywords

Radiograph; Prevalence; Intra-Coronal; Panoramic; Resorption.

Introduction

PEIR is an anomaly presenting as an abnormal, well circumscribed, radiolucent area, often occurring in the coronal dentin adjacent to the amelo-dentin junction of unerupted teeth [1-3] Most PEIR’s are often detected as incidental findings in routine dental radiographs [4]. The depth of the lesion is adaptable and not often involves the pulp. Although some lesions progress rapidly, the others progress slowly before the tooth erupts into the oral cavity [5-8]. In most scenarios, a single tooth is affected, although cases involving several teeth have also been reported [9]. Most commonly affected teeth are molars and premolars [4].

PEIR can have three etiological factors (1) Chronic apical inflammation of primary teeth affecting the erupting successor, dental caries [10, 11, 12]; (2) Developmental mineralization defect of dentine [13, 12]; (3) Resorption superimposed on existing developmental defects [10-14] The conventional theory describes the lesion as an idiopathic external resorption of coronal dentin; resorptive cells originating from the surrounding connective tissue or bone penetrating the developing tooth through a breach in the reduced enamel epithelium and cause dentin resorption [13, 15, 16]. Factors to contemplate in timing the intervention include lesion size, expected time of tooth emergence, nature of the lesion (Static or Progressive), patient’s caries risk [4, 17]. The prevalence of PEIR is of 3-6% of the patients and in 0.5-2% 0f the teeth [16, 18, 19].

Forensic odontology is an emerging science and has a greater scope of development. Many methods have been developed to determine age, sex and ethnicity of the person using dental tissues. Every individual has a unique dentition which can sometimes be attributed to the dental procedures. Dentition of a person serves the purpose of individual identification and comparison. Forensic identification of dentition is dependent on the availability and accuracy of antemortem dental records. By comparing antemortem and postmortem radiographs, forensic remains can be reliably identified. This raises the need for appropriate cataloging of dental records which is duly the duty of the dentist there by providing an information source in medico-legal, administrative, and for forensic purposes. Dental analysis plays an important role similar to fingerprint and DNA analysis.

To the best of our observation, there have not been any epidemiological studies of PEIR in Chennai residents. Consequently, the purpose of the current study was to observe for the presence of PEIR in unerupted teeth by examining OPG’s of 4-15year old Chennai patients. In addition, these radiographs might help in forensic identification of PEIR in the future.

Materials and Methods

Ethical Approval:

The protocol for the current study was approved by the Institutional Review Board (SRB/MDS/PEDO/18-19/0007) from October 2018 - December 2018.

Sample Selection:

In this retrospective study, standard OPG’s were taken as they are commonly taken in clinical practice for patients with developing dentition, and show the maximum number of teeth in a single radiograph. The sample for the current study consisted of 4700 OPG’s [2754 (59%) boys; 1946 (41%) girls] from different parts of chennai with an age range of 4-15 years.

Inclusion Criteria:

Presence of at least one unerupted tooth with full crown formation, age less than 15 years. Supernumerary teeth and unerupted third molars and were included. Patients with documented medical and dental anomalies such as amelogenesis imperfecta, dentinogenesis imperfecta, and hypophosphatemic rickets were eliminated from the study. Radiographs which were not of optimal diagnostic quality were also excluded. Due to lack of definition of teeth in the anterior region of OPG, incisor teeth were excluded from examination. Also, radiolucencies on mandibular molars showed a linear appearance resembling buccal grooves were not recorded as PEIR defects.

Radiographic Examination:

OPG’s used in this study were taken from different parts of Chennai. They were taken as standard OPG’s. The examiner was trained to detect PEIR defects using OPG’s which were not part of the study, and were assessed twice for calibration and reproducibility purposes. The intra-examiner correlation coefficient was measured using Kappa statistics which found to be 0.9.

A tooth beneath the bone and/or mucosa was considered as an unerupted tooth and those deviated from the normal eruption pathway were considered as ectopically positioned. According to the classification scheme of a study [19], the size of each defect relative to coronal dentine thickness was noted, whether it is (1) within one-third of the dentin thickness (2) or two-third of the dentin thickness (3) or extended through the full dentin thickness of the crown.

Results

A total of 4700 OPG’s were evaluated in the current study. In total, 3568 OPG’s had at least one unerupted tooth with a pervasiveness of 75.9%. Of the 3568 OPG’s screened, 2103 were male and 1465 were female. Intra-coronal resorption was identified in 20 teeth with a frequency of 0.5% (Table-1) The localization of intracoronal radiolucencies is shown in Table-1. Intra-cornal resorption was identified in both maxillary and mandibular teeth. 9 affected teeth were observed in maxilla (0.2%), where as 11 were in the mandible (0.3%). PEIR were seen to be equally distributed on both sides. Intra-coronal radiolucency by tooth type, location and size of the defect is documented according to male and female cases in Table-2. Of the 20 intra-coronal resorption, 9 (45%) were seen in canine, followed by 7 molar teeth (35%) and 4 premolar teeth (20%). For the sizes of the defects scored relative to the width of dentin thickness, most prevalent (50%) was a score of 2 and scores of 1 and 3 were equally prevalent (25% each). (Table-2) (Fig-1,2,3).

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Table 1:

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Table 1. Demographic analysis, prevalence and localization of intra-coronal resorption.

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Table 2:

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Table 2. Distribution of patients with PEIR and radiographic features.