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Volume2 Issue6
S
upporting
Y
our
P
ractice
Intra-oral examinationof the soft tissues revealeda slight
colour change in the leftmandibular area,whichwas
particularly sensitive topalpation (
Fig.
➋
). Thehard tissues
appearednormal and thepatientwas caries free.
Examination revealed that tooth35 showeda small degree
of rotation, grade II+mobilityandpainonpercussion,
which indicated likely inflammation in theperiapical
tissues. Bite-wing radiographswereavailable from4years
beforeand further panoramic (
Fig.
➌
) andperiapical
radiographswere taken. They revealeda large radiolucent
areaunder theocclusal dentin-enamel junctionof tooth35
andwideningof the laminadura. Acold testwasnegative,
and the toothwasdetermined tohaveanacuteperiapical
abscess. Adecisionwasmade to start root canal treatment.
Acalciumhydroxidedressingwasplaced in thecanal.
Adry sterilecottonwool pelletwasplaced in thepulp
chamberwitha temporaryfilling to seal theaccess cavity.
Amoxicillinwasprescribed, andwhen thepatient returned
for a further appointment 7days later, hewas completely
freeof symptoms. Obturationwasperformedandpost-
obturation radiographswere taken. Theaccess cavitywas
reopenedaweek later andfinal restorationwas completed
withhybrid resincompositeandbondedwithanetch-
and-rinseadhesive (
Fig.
➍
).
Discussion
This caseof PEIRwasnot diagnosedat thepre-eruptive
stageas radiographsof theareawerenot obtained.
Nevertheless, thepresentationof an intact outer enamel
surfacealongwitha large radiolucent area in thedentin
suggested that PEIRwas themost likelydefinitive
diagnosis.
Theprognosis for teethaffectedbyPEIRdependson the
sizeof the lesionat the timeof discovery. Becauseof the
relativelyhighprevalenceof PEIR, itmight beprudent to
routinely scrutinize for PEIRall unerupted teethdiscovered
onbite-wingandother intra- andextra-oral radiographs.
Wherean intracoronal radiolucency isdetected inan
unerupteddeveloping tooth, the toothcanbe re-
examinedwithamoredetailed radiograph toconfirm the
diagnosis and thenbe treatedaccordingly.
If a relatively small lesion isdiscovered ina tooth, it
maybemonitoredcarefullyuntil after tootheruption
when thecavitymaybe routinely restored. Holanet
al. describedpulp reaction inPEIRbeforeeruptionand,
therefore, authorshave recommended that,when lesions
are largeandappear tobeencroachingon thepulp,
care shouldbe taken toexpose the tooth surgicallyand
restore it toprotect pulpvitalityand facilitatenormal root
development.
Conclusion
This casedemonstrates that enlargeddefects caused
byPEIRcaneasily threaten thepulp tissuewithina short
timeduring tootheruption, and that PEIRmaybean
important causeof unusual pulpal abscesses inchildren.
Asuneruptedpermanent teethmaynot always appear
inoptimumview inbite-wing radiographsof themixed
dentition, apanoramic radiograph shouldbeconsidered,
basedon the recommendationsof theAmerican
Dental Associationand theUnitedStates Food&Drug
Administration. Anearlier diagnosismight haveprevented
theneed for root canal treatment inanotherwisecaries-
freepatient.
a
➋
Intra-oral clinical appearance
of the left quadrant. Note:
tooth35hasnovisiblecaries.
➌
Panoramic radiograph
showingan intracoronal
radiolucencyandaperiapical
lesionon tooth35.
➍
Immediatepostoperative
radiographwith rubber dam
clamp revealingagood seal of
thecanal.
➍
➌
➋
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