Treatment of an undiagnosed pre-eruptive intra-coronal radiolucency.

Bitewing radiographs have been one of the dentist’s chief diagnostic tools in the dental clinic. They increase detection of interproximal caries approximately two-fold when compared to clinical examination alone. To a much lesser extent, the bitewing may be used to diagnose occlusal caries. The dentist examining a bitewing radiograph will pay attention to the alveolar crests thus assessing periodontal disease. The clinician will attempt to diagnose pathologies of the furcation areas of primary molars, identify submerged or ankylotic primary molars, and detect ectopically erupting permanent molars and missing succedaneous teeth. The use of size two films or complementary periapical films will enhance diagnostic ability. However, the pediatric dentist must bear in mind less common pathologies that may be found in bitewing radiographs that may be overlooked. This report describes a case of a pre-eruptive intra-coronal radiolucent lesion (PICRL) in a mandibular second premolar that was detectable yet not diagnosed, prior to the tooth’s eruption. The subsequent treatment is described and illustrated below. The prevalence and etiology of the PICRL has recently been reported in a series of studies and case reports in the pediatric dental literature. The prevalence of PICRL is approximately 6%. The mandibular permanent first molar is the most commonly affected tooth, followed by the mandibular second premolar and molar, and finally the maxillary first molar and premolar teeth. The majority of patients show only one affected tooth each, however cases of multiple PICRL’s in individual subjects have also been reported. A single report of PICRL’s in primary teeth has also been published and is extremely rare. The etiology of PICRL remains a subject of controversy. Suggested causes include apical inflammation of primary molars (relevant only to PICRL in premolars) and dental caries. The most likely hypothesis is that the defects are acquired as a Prevalence: 6%, usually only one lesion per individual