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Two case reports are described along with differential diagnoses and management strategies from the literature for teeth discovered with intra-coronal resorption prior to their eruption. Our cases feature impacted maxillary anterior teeth. In both instances, significant coronal resorption presented itself mid-way through fixed appliance treatment, prior to full eruption of the involved teeth. This was detected radiographically and not through patient-reported symptoms. Once sufficiently erupted, root canal therapy was carried out in both cases and orthodontic treatment was successfully completed.
CPD/Clinical Relevance: Orthodontists are often first to identify pathological lesions in unerupted teeth and should be equipped with differential diagnoses in order to manage and refer patients appropriately.
Article
Coronal radiolucencies identified on radiographs of permanent teeth are mostly attributable to demineralization, hypomineralization or hypoplasia.1 Internal resorption, following dental trauma, can also appear as a radiolucency within the crown. A comprehensive history and clinical examination will help to determine the aetiology of the pathology so that the tooth can be managed correctly. But what if the crown of an unerupted tooth is found by chance to be afflicted with a resorptive lesion where the patient is often not able to offer a history? The aetiology, diagnosis and management become more difficult.
Orthodontic patients are carefully examined for the absence of dento-alveolar pathology and the presence of normal crown and root development prior to commencing treatment. In the two cases described below, the involved unerupted anterior teeth demonstrated normal radiographic development and orthodontic treatment was started. Mid-treatment, coronal radiolucencies were observed on progress radiographs and, at the time, the aetiology was assumed to be idiopathic resorption. Idiopathic coronal resorption of an unerupted tooth has historically often been misdiagnosed as occult caries.1 Many terms have been coined for it in the past, the very first of which was ‘intrafollicular caries’.1,2,3 Now, it is most commonly referred to as ‘pre-eruptive intra-coronal resorption’ (PIR).4,5
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