A clinical approach strategy for the diagnosis, treatment and evaluation of external cervical resorption.

AIM: To propose a clinical approach strategy on the diagnosis, treatment and evaluation of external cervical tooth resorption (ECR) cases. To investigate and discuss the outcome of this approach. METHODOLOGY: A clinical approach strategy on ECR was developed based on a retrospective observation study of 542 teeth. Forty-seven teeth were excluded due to lack of clinical/radiographical information, and 182 were immediately extracted. This approach had three steps: diagnosis, treatment planning and evaluation. During diagnosis, the medical, dental history and clinical/radiographical characteristics were evaluated. Depending on the resorption extent, ECR cases were categorized into four classes according to Heithersay's classification. During treatment planning, a treatment decision flowchart was prepared based on four main decisive criteria: probing feasibility, pain, location and extent of resorption (class), and existence of bone-like tissue. Three treatment options were applied: (a) extraction, (b) monitoring or (c) conservative treatment by external, internal or combination of internal-external treatments. During evaluation, assessment of ECR progression, tooth survival and other factors like aesthetics and periodontal attachment were performed. Descriptive statistical analysis of the outcome for up to 10 years (for the overall clinical approach and for each individual treatment decision), was carried out with OriginLabs OriginPro 9 and Microsoft Excel 365. RESULTS: A three-step strategy was developed on how to deal with ECR cases. Indicative examples of each treatment decision were presented and discussed. The overall survival rate of this strategy was 84.6% (3 years), 70.3% (5 years), 42.7% (8 years) and 28.6% (10 years). Higher survival rate was observed for external treatment decision than for internal. The success of each treatment decision depended on the extent of the resorption (class). The success of a treatment decision should be based on the long-term outcome, as a different evolution can be observed with time. CONCLUSIONS: A clinical approach strategy was introduced on ECR pathosis. This strategy was not solely based on ECR class, as other important decisive criteria were considered. This step-wise approach, has a 70.3% survival rate with a mean of 5 years. This work will hopefully provide an incentive for a broader collaboration, to potentially establish a universally accepted ECR treatment strategy.

Update on Equine Odontoclastic Tooth Resorption and Hypercementosis.

Equine odontoclastic tooth resorption and hypercementosis (EOTRH) is a progressive, painful disease, affecting incisors, canines, and cheek teeth. Examination findings include gingival inflammation, gingival recession and/or hyperplasia, subgingival swelling, bulbous enlargement of teeth, associated periodontal disease, pathologic tooth fracture, and/or tooth mobility and loss. Current hypotheses include biomechanical stresses and secondary bacterial involvement. Early recognition allows case management, but it is a progressive disease. Owner education is crucial; horses with complete or multiple extractions have a favorable prognosis. Human oral and dental health may be affected by bisphosophonate use; long-term effects of these drugs are currently unknown in horses.

Nonsurgical Management and 2-year Follow-up by means of Cone Beam Computed Tomography of an Invasive Cervical Resorption in a Molar.

BACKGROUND: Invasive cervical resorption (ICR) is a relatively uncommon form of external tooth resorption, characterized by an invasive nature. It is usually painless and detection of lesions is often made incidentally. Three-dimensional imaging techniques, such as cone beam computed tomography (CBCT), are useful in the diagnosis and management of ICR as the true extent of the defect cannot always be estimated using conventional radiographs. AIM: The aim of this article is to report on the successful treatment of ICR in mandibular first molar by nonsurgical approach and follow-up by means of CBCT. CASE REPORT: An 18-year-old patient was referred with a complaint of unusual radiolucency in the mesial cervical area of tooth #19 with unknown etiology. Cone beam computed tomography was performed to assess the extent of the lesion in three spatial levels and diagnosis of Heithersay class III ICR was made. This case presented with ICR (Heithersay class III) on tooth #19. Nonsurgical root canal treatment and removal of the lesion from the coronal access was performed; the resorptive defect was filled with dual-cure, self-adhesive, resin-modified glass ionomer cement (RMGIC); 6-month follow-up X-ray film showed no changes at the lesion site and tooth was asymptomatic; 1-year follow-up X-ray film showed slight mesial bone loss and a probing depth of 3 mm; finally, 2-year follow-up CBCT images showed no recurrence and no further bone destruction at the lesion site. CONCLUSION: The intraoral radiographs revealed the resorptive changes in two dimensions; therefore, the actual extent and location of the lesions are not fully understood. On the contrary, CBCT is a very useful tool to achieve a proper diagnosis; it detects the extent of the defect more accurately and hence, improves the treatment outcomes of ICR. CLINICAL SIGNIFICANCE: The ICR is usually seen as a late complication to traumatic injuries of the teeth; it is essential, therefore, that the patients who were exposed to situations that can damage the integrity of periodontal tissue need to have careful periodic recalls and X-ray examinations.

Invasive Cervical Resorption: Clinical Management in the Anterior Zone.

According to the high number of articles published on invasive cervical resorption (ICR), this pathology, as commonly believed, is a more frequent form of cervical resorption. ICR is often misdiagnosed as internal resorption or caries, which leads to inappropriate treatment and even unnecessary tooth loss. Despite a correct diagnosis, the treatment of this type of hyperplastic invasive external resorption poses a challenge for the clinician. The Heithersay classification and the use of cone-beam computed tomographic imaging have increased our knowledge of the pathology and helped improve its prognosis. Nevertheless, there is no standard protocol for the treatment of this type of lesion. This article proposes a treatment protocol for ICR based on the pattern and location of resorption. Three treatment approaches (internal access, external access, and intentional replantation) are presented through 3 clinical cases.

External cervical resorption: part 2 - management.

Effective management of external cervical resorption (ECR) depends on accurate assessment of the true nature and accessibility of ECR; this has been discussed in part 1 of this 2 part article. This aim of this article was firstly, to review the literature in relation to the management of ECR and secondly, based on the available evidence, describe different strategies for the management of ECR. In cases where ECR is supracrestal, superficial and with limited circumferential spread, a surgical repair without root canal treatment is the preferred approach. With more extensive ECR lesions, vital pulp therapy or root canal treatment may also be indicated. Internal repair is indicated where there is limited resorptive damage to the external aspect of the tooth and/or where an external (surgical) approach is not possible due to the inaccessible nature of subcrestal ECR. In these cases, root canal treatment will also need to be carried out. Intentional reimplantation is indicated in cases where a surgical or internal approach is not practical. An atraumatic extraction technique and short extraoral period followed by 2-week splinting are important prognostic factors. Periodic reviews may be indicated in cases where active management is not pragmatic. Finally, extraction of the affected tooth may be the only option in untreatable cases where there are aesthetic, functional and/or symptomatic issues.

Abordagem multidisciplinar para o tratamento da reabsorção cervical externa: relato de caso / Multidisciplinary approach for the treatment of external cervical resorption: case report

Introdução: a reabsorção radicular é um processo patológico que resulta na perda de cemento, dentina e osso, sendo desencadeada por desequilíbrio entre osteoblastos e osteoclastos. O diagnóstico geralmente ocorre por meio de exame radiográfico e/ou tomográfico. Objetivo: relatar o tratamento de um caso de reabsorção cervical no dente #14 com abordagem multidisciplinar envolvendo Endodontia, Ortodontia, Periodontia e Prótese. Métodos: após realização de tomografia, verificou-se que a imagem correspondia a uma reabsorção cervical externa na raiz palatina, estendendo-se desde distal, seguindo para palatal e mesial. Após abertura e medicação intracanal, o endodontista optou por encaminhar a paciente para avaliação com ortodontista, sendo sugerida a realização de tracionamento ortodôntico, numa tentativa de expor a área da lesão. Para se atingir a posição final do dente, entre ativações de segunda e terceira ordens e ajustes oclusais, a etapa ortodôntica durou onze meses, incluindo três meses de contenção. Um mês antes de remover o aparelho ortodôntico e após um ano desde o início do tracionamento, realizou-se a obturação dos canais radiculares. Ainda com o dispositivo ortodôntico, foi realizada a cirurgia para correção do nível ósseo e gengival, que tende a acompanhar o dente, visualizando-se totalmente a área da reabsorção. Após um mês da cirurgia de aumento de coroa clínica, removeu-se o aparelho ortodôntico e realizou-se o tratamento protético com núcleo metálico fundido com liga de ouro e coroa em cerâmica com infraestrutura de zircônia. Conclusão: a partir de uma abordagem multidisciplinar, torna-se possível o tratamento de casos de reabsorções cervicais externas.

External cervical resorption: diagnostic and treatment tips.

External cervical resorption is caused, almost exclusively, by dental trauma - especially those characterized by concussion - and is a dental disease to be diagnosed and treated accurately by endodontists. However, the vast majority of the cases is initially diagnosed by an orthodontist, due to the imaging possibilities in standardized documentations. Among the causes of external cervical resorption, it is common to mistakenly attribute it to orthodontic treatment, traumatic occlusion or even to chronic inflammatory periodontal disease. External cervical resorption is associated to dental trauma in several situations mentioned in this paper. In old cases, and eventually still nowadays, it may have been induced by internal tooth bleaching, which is increasingly less frequent in endodontically treated teeth. There are some tips to be followed and some care that must be taken during the diagnosis and treatment of external cervical resorption clinical cases. The present study lists foundations that will allow the professional to perform safely and accurately in each specific case. Some of these tips and care measures are of orthodontic nature.

External cervical resorption: diagnostic and treatment tips

ABSTRACT External cervical resorption is caused, almost exclusively, by dental trauma - especially those characterized by concussion - and is a dental disease to be diagnosed and treated accurately by endodontists. However, the vast majority of the cases is initially diagnosed by an orthodontist, due to the imaging possibilities in standardized documentations. Among the causes of external cervical resorption, it is common to mistakenly attribute it to orthodontic treatment, traumatic occlusion or even to chronic inflammatory periodontal disease. External cervical resorption is associated to dental trauma in several situations mentioned in this paper. In old cases, and eventually still nowadays, it may have been induced by internal tooth bleaching, which is increasingly less frequent in endodontically treated teeth. There are some tips to be followed and some care that must be taken during the diagnosis and treatment of external cervical resorption clinical cases. The present study lists foundations that will allow the professional to perform safely and accurately in each specific case. Some of these tips and care measures are of orthodontic nature.

RESUMO A reabsorção cervical externa é provocada, quase exclusivamente, pelo traumatismo dentário, especialmente os do tipo concussão. Ela constitui uma doença dentária a ser diagnosticada e tratada com precisão pelo endodontista, mas a grande maioria dos casos é inicialmente diagnosticada pelo ortodontista, em função das oportunidades imagiológicas nas documentações padronizadas. Entre as causas da reabsorção cervical externa, é comum atribuí-la equivocamente ao tratamento ortodôntico, à oclusão traumática ou, ainda, à doença periodontal inflamatória crônica. A reabsorção cervical externa está associada ao traumatismo dentário em várias situações mencionadas neste trabalho. Em casos mais antigos - e ainda hoje, eventualmente -, pode ter sido induzida pelo clareamento dentário interno, cada vez menos realizado em dentes endodonticamente tratados. Algumas dicas e cuidados devem ser tomados no diagnóstico e no tratamento dos casos clínicos de reabsorção cervical externa. No presente trabalho, são listados fundamentos para que o clínico possa atuar com segurança e precisão em cada caso, especificamente. Nessas dicas e cuidados, encontram-se alguns de natureza ortodôntica.

The Assessment and Management of External Cervical Resorption with Periapical Radiographs and Cone-beam Computed Tomography: A Clinical Study.

INTRODUCTION: This in vivo study assessed whether there was a difference between periapical radiographs (PRs) and cone-beam computed tomographic (CBCT) imaging in the detection, assessment, and management of external cervical resorption (ECR). The secondary aim was to determine if parallax radiographs were of any further benefit compared with a single PR. METHODS: PR and CBCT data were gathered for 115 teeth (98 patients) consecutively diagnosed with ECR. The diagnosis and treatment plan of each tooth were determined with PRs and CBCT imaging. Sensitivity, specificity, positive predictive values, negative predictive values, and receiver operator characteristic values were determined. RESULTS: The overall sensitivity (0.86) and specificity (0.89) of PRs was significantly lower than CBCT imaging (P < .001). PRs had a limited ability to accurately detect the size (0.75), circumferential spread (0.60), and location of ECR compared with CBCT imaging (P < .001). PRs also underestimated the size of the ECR lesion. Significant differences (P < .001) were apparent in the treatment plans formed when PRs were assessed versus CBCT imaging. Parallax radiographs were shown to be of no additional benefit compared with a single radiograph. CONCLUSIONS: PRs have significant limitations in the detection, assessment, and treatment planning of ECR when compared with CBCT imaging. A CBCT scan should be considered before the management of a potentially restorable ECR lesion.

Management of bilateral invasive cervical resorption lesions in maxillary incisors using a novel calcium silicate-based cement: A case report.

Invasive cervical resorption is a pathologic process leading to progressive and usually destructive loss of tooth structure. The pathogenic mechanism is not completely understood and the diagnosis may be challenging. The aim of this article is to present an unusual case of bilateral presence of invasive cervical resorption lesions in maxillary central incisors and to discuss the treatment procedures using a novel repair material. The management of the present case was carried out in three phases. The first stage of the treatment aimed at curetting the active tissue from the resorption cavity and restoring the defect with the novel calcium silicate-based cement (Biodentine, Septodont). In the maxillary left central incisor it was not possible to remove the resorptive tissue without exposing the pulp, and therefore root canal treatment was performed. At the second phase, a full-thickness flap was raised in order to expose and repair the defect that was extending subgingivally. At the third phase teeth were restored with composite resin. The patient was kept under review and after a follow-up period of 2 years neither signs of periradicular lesion nor recurrence of resorption were observed. The teeth were asymptomatic, and restorations appeared to be in excellent condition. In conclusion, Biodentine seems to be a promising material for the treatment of invasive cervical resorption lesions.

The use of a single-step regenerative approach for the treatment of a replanted mandibular central incisor with severe resorption.

AIM: To report the clinical and radiographic treatment outcome of an immature replanted mandibular incisor with severe inflammatory external root resorption following a single-step regenerative approach. SUMMARY: A 7-year-old female patient was referred 1 week following an extrusion injury to her mandibular central incisor (tooth 31). There was a history of a 6 months previous avulsion injury to the same tooth, which had been replanted after 20 min of extra-oral time. On clinical examination, all teeth were asymptomatic and there was an arch wire splint placed on the mandibular incisors. Radiographic examination revealed severe inflammatory external root resorption of tooth 31. A diagnosis of necrotic pulp and asymptomatic apical periodontitis was made. Under local anaesthesia and rubber dam isolation, an access cavity was prepared. The canal was irrigated using 6% NaOCl solution delivered through the EndoVac negative pressure irrigation system (Endo Vac, Axis/SybronEndo, Coppell, TX, USA). A 17% EDTA solution was used for 5 min followed by a final rinse of sterile water. The periapical tissues were probed using a K-file, and bleeding was induced. A blood clot was allowed to form filling the entire canal. A thick plug of MTA was placed in direct contact with the blood clot. The tooth was restored with composite resin. All procedures were performed in a single visit. The splint was removed 2 weeks later. Recall examination after 24 months revealed healthy soft tissues with normal periodontal probing and mobility. The 24 months radiographic evaluation revealed healing of the severe inflammatory external root resorption and continuous root development/dentine wall thickening of the apical third. No signs of ankylosis or significant discoloration was present.

Clinical treatment and prognosis of equine odontoclastic tooth resorption and hypercementosis.

REASONS FOR PERFORMING STUDY: Equine odontoclastic tooth resorption and hypercementosis is an infrequent and underdiagnosed form of severe dental disease in horses that can affect quality of life. The study was performed to compare the clinical, radiographic, histological and prognostic findings specific to equine odontoclastic tooth resorption and hypercementosis in horses. Removal of affected teeth is currently the best treatment. OBJECTIVES: The goals are to report salient clinical and histological features of the disease and its management in a case series describing an under-reported syndrome in horses and the long-term prognosis. STUDY DESIGN: Retrospective case series. METHODS: Medical records from New Bolton Center, University of Pennsylvania from January 2000 to December 2012 were reviewed from horses that had a diagnosis of 'cementoma' or 'hypercementosis' and any associated dental-related diagnosis affecting the teeth and oral cavity. Radiographic, surgical and histological reports were collated and the clinical cases compared and tabulated to provide a better description of the equine disease. RESULTS: A total of 18 cases were identified, 17 of which were geldings and one of which was a nonbreeding stallion; no mares had the disease. The mean age at diagnosis was 24 years, with a range of 17-29 years. There was no breed predilection, and varied clinical signs relating to the mouth were found. Some teeth involved had only radiographic changes of disease and not gross clinical evidence. The mandibular incisors were generally affected earlier than the maxillary incisors, but the disease is progressive, and eventually, all of the incisors and sometimes the canines are involved. No premolars or molars were affected in this case series. CONCLUSIONS: Based on this case series, all teeth, and particularly the incisors, should be examined for signs of gingivitis and hypercementosis and subsequently radiographed for an early diagnosis and management. When compared with our hospital population, older geldings were more likely to be affected with cementoma formation and its accompanying resorptive process. Removal of clinically and radiographically affected teeth carries a good prognosis for improved quality of life.

Abordagem endodôntica e periodontal de uma reabsorção radicular cervical externa: relato de caso / Endodontic and periodontal treatment of external cervical root resorption: a case report

A reabsorção radicular cervical externa (RCE) consiste na perda de tecido duro dentário como resultado da ação odontoclástica. Frequentemente, inicia-se na região cervical da superfície radicular e as lesões são diagnosticadas de maneira equivocada, sendo confundidas com lesões de cárie e reabsorção interna. Como resultado, corriqueiramente é realizado o tratamento inadequado. O diagnóstico precoce e uma abordagem adequada são as chaves para o sucesso do tratamento. A etiologia da RCE é principalmente o trauma, tratamento ortodôntico ou fatores idiopáticos. O objetivo do presente estudo é descrever o tratamento endodôntico, periodontal cirúrgico e restaurador de um caso de reabsorção radicular externa Classe III de Heithersay, o qual apresentava RCE no elemento 43, de natureza idiopática. O tratamento foi combinado, sendo, inicialmente, realizada a exposição cirúrgica do defeito reabsortivo, seguida pela remoção cirúrgica de todo tecido inflamatório de granulação presente e, por fim, o tratamento restaurador utilizando cimento de ionômero de vidro modificado por resina. Além disso, um tratamento endodôntico foi conduzido, devido ao diagnóstico de necrose pulpar. Após 12 meses de acompanhamento clínico e radiográfico, não foi observada recidiva da lesão reabsortiva.

External cervical resorption associated with the use of bisphosphonates: a case series.

Although the pathogenesis and etiology of external cervical resorption (ECR) are not well understood, several predisposing factors have been reported to potentially contribute toward the initiation of ECR. However, a potential link between systemic medication and ECR has not been reported. Bisphosphonates (BSPs) are 1 group of these medications (the amino-containing BSP), which are associated with an acute-phase response and the release of proinflammatory cytokines, which could be associated with the initiation of ECR. Therefore, a possible causal link between BSPs and ECR could be drawn.

Pre-eruptive intracoronal resorption of a permanent first molar.

For the last 70 years, the phenomenon of pre-eruptive intracoronal resorption (PIR) has been described in the literature, including a number of case reports illustrating the challenges clinicians face in diagnosing and managing these resorptive defects. Pre-eruptively affected teeth can be difficult to access and posteruptively they are difficult to diagnose because the defects resemble caries. Many times, these defects are not detected until after eruption, when the majority are diagnosed as dental decay and teeth are often subjected to surgical tooth restoration. The purposes of this paper are to report a case of nonprogressive PIR that was detected early, treated with a preventive glass ionomer sealant, and monitored for 44 months, and to propose an alternative approach to management of nonprogressive defects that may help preserve tooth structure.

Estudio comparativo de tres técnicas de obturación endodóntica en dientes con reabsorción interna simulada evaluados con Cone Beam / Comparative study of endodontic obturation techniques in teeth with simulated internal reabsorption by Cone Beam evaluation

Objetivo: Comparar la calidad de obturación (adaptación y homogeneidad) en dientes con reabsorción interna simulada utilizando la técnica de compactación lateral en frío (CL), compactación termomecánica (CT) e inyección de gutapercha termoplastificada (IT). Meterial y método: Se realizó la preparación químico-mecánica de los canales radiculares, se simuló una reabsorción interna en el tercio medio del canal, se dividieron al azar en tres grupos de 15 dientes y se obturaron con las técnicas nombradas. Se observó la calidad de la obturación mediante el equipo Cone Beam Planmeca ProMax 3D. Se realizaron cuatro cortes de 0,02 mm en cada sentido del espacio (vestibulopalatino, mesiodistal y axial). La adaptación se analizó con test Anova y Tukey y homogeneidad con Kruskar-Wallis y Conover-Iman. Resultados: En adaptación se encontraron diferencias estadísticamente significativas (p < 0,05) entre las tres técnicas, se obtuvieron menos fallas para IT, seguida por CT y luego por CL. En homogeneidad se encontraron diferencias estadísticamente significativas (p < 0,05) entre la técnica de CL y las otras dos técnicas en los tres sentidos, presentando IT y CT menos fallas que CL. Conclusión: IT logró mejores resultados de adaptación y homogeneidad en la zona de la reabsorción interna en comparación a las otras dos técnicas

Objective: To compare obturation quality (both in adaptation and homogeneity) in teeth with simulated internal reabsorption (middle third of the canal) by means of Cold Lateral Condensation (CLC), Thermomechanical Condensation (TC), and Thermoplastified Gutta- percha injection (GP) techniques. Methods: 45 teeth were prepared and internal reabsorption was simulated in the middle third of the canal. Three groups of 15 teeth each were randomly generated and obturated according to the stated techniques. The obturation quality was evaluated with Cone Beam Planmeca ProMax 3D equipment. Four sections of 0,02 mm in 3 space dimensions were generated (Vestibule palatine, Mesiodistal and Axial). Adaptation was analyzed with the Anova and Tukey test and homogeneity with Kruskar-Wallis and Conover-Iman tests. Results: Adaptation analyses revealed statistically significant differences (p < 0,05) when comparing the three techniques. Fewer flaws were found in the corresponding order: GP, TC and CLC. In terms of homogeneity, we found statistically significant differences (p<0,05) between CLC and the other two techniques in the three dimensions analyzed. Conclusion: GP achieved better results regarding adaptation and homogeneity in the internal reabsorption area in comparison to the other techniques under analysis

Reabsorção externa cervical: relato de caso clínico / External cervical resorption: clinical case report

Reabsorções cervicais externas são reabsorções invasivas que iniciam abaixo da junção epitelial, atacando os tecidos mineralizados, como cemento e dentina. A maioria dos autores coloca como etiologia dessas lesões os traumatismos, agentes clareadores ou ortodontia, sendo seu diagnóstico clínico realizado através da inspeção da margem ou do sulco gengival. Nesse sentido, um dos recursos semiotécnicos auxiliares de grande validade constitui-se na tomografia cone beam, onde se consegue verificar a proximidade da reabsorção com a cavidade pulpar e, assim, planejar o tratamento. Este artigo relata, através de um caso clínico, o diagnóstico e tratamento de uma reabsorção externa cervical do dente nº 11, classificada de acordo com Heitersay como classe III, desde sua abordagem cirúrgica, restauração da cavidade e resolução clínica com um acompanhamento pelo período de 2 anos. Levando em consideração os achados clínicos e radiográficos dentro do período de observação, verificou-se que o tratamento apresentou uma boa resolução dos tecidos periodontais, o que dá indícios de um bom prognóstico para o caso...

External cervical resorption (ECR) is an invasive type of resorption that begins below the gingival epithelium and affects mineralized tissues, e.g., cementum and dentin. Most authors refer to dental trauma, whitening agents, and orthodontic treatment as etiologic factors of ECR; clinical diagnosis is performed via inspection of the gingival groove and margin. In this scenario, cone beam computed tomography has become a highly valuable ancillary method, as it allows to assess the proximity between the resorption and the pulp cavity, and thus, plan treatment. This article describes, in the form of a clinical case report, the diagnosis and treatment of a case of ECR affecting tooth no. 11, classified as Class III according to Heitersay’s classification. Surgical approach, restoration and clinical follow-up over 2-years of follow-up are described. In view of the clinical and radiographic findings observed during follow-up, it can be concluded that treatment was successful in healing periodontal tissues, suggesting a good prognosis...

Pre-eruptive intra-coronal resorption: controversies and treatment options.

Pre-eruptive intra-coronal resorption (PIER) is a defect located in the dentin of an unerupted tooth, just beneath the dentin-enamel junction, with a prevalence of 0.5-2% of the teeth. The depth of the lesion is variable and may also reach the pulp. In the past, these lesions were confused with caries, and were therefore called "hidden" or "pre-eruptive caries". These defects are usually detected incidentally in routine dental radiographs. It has been proven that in the pre-eruptive stage the lesions contain soft tissue and inflammatory cells. The present report describes the clinical management of a case of PEIR on a mandibular first permanent molar and discusses the alternatives for treatment.