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Restorative Dentistry

What is Pre-Eruptive Intra-Coronal Radiolucency (PEIR)?

This question was submitted by a general dentist: Has anyone seen ‘pre-eruption caries’? I have several cases where radiographically. there appeared to be caries on the occlusal surfaces of unerupted teeth. On eruption, I observed them for a while and after the first one increased in size over time, I went in and restored all of them. All seemed to be carious.

Dr. Anuradha Prakki, Assistant Professor in Restorative Dentistry at the University of Toronto School of Dentistry, provided this quick initial response: 

Researchers identify these cases as pre-eruptive intra-coronal radiolucency (PEIR), as the etiology of pre-eruptive intra-coronal radiolucent lesions is not yet fully understood.  

In definition, PEIR are radiolucent lesions (or defects) located in the coronal dentine, beneath the enamel-dentine junction of unerupted teeth. The prevalence of this type of lesions varies, depending on the type and quality of radiographic exposure as well as the age of the assessed patient. Apparently, 3% of subjects and/or 0.5% teeth may have PEIR.

However, there is consensus that the highest PEIR prevalence is observed in the maxillary and mandibular first permanent molars. Published clinical and histological evidence suggests that these lesions are resorptive in nature.

Based on the little information available on this topic, I would suggest observing the progression of these lesions initially. In case of clear progression teeth should be restored.


Follow-up: What further information would you like on this topic?  Email us at jcdaoasis@cda-adc.ca

Readers are invited to comment on this initial response and provide further insights by posting in the comment box which you will find by clicking on “Leave a reply“ below. You are welcome to remain anonymous and your email address will not be posted.


  1. Timucin Ari April 7, 2013

    Just a reminder;
    I had a PEIR case recently in which #35 (it’s seen in premolars as well) was lately diagnosed and a RCT was needed. Therefore, I would strongly suggest considering to take panorex where possible as unerupted permanent teeth may not always appear in optimum view in bite-wing radiographs of the mixed dentition. Hopefully we will be submitting this case report soon and you will be able to see the consequences of late diagnosis of PEIR.

    1. Anuradha Prakki April 8, 2013

      Thanks! It would be great to see cases on PEIR.

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