Gaya Tessel
5th Course, group 13PRE-ERUPTIVE INTRACORONAL RESORPTION:
PREVALENCE, CAUSES AND DIAGNOSIS.
A LITERATURE REVIEW
Master’s Thesis
Supervisor
Assistant, Živilė Kristina Matulaitienė
LITHUANIAN UNIVERSITY OF HEALTH SCIENCES MEDICAL ACADEMY
FACULTY OF ODONTOLOGY
THE CLINIC OF ORAL CARE AND PEDIATRIC DENTISTRY
PRE-ERUPTIVE INTRACORONAL RESORPTION: PREVALENCE, CAUSES AND DIAGNOSIS.
A LITERATURE REVIEW
Master’s Thesis
The thesis was done
by student Gaya Tessel, 5th course, group 13 Supervisor Assistant, Živilė Matulaitienė
(name surname, year, group) (degree, name surname)
………
(signature) (signature)
……2021/04/30…. ………2021/04/30….
(day/month) (day/month)
FINAL MASTER‘S THESIS IS CONDUCTED AT THE DEPARTMENT OF ORAL CARE AND PEDIATRIC DENTISTRY
STATEMENT OF THESIS ORIGINALITY
I confirm that the submitted Final Master‘s Thesis: PRE-ERUPTIVE INTRACORONAL RESORPTION: PREVALENCE, CAUSES AND DIAGNOSIS. A LITERATURE REVIEW
1. Is done by myself.
2. Has not been used at another university in Lithuania or abroad.
3. I did not used any additional sources that are not listed in the Thesis, and I provide a complete list of references.
I confirm by e-mail, and the work will be signed after the end of the quarantine and emergency situation due to the COVID-19 pandemic in the republic of Lithuania.
(2021/04/30) (Gaya Tessel) (signature)
CONCLUSION OF FINAL MASTER‘S THESIS ACADEMIC SUPERVISOR ON THE DEFENSE OF THE THESIS
I confirm by e-mail, and the work will be signed after the end of the quarantine and emergency situation due to
the COVID-19 pandemic in the republic of Lithuania.
(2021/04/30) (Živilė Kristina Matulaitienė) …………...(signature)
FINAL MASTER‘S THESIS IS APPROVED AT THE DEPARTMENT
I confirm by e-mail, and the work will be signed after the end of the quarantine and emergency situation due to
the COVID-19 pandemic in the republic of Lithuania.
(date of approval) (name of the Department and full name of the Head of the Department) (signature)
(signature)
Final Master‘s Thesis reviewer
I confirm by e-mail, and the work will be signed after the end of the quarantine and emergency situation due to
the COVID-19 pandemic in the republic of Lithuania.
(full name) (signature)
Evaluation of Final Master‘s Thesis Defense Board:
I confirm by e-mail, and the work will be signed after the end of the quarantine and emergency situation due to
the COVID-19 pandemic in the republic of Lithuania.
(date) (full name of the secretary of Master‘s Thesis
Defense Board)
I, Gaya Tessel, confirm by e-mail, that the original Bioethical approval will be added at the end of quarantine and emergency situation due to the COVID-19 pandemic in the republic of
Lithuania. Bioethical approval's registration No. is BEC-OF-37.
EVALUATION TABLE OF THE MASTER’S THESIS
OF THE TYPE OF SYSTEMIC REVIEW OF SCIENTIFIC LITERATURE Evaluation: ... Reviewer: ...
(scientific degree. name and surname)
Reviewing date: ...
Compliance with MT
No. MT parts MT evaluation aspects requirements and
evaluation
Yes Partially No
1 Is summary informative and in compliance with the 0.3 0.1 0
Summary thesis content and requirements?
2 (0.5 point) Are keywords In compliance with TheThesis 0.2 0.1 0
essence?
3 Introduc- Are the novelty, relevance and significance of the 0.4 0.2 0
work justified in the introduction of the thesis?
tion, aim
Are the problem, hypothesis, aim and tasks formed
4 and tasks 0.4 0.2 0
clearly and properly?
(1 point)
5 Are the aim and tasks interrelated? 0.2 0.1 0
6 Selection Is the protocol of systemic review present? 0.6 0.3 0
criteria of Were the eligibility criteria of articles for the
7 the studies, selected protocol determined (e.g., year, language, 0.4 0.2 0
search publication condition, etc.)
methods and Are all the information sources (databases with
8 strategy dates of coverage, contact with study authorsTo 0.2 0.1 0
(3.4 points) identify additional studies) described and is the last
search day indicated?
Is the electronic search strategy described in such a way that it could be repeated (year of search, the
9 last search day; keywords and their combinations; 0.4 0.1 0 number of found and selected articles according to
the combinations of keywords)? Is the selection process of studies (screening,
10 eligibility, included in systemic Review or, If 0.4 0.2 0 applicable, included in the meta-analysis)
described?
Is the data extraction method from the articles
11 (types of investigations, participants, interventions, 0.4 0.2 0 analyzed factors, indexes) described?
Are all the variables (for which data were sought
12 and any assumptions and simplifications made) 0.4 0.2 0 listed and defined?
Are the methods, which were used to evaluate the
13 Risk of bias of individual studies and how this 0.2 0.1 0
information is to be used in data synthesis,
described?
14 Were the principal summary measures (risk ratio, 0.4 0.2 0 difference in means) stated?
Is the number of studies screened: included upon
15 assessment for eligibility and excluded upon giving 0.6 0.3 0 the reasons in each stage of exclusion presented?
Are the characteristics of studies presented in the
16 Systemiza- included articles, according to which the data were 0.6 0.3 0
extracted (e.g., study size, follow-up period, type of
tion and
respondents) presented?
analysis of
Are the evaluations Of beneficial or Harmful
data
outcomes for each study presented? (a) Simple
17 (2.2 points) 0.4 0.2 0
summary data for each intervention group; b) effect estimates and confidence intervals)
Are the extracted and systemized data from studies
18 presented in the tables according to individual 0.6 0.3 0
tasks?
19 Are the main findings summarized and is their 0.4 0.2 0 relevance indicated?
20 Discussion Are the limitations of the performed systemic 0.4 0.2 0
(1.4 points) review discussed?
21 Does author present the interpretation of The 0.4 0.2 0 results?
22 Do the conclusions reflect the topic, aim and tasks 0.2 0.1 0
Conclusions of the Master’s thesis?
23 (0.5 points) Are the conclusions based on the analyzed material? 0.2 0.1 0
24 Are the conclusions clear and laconic? 0.1 0.1 0
25 Is the references list formed according to The 0.4 0.2 0 requirements?
Are the links of the references to the text, correct?
26 Are the literature sources cited correctly and 0.2 0.1 0
References precisely?
27 (1 point) Is the scientific levelMaster’s thesis? Of references suitable For 0.2 0.1 0
Do the cited sources not older than 10 years old
28 form at least 70% of sources, and the not older than 0.2 0.1 0 5 years – at least 40%?
Additional sections, which may increase the collected number of points
29 Annexes Do the presented annexes help to understand The +0.2 +0.1 0
analyzed topic?
Practical
Are the practical recommendations suggested and
30 recommen- +0.4 +0.2 0
are they related to the received results?
dations
Were additional methods of data analysis and their
31 results used and described (sensitivity analyses, +1 +0.5 0 meta-regression)?
Was meta-analysis applied? Are the selected
32 statistical methods indicated? Are the results of +2 +1 0 each meta-analysis presented?
General requirements, non-compliance with which reduce thenumberof points
33 Is the thesis volume sufficient (excluding 15-20 pages <15 pages
annexes)?
(-2 points) (-5 points)
34 Is the thesis volume increased -2 points -1 point
artificially?
35 Does the thesis structure satisfy the -1 point -2 points requirements of Master’s thesis?
36 Is the thesis written in correct language? -0.5 point -1 points scientifically, logically and laconically?
37 Are there any grammatical, style or -2 points -1 points computer literacy-related mistakes?
38 Is text consistent, integral, and are the -0.2 point -0.5 points volumes of its structural parts balanced?
General
39 Amount of plagiarism in the thesis. >20%
require- (not evaluated)
ments Is the content (names of sections and sub-
40 sections and enumeration of pages) in -0.2 point -0.5 points compliance with the thesis structure and
aims?
Are the names of the thesis parts in
41 compliance with the text? Are the titles of -0.2 point -0.5 points sections and sub-sections distinguished
logically and correctly?
42 Are there explanations of the key terms -0.2 point -0.5 points and abbreviations (if needed)?
Is the quality of the thesis typography
43 (quality of printing, visual aids, binding) -0.2 point -0.5 points
good?
*In total (maximum 10 points):
*Remark: the amount of collected points may exceed 10 points.
Reviewer’s comments: _________________________________________________________ ________________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ____________________________________________________________________
8
TABLE OF CONTENTS
SUMMARY ... 9
INTRODUCTION ... 10
1. SELECTION CRITERIA OF THE STUDIES, SEARCH METHODS AND STARTEGY 12 1.1 The Protocol for Systematic Review ... 12
1.2 Inclusion and Exclusion Criteria ... 13
1.3 Literature Search Strategy ... 14
1.4 Selection of Studies ... 14
1.5 Variables, Assumptions and Simplifications ... 14
1.6 The Risk of Systemic Errors of Studies ... 15
1.7 The Principal Summary Measures ... 15
2. SYSTEMIZATION AND ANALYSIS OF DATA... 16
2.1 The Number of Studies Screened ... 16
2.2 The Characteristics of Studies ... 17
2.3 The Evaluations of Outcomes of the Studies ... 18
2.4 Risk Assessment of Systemic Errors ... 19
2.5 An Overview of the Results of the Studies ... 19
3. DISCUSSION ... 22 4. CONCLUSIONS ... 29 5. PRACTICAL RECOMMENDATIONS ... 29 6. REFERENCES ... 30 7. ANNEXES ... 33
9
Pre-eruptive Intracoronal Resorption:
Prevalence, Causes and Diagnosis. A Literature Review
SUMMARY
Relevance of the Problem and the Aim of the Work:
In pediatric dentistry, saving primary teeth until physiological exfoliation, is one of the most important tasks to achieve for the dentist and the patient. In addition, keeping permanent teeth healthy is essential throughout each stage of development of thetooth, including before eruption. The purpose of this study istoinvestigate the prevalence, causes and diagnosis of pre-eruptive intracoronal resorption.
Materials and Methods:
Research materials were obtained from databases, such as PubMed/Medline and ScienceDirect, where articles were examined based on the titles and/or abstracts links to pre-eruptive intracoronal resorption. Further in-depth research was carried out using inclusion and exclusion criteria in order to select specific articles relevant to the study topic. All research materials were published in English less than 10 years ago and all subjects were human from the age of four.
Results:
Preliminary research resulted in a total of 577 results. Following application of the criteria a total of 7 articles were selected for a further in-depth systematic study, which included a total of 432
patients.
Conclusions:
Pre-eruptive intracoronal resorption was evaluated according several criteria. These lesions seem, to be more prevalent compared to previous findings, which might be due to several causal factors explored through the study. Diagnosis should be achieved through panoramic radiographs which should be routinely screened, with cone beam computed tomography when available, followed by bitewing for primary teeth if information is insufficient during periapical view.
Keywords:
10
INTRODUCTION
Dental caries is one of the most frequent chronic infectious diseases. It is caused by bacteria and results in a tooth spot lesion which eventually with time can turn into a tooth cavity. Caries control should be created with the aim of eliminating the risk factors and provide usage of preventive methods [1,2].
It is considered that caries is said to be affected by tooth position and inclination, amongst many other variables. Especially in the case of partially erupted tooth, since it is not included in the mastication process, it results in an increased likelihood of bacterial build-up in comparison to a fully erupted tooth [3]. Visits at the dentist should be made periodically in order to apply
prophylactic methods; such as the stoppage of progression of the disease, if any, and prevent future complications.
Pre-eruptive intracoronal resorption (PEIR) is a type of lesion which occurs in a tooth that is yet to be emerge from the oral cavity. It can occur in both primary [4] and permanent [5] dentitions. They appear to be somewhat similar to caries by their appearance, but are not considered as they do not involve bacterial invasion and can only be diagnosed using dental radiography [6-8]. In most cases, it is difficult to diagnose because the patient experiences no symptoms [5,8,9], only during
occasional dental checkups has it been discovered [10,11], if the lesion did not reach the pulp [5,7] and/or the tooth has not emerged yet [4,6,7,9]. Not to mention that usually below the age of three x-rays are not performed [4,12].
The terms “pre-eruptive intracoronal radiolucency” or “pre-eruptive dentine radiolucency” are synonyms found in the literatures [7,9]. “Pre-eruptive caries”, was inadequately defined this type of lesion [7], however it is associated with a defect that occurs following the eruption of a tooth [12] and also since the tooth is not affected by caries [5,7,8,11]. Other terms such as “occult caries” and “hidden caries” were also used [10], but are not considered to be accurate to describe this
phenomenon [5,7–9,11].
Radiolucency can be seen on an X-ray, either on the center [7,11,12], mesial [7,11] or distal [9] part of the crown, in the dentin near [6–8,11,12] or below [5,9] the enamel-dentin junction. The size of the lesion ranges from less than 1/3 [5,8] to more than 2/3 [11]. It has been reported that single tooth cases are the most common [5,8], although several teeth in a single patient were detected too [6].
11 Even though this condition has been proven and existed for more than 3000 years [5],it has been deemed as a rare condition, although it can affect children's dentition [9]. As a result, it is solely considered by dentists and not widely examined. The etiology is still unknown, as it is thought to be associated with the appearance of resorptive cells that passed into the tooth through the reduced enamel epithelium [6–9,12]. In addition, there are suggestions related to causal local factors, such as ectopic position of the tooth bud, that may be a stimulating factor [6,9,11]. In one article, impaction was cited to be correlated [7].
Previous studies about prevalence related to gender or different population groups (race, ethnicity) did not find any significant differences [5,6,8,12]. On the other hand, prevalence of age [8,11], delayed dental development [7,10,12], tooth type, location and type of radiography were searched in previous studies and were found that they have an impact on the prevalence of those criteria [5,6,8,10,11].
Whether the dentist should start treatment immediately once the lesion is detected or wait till the tooth eruption, is a question of treatment approach, which depends on several considerations such as the size of lesion, time of diagnosis and predicted time for eruption of tooth [7]. The prognosis is subject to early diagnosis along with the suggestion of conservative treatment[5,8,9].
Aim:
To assess the prevalence, causes and diagnosis of pre-eruptive intracoronal resorption or radiolucency (PEIR).
Tasks:
1. To evaluate the prevalence of intracoronal resorption according different criteria.
2. To search possible causes of intracoronal radiolucency or resorption in pre-erupted teeth. 3. To explore the diagnosis methods of intracoronal radiolucencies in pre-erupted teeth and to
determine the best diagnostic tool for evaluation.
Hypothesis:
12
1. SELECTION CRITERIA OF THE STUDIES, SEARCH METHODS
AND STARTEGY
1.1 The Protocol for Systematic Review
The request for Bioethics center approval for systematic literature review was got in Lithuanian University of Health Sciences (LSMU) (Nr. BEC-OF-37, annex 1).
The approach to this systematic review was guided by following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement [13].
The searching of research articles was carried out from 28 of October 2020until 24 of December 2020 in databases PubMed/Medline and ScienceDirect, according to that database adopted search program. Using Medical Subject Headings dictionary were confirmed key words and related synonyms.
Types of Publication
The analysis detailed studies on humans published in the English language, which were examined openly and were available publications.
Types of Studies
All human retrospective and prospective studies published between 2010 and 2020 were included in the analysis, which reported on caries in pre-erupted teeth, pre-eruptive intracoronal resorption and pre-eruptive intracoronal radiolucency on patients from four years of age.
Information Sources
The data sources used were PubMed/Medline, and ScienceDirect databases.
Disease Definition
Pre-eruptive intracoronal resorption (PEIR) describes a radiolucent lesion located in the coronal dentine, just beneath or near the enamel-dentine junction of unerupted teeth in the occlusal aspect of the crown.
Literature Search and Screening
Publications were selected based on the inclusion and exclusion criteria, along with the use of various keyword combinations, resulting in the use of electronic data sources, such as PubMed/Medline, and ScienceDirect, in addition to, relevant academic publications in order to attain all relevant data.
13
1.2 Inclusion and Exclusion Criteria
The focus question was formulated with population, intervention, comparison, outcome and study design framework in mind, which is presented in table 1 (PICO).
Table 1. PICO framework of the framed clinical question.
Focus Question
Is the prevalence of PEIR related to age groups and ectopic and/or impaction of tooth?
Inclusion Criteria
• Non-syndromic patients.
• Patients with pre-eruptive intracoronal resorption/radiolucency. • Patients’ age are 4 years and older.
• Articles performed on human only.
• Studies published in English, publicised before 2010. • Research type: retrospective studies, prospective studies.
Exclusion Criteria
•
Patients with syndromic diseases.•
Patients younger than four of age.•
Studies performed on animals or in laboratory (in vivo, in vitro).•
Not written about prevalence and radiologic methods.•
Studies not published in English, publicised before 2010.•
Research type: case reports, systematic reviews, literature review and meta-analyses.Component Description
Population (P) Non-syndromic patients
Patients’ age are 4 years and older
Intervention (I)
Patients with intracoronal resorption/radiolucency in pre-erupted teeth Checking the prevalence of the listed disease
The causal factors and diagnostic methods using specific material or technique
Comparison (C) Subjects with intracoronal resorption/radiolucency in pre-erupted teeth
Outcome (O)
Prevalence of PEIR according different criteria Potential causes for this lesion
Most efficient radiologic tool for diagnosis
Study
characteristics (S)
Written in English, not older than 10 years of publication. Retrospective studies, prospective studies,
14
1.3 Literature Search Strategy
A literature search was provided by one researcher, with the help of a supervisor. While an in-depth electronic data search, with the use of various keyword combinations, was performed to gather appropriate research materials, based on PRISMA guidelines [13] within PubMed/Medline, and ScienceDirect Publishing databases. The following keyword combination were used: “caries pre- erupted teeth”, “pre-eruptive intracoronal resorption”, “pre-eruptive intracoronal radiolucencies”; After the literature search was completed, a further investigation into bibliography was conducted, for possible inclusion in the systemic study.
The analysis information for the third block can be seen below:
("pre-eruptive"[All Fields] AND ("intracoronal"[All Fields] OR "intracoronally"[All Fields]) AND ("radiolucence"[All Fields] OR "radiolucencies"[All Fields] OR "radiolucency"[All Fields] OR "radiolucent"[All Fields])) AND (2010:2020[pdat])
1.4 Selection of Studies
The following publication were individually examined with the inclusion and exclusion criteria in mind. The article titles and abstracts were first analyzed in other to comprehend the relevance of the full articles and whether they could be considered as informative sources for the systematic
analysis. The annex 2 of Journal sources is attached. We selected the main information:
• Author
• The year of publication • Type of research
• Research group • Criteria of evaluation • Results and conclusion
1.5 Variables, Assumptions and Simplifications
The database search highlighted 63 articles in PubMed, 514 articles in ScienceDirect were marked as relevant. Through the use of the PRISMA flow chart, a rundown of the article’s selection process is described in figure 1. Subsequently, following the removal of the 62 duplicate articles, 515 articles remained highlighted and there were an additional 4 records identified which were correlated from different sources of information.
During the preliminary steps of screening process, 443 articles were considered irrelevant on the basis of the exclusion criteria. During the next step of the screening process, 52 other articles were
15 eliminated as they didn’t fit the inclusion criteria. Following the examination of the remaining texts, 7 cohort studies of patients with pre-eruptive intracoronal resorption aged from four years and up were included in this systematic review.
The following variables of each article were extracted: (annex 3)
•
Study design•
Investigation method•
Number of patients with pre-eruptive intracoronal resorption•
Number of teeth with pre-eruptive intracoronal resorption•
Most affected tooth•
Most common location in the coronal part•
Size of lesion1.6 The Risk of Systemic Errors of Studies
The seven included studies were assessed for risk of bias using a tool developed specifically for conducting quality appraisal of studies in systematic reviews of prevalence data [14]. The tool addresses critical issues of internal and external validity that must be considered when assessing the soundness of prevalent data and can be used across different study designs. No study was excluded based on this risk of bias. The instrumental framework evaluates representativeness, recruitment, sample size, reporting, data coverage, condition reliability, statistical analysis and confounding factors using a simple “yes”, “no”, “unclear” or “not/applicable”. Overall appraisal should determine include, exclude or seek further information and commenting reason for exclusion. The outcome of the assessment will be presented in table 5 (annex 4).
1.7 The Principal Summary Measures Synthesis of Results
Appropriate data of interest on the previously stated variables were tabulated and discussed.
Statistical Analysis
Heterogeneity between studies was found therefore meta-analysis could not be performed.
Parametric data were expressed as mean and standard deviation (M [SD]). Statistical significance level was defined at P ≤ 0.05.
16
2. SYSTEMIZATION AND ANALYSIS OF DATA
2.1 The Number of Studies ScreenedFigure 1. PRISMA flow diagram
.
PubMed/MEDLINE and ScienceDirect library database advanced search: •Search keywords: “caries in pre-erupted teeth”, “intracoronal resorption in pre-erupted
teeth” “pre-eruptive intracoronal radiolucencies” ; •Publication dates: 2010-2020 •Language: English (N=577) Identificati o n Additional records identified through other sources
(N=4)
Filtered
Removal of duplication
(N=62) Records after duplicates removed
(N=519) (n = 400 ) Screening Records screened (N=457)
Filtered
EligibilityFull-text articles assessed for eligibility (N=24)
433 articles excluded after title and abstract
screen
Full-text articles reviewed and excluded:
- not relevant content (N=17)
Filtered
Included
Studies included in qualitative synthesis (N=7)
17
2.2 The Characteristics of Studies
Types of studies, population origin, prevalence of PEIR by subject, tooth, age of subjects and radiography type are presented in table 2.
Table 2. Characteristics of the qualified studies in the systematic review
CBCT- cone-beam computed tomography
The most common location in the coronal part and size of lesion are shown in table 3.
Table 3. Location and size of PEIR within the crown of the tooth.
Author/year Radiography Mesial Central Distal Total
number of teeth with
lesion
Score 1 Score 2 Score 3
Al-Batayneh et al. 2014 [15] Panoramic 49.2% 39.1% 11.7% 128 64 (50%) 44 (34.4%) 20 (15.6) Umansky et al. 2016 [16] Panoramic and bitewing 46.1% 38.5% 15.4% 13 9 (69.2%) 4 (30.8%) 0 Demirtas et al. 2016a [17] CBCT 16.7% 60.4% 22.9% 48 27 (56%) 5 (11%) 16 (33%) Demirtas et al. 2016b [18] Panoramic 5.1% 81% 13.9% 23 10 (43.5) 5 (21.7%) 8 (34.8%) CBCT 17.4% 34.8% 47.8% 79 58 (73.4%) 6 (7.6%) 15 (19%) Al-Tuwirqi and Seow 2017 [19]
Panoramic N/A N/A N/A 21 vs. 5 N/A N/A N/A
Konde et al. 2018 [20] Panoramic 52.3% 10.2% 37.5% 136 (53%) 27% (20%) Manmontri et al. 2018 [21] Panoramic 13.79% 68.97% 17.24% 29 24 (82.76%) 4 (13.79%) 1 (3.45%) The most common tooth reported, and number of teeth affected are presented in table 4.
Author/year Type of
Study
Radiography Country Age of
subjects (years) Subject prevalence (%) Tooth prevalence (%) Al-Batayneh et al. 2014 [15]
Prospective Panoramic Jordan 6-15 8.1 (128/1571) 0.62 (128/20788) Umansky et al.
2016 [16]
Retrospective Panoramic and bitewing Israel 4-53 3.9 (13/335) 3.9 (13/335) Demirtas et al. 2016a [17] Retrospective CBCT Turkey 10-65 15.1 (42/278) 3.5 (48/1384) Demirtas et al. 2016b [18] Retrospective Panoramic vs. CBCT Turkey 7-65 3.14 (23/733) vs. 9.5 (70/733) 0.6 (28/4096) vs. 1.93 (79/4096) Al-Tuwirqi and Seow. 2017 [19] Retrospective comparative Panoramic Australia vs. Saudi Arabia 5-14 2 (14/842) vs. 0.6 (3/456) 0.4 (21/5140) vs. 0.2(5/3217) Konde et al. 2018 [20]
Retrospective Panoramic India <12 13.6 (136/1000) 1.20 (136/11300) Manmontri et
al. 2018 [21]
18
Table 4. Percentages, numbers of affected teeth and location per subject diagnosed with PEIR.
Author/year Total number of
cases (subjects with PEIR) One tooth affected/ subject Two teeth affected/ subject Three teeth affected/ subject Four teeth affected/ subject Most common tooth reported Al-Batayneh et al. 2014 [15] 128/1571 128 (100%) 0 0 0 Mandibular 1st premolar Umansky et al. 2016 [16] 13/336 13 (100%) 0 0 0 Maxillary Third molars Demirtas et al. 2016a [17] 42/278 38 3 1 0 Mandibular Third molars Demirtas et al. 2016b [18] 23/733 21 0 1 1 Mandibular Third molars 70/733 65 2 2 1 Al-Tuwirqi and Seow. 2017 [19] 14/842 Vs. 3/456
N/A N/A N/A N/A Mandibular 2nd
molars Konde et al. 2018 [20] 136/1000 136 (100%) 0 0 0 Mandibular 1st premolar Manmontri et al. 2018 [21] 26/1599 23 3 0 0 Mandibular 2nd molars
2.3 The Evaluations of Outcomes of the Studies
In total seven publications were assessed, in which total population was 432 individuals with pre-eruptive intracoronal radiolucency. The articles are retrospective and prospective studies. The publications were found on PubMed/Medline and ScienceDirect data bases.
Studies were conducted on patients from Jordan [15], Israel [16], Turkey[17,18], Australia, Saudi Arabia [19], India [20] and Thailand [21].
Sample sizes ranged from 278 to 4,096 participants. A total number of 6,834 subjects were collected according to inclusion criteria, of which 432 patients had pre-eruptive intracoronal resorption. The total number of teeth with pre-eruptive intracoronal resorption were checked in all the included studies.
The age of participants in all seven studies ranged from 4 to 65 years. The mean age of participants was calculated based on three studies which were 8.72 ± 2.5, 20.2 and 14± 4.0 years respectively [15,17,21].
Investigation method of pre-eruptive intracoronal resorption were assessed using Bitewing [16], Panoramic [15,16,18–21] and CBCT [17,18].
To determine the size of PEIR lesions in two dimensional radiographs, as bitewing and panoramic, Seow and Hackley 1996 [22] described the relative size of the lesion with regard to the mesiodistal dimension of the coronal dentin in the tooth’s crown. Using this evaluation method, the authors
19 reported whether the resorption was: (i) less than third of the dentin thickness; (ii) between one-third and two-one-thirds of the dentin thickness; or (iii) more than two-one-thirds of the dentin thickness. In articles where CBCT was the method of investigation, since it is a 3D radiography, the volume of the resorption area was estimated and compared: (i) less than one-third; (ii) between one-third and two-thirds; (iii) more than two-thirds with that of the whole dentin of the entire crown.
The prevalent jaw was found to be the most mandible, where the effected side is not strongly associated with either right or left.
2.4 Risk Assessment of Systemic Errors Table 5. Assessment of the risk of bias
Study 1 2 3 4 5 6 7 8 9 score Include? Exclude?
Seek further info? Comments (Including
reason for exclusion)
Al-Batayneh et
al. 2014 [15] Y Y Y Y Y Y Y Y U 8 Include
Umansky et al.
2016 [16] Y Y N Y Y Y Y Y U 7 Include
Demirtas et al.
2016a [17] Y Y Y Y Y Y Y N/A U 7 Include
Demirtas et al. 2016b [18] Y Y Y Y Y Y Y Y U 8 Include Al-Tuwirqi and Seow 2017 [19] Y Y Y Y Y Y Y Y U 8 Include Konde et al. 2018 [20] Y U Y U/A Y N U Y U 5 Include Manmontri et al. 2018 [21] Y Y Y Y Y Y Y Y U 8 Include
Y=Yes, N=No, U=Unclear, N/A = Not Applicable
2.5 An Overview of the Results of the Studies
The literature search yielded 577 articles that were screened for eligibility. After removing
duplicates and following full-text review of the potentially eligible studies, 7 studies were included in the systematic review. Of the 7 included studies, 6 were retrospective and 1 was prospective cohort studies. Figure 1 describes the study selection process, characteristics of included studies are given in tables 2,3,4.
20 Table 5 shows risk of bias assessment in the included studies. The majority of the studies followed appropriate methodology for recruitment of eligible patients’ prevalence and diagnosis of pre-eruptive intracoronal resorption.
The articles assessed prevalence by several factors. The total number of patients evaluated was 6,834, of which 432 with pre-eruptive intracoronal resorption.
Prevalence of subjects with PEIR out of the entire searched population was ranged from 0.6%-15.1%. A study by Demirtas et al. [17] showcased the highest prevalence of 15.1% within the included articles in the review. One study [20] evaluated PEIR using panoramic radiography and found the prevalence to be 13.6%, which was higher than a study with a prevalence of 8.1% [15]. Followed by 3 authors with frequencies of 3.9%, 0.2% and 1.63% respectively [16,19,21].
Al-Tuwirqi and Seow [19] compared the prevalence of two populations: Australian subjects’ frequency was 2% and the Saudi Arabian subjects’ frequency of 0.6%. Even though the Australian population’s frequency was higher, the difference was not statistically significant.
Tooth prevalence ranged from 0.1% to 3.5%. PEIR defects were observed most commonly in the mandibular first premolar [15,20], mandibular second molar [19,21], mandibular third molars [17,18] and maxillary third molars [16].
PEIR can appear on single tooth only [15,16,19] or on several teeth [17,18,21] in a single patient. PEIR and age were not found to be related [16,17,18], whereas the prevalence by age was not mentioned [15,19-21].
In five articles we found that there was no significant prevalence difference between PEIR and gender in articles [15,16,18,19,21]. Although in males the percentage was higher, while no obvious difference in race and gender was reported by Demirtas et al. [17]. In one article [20], no
information was provided regarding the gender of the searched group.
The included criteria were unerupted teeth [18,20], which had not emerged [15] and/or no superposition [16]. At least one unerupted was included in two studies [18,21]. Additional
information was <15 years [15] and <12 years [20]. Both CBCT and panoramic good quality [18] and healthy individual [19]. Manmontri et al. [21] also considered criteria of complete crown formation, good quality and no overlapping by adjacent structures.
Dental anomalies were excluded [15,17-19,21], but were included in one article [16], however it wasn’t found to be of association to PEIR.
21 Developmental anomalies [15] and medical conditions that are known to affect tooth development [16] were excluded, no chronic [19], systemic diseases patients [21] nor congenital, syndromic patients and skeletal disorders [17,18]. A study by Konde et al. [20] did not mention about any of this information. Nonetheless, poor radiology [15-18] was excluded while incisors were excluded in two articles [15,21].
All lesions sized were scored 1 most commonly and were localized just beneath [15,18,21] or adjacent to [16,17] the enamel–dentine junction.
The most common location of the lesion was found to be on the mesial [15,16,20] and central [17,18,21]. Demirtas et al. [18] stated that panoramic radiography revealed more common lesions in the distal side.
Prevalence of PEIR in relation to ectopic position was found in several studies [17-19]. However, in one study it was found to be particularly associated with non-ectopic [15]. While article of Konde et al. [20] did not provide information about ectopic position, in two articles, no ectopic position was found [16,21].
In one study, the differences in prevalence of impaction of teeth with and without PEIR in all children were statistically significant [19].
22
3. DISCUSSION
The aim of this review was to investigate the prevalence, causes and diagnosis of pre-eruptive intracoronal subjects.After extensive research and quality assessments of the studies, seven studies were included.
Subject and Tooth Prevalence
The prevalence of subjects affected by pre-eruptive intracoronal resorption (PEIR) ranges from 0.2%-15.1% and tooth prevalence between 0.2% and 8.1%. The range found could be due to ethnicity or population variations, the types of study and teeth examined or the age range of the population tested.
Demirtas et al. [18] conducted a study using both CBCT and panoramic radiographs. The prevalence in the subject with CBCT was higher (9.5%) than panoramic (3.14%). This can be explained by a high-resolution 3D radiography, whereas panoramic radiography provides 2D view, which has several limitations. Therefore, the radiologic technique used and diagnostic difficulties can affect the prevalence too. When comparing CBCT prevalence of 15.1% [17] and 9.5% [18], the difference between the findings may be related to the different methods used to score the PEIR and the sample size.
Al-Tuwirqi and Seow [19] compared the prevalence of two populations: even though the Australian population’s frequency was higher, the difference was statistically insignificant. It can be then concluded that ethnicity doesn’t play a role in PEIR. Not to mention that all other articles in our research reported PEIR in different populations which strengthen this conclusion.
This systematic review involves 7 observational studies and a total of 6,834 subjects, among them 432 with PEIR. It suggested that these lesions are more prevalent than they were believed to be before. The reasons for this defect may be related to:
1) Local factors that affect tooth development: ectopic or impaction positioning, delay in dental development and supernumerary teeth
2) Systemic factors and medical conditions that cause dental anomalies
3) Age of the patient; all the included articles mentioned that gender isn’t considered as factor in the prevalence of PEIR.
Tooth’s Characteristics Prevalence
In Al-Batayneh et al. [15] study sample, the most commonly affected teeth, were similar tooth groups (mostly premolars and molars) but jaw predominance was different. Most PEIR defects were found in the mandible in [15,17-19,21] studies. Whereas the most affected teeth were in the maxilla only in Umansky et al. study [16].
23 Unerupted permanent incisors were excluded in two studies [15,21], because the panoramic was the method of investigation and it didn’t obtain a clear view of front teeth. Primary teeth were also not included, so the prevalence may possibly be lower than the true prevalence.
Most of PEIR lesions in Al-Batayneh et al. [15] study were detected in permanent teeth with
precursor primary teeth (premolars). On the other hand, two authors [17,21] reported about PEIR in teeth with no primary predecessor.
Different age groups, radiographic techniques used, condition of primary predecessor (if existent) or unknown local factors may be the explanation for the above-mentioned data.
Number of Defects within the same Individual
Three studies found that usually a single tooth is affected with PEIR [15,16,20], suggesting a local factor etiology. While three others reported more than one affected tooth in an individual
[17,18,21]. We can deducethat systemic or several local factors, radiographic technique or unknown reasons could explain these outcomes. However, having said this, it would not discount the role of local aetiologic factors.
PEIR and Age, Dentition Stage
The age range (4-20 years) in Manmontri et al. [21] study, composed from primary, mixed and permanent dentitions can be compared to Al-Batayneh et al. [15], that searched a broad age of population as well and reported the highest prevalence of PEIR in the mixed dentition. They assumed that the number of subjects, the greater the number of unerupted teeth at that group type, given longer time for defect development from the very beginning of formation till its eruption are longest in that stage and are possible causes for that result. Not to mention, in the permanent
dentition stage, fewer teeth remain unerupted and if not identified prior to their eruption, along with the possibility of being firstly detected in the oral cavity, it can be misdiagnosed and mistakenly considered as caries.
In the youngest age group (4-8 years) of Umansky et al. study [16], PEIR was not detected, and the two other groups (intermediate and adult) had about the same prevalence of lesions. Possible explanation for this result can be, that at the age of 4-8, the second and third molars are not yet developed, while at the age of 9-12 years, as the intermediate group, second molars have already begun to form and at the age of 13-53, as the adult group, third molars have fully developed, so both can be detected and seen on x-rays.
It might also be, that the sample size of the study was not wide enough, even though all patients at the department participated. In addition, the study provided limited criteria and may have excluded potential candidates. Since pre-eruptive lesion is a more common finding in the second and third
24 molars and less in primary molars, the fact that this (Umansky et. al [16]) study did not find a connection between younger age and a higher prevalence of PEIR and that the frequency was compared to other articles, a bigger sample size may not change the overall prevalence result. Two studies carried out by Demirtas et al. [17,18], searched on a wider age range and reported no relation of age to PEIR. As a result, prevalence of PEIR may not be related to age group, but to type of teeth and diagnosticevaluation reasons (i.e.: techniques used, diagnostic difficulties from
radiographic quality, or examiner experience of this rare condition)
The Size of PEIR Defect Score Relative to the Width of Dentine Thickness
In most of the articles, the size of lesion on the coronal part was score 1 (both panoramic and CBCT radiographs) [15-18,20,21]. In Al-Tuwirqi and Seow [19], no information was given regarding the size of the lesion. It might be that they were diagnosed in time before they could grow. In different articles which were not included in our systematic review and size of lesion were bigger than 1, however, this was accredits to an older mean age of patients in comparison to other studies, which obviously allowed for a longer period of time to allow the growth of defects.
Location of PEIR within the Tooth Crown
The most common location of the lesions inside the crown varied in different studies, some reported central aspects [17,18,21], or mesial aspects [15,16,20]. It can be because those articles’ evaluation was based on CBCT, which is a more accurate tool and in the other articles it was panoramic, maybe lesions are less dominant in the center when orthopantomogram is the tool of investigation.
Etiology of PEIR
The etiology of PEIR is still unclear, although it has some theories for its causes through local and systemic factors.
Local factors are considered of high importance in the etiology of PEIR [28]. Al-Batayneh et al. [15] observed a relation between decayed or filled primary teeth and PEIR, inferring that caries in a patient might be related. Although it has still not been clinically proven that caries can develop in an unerupted tooth [32].
Also, non-endodontically treated patients were significantly related with PEIR defects [15], meaning that subsequent care of affected primary teeth, has not been proven to increase the risk of lesions.
Most of the studies that used histological examination, proposed that the nature of PEIR is in the existence of resorptive cells (multinucleated, osteoclasts and chronic inflammatory cells) in primary
25 teeth with periapical inflammation, eventually resulting in contaminating and invading the
unerupted underlying permanent teeth causing them PEIR [23,32]having said it that, however, it does not account for the presence in molars and cases with no presence of primary predecessor. “localized developmental defects of dentine with or without an accompanying enamel defect during crown formation and internal or external resorption” [22]were also suggested.
In addition to above suggested, the link of PEIR to developmental defects was raised:
1. PEIR and Ectopic
Ectopic position is defined when the supposed axial location of a tooth is deviated from the long axis or crown on the radiograph. An association of PEIR with ectopic teeth has been reported (Seow et al. 1999 [30]) and explained by the local pressure it applies which induces the aforementioned resorptive cells to penetrate the dentin and cause resorption [23,29,30].
One study by Demirtas et al. [17] reported that more than half of the patients with PEIR defects, that their teeth were in ectopic eruption, in another study [18], almost half the teeth with defects were in ectopic eruption, supporting this theory. Contrary to that idea, Umansky et al. [16] study didn’t detect such association. Al-Batayneh et al. [15] study noted that ectopic position was not significantly associated with PEIR lesions and actually the ectopic teeth in this study were located away from PEIR lesions. Therefore, this idea does not explain PEIR defects with normal axial inclination and in teeth that does not have ectopic neighboring teeth. Resulting in contradictory issues, further investigation of effects of ectopic eruption on PEIR defects is needed.
2. PEIR and Impaction
“An impacted tooth is one that fails to erupt into dental arch within the specific time” [3,24,34]. Al-Tuwirqi and Seow [19] found that nearly 30% of all teeth with PEIR were related to impaction, whereas less than 1% impaction with no PEIR lesions. Thus, they assumed that inflammation caused by impaction provide opportunity for the spoken resorptive cells reaching the un-erupted tooth which causes intracoronal resorption. This study supports the hypothesis that dental impaction could possibly result in inflammation, leading to the creation of resorptive cells entering the tooth follicle and into the dentin, resulting in the formation of a PEIR lesion.
3. Delay in Dental Development
A delay in dental development was observed by Al-Tuwirqi and Seow [19] on subjects with PEIR compared to control subjects without PEIR. They suggested that a change of the teeth or alveolar bone is the cause for the delay. These changes were connected to delay in dental development in patients with systematic diseases, such as cleidocranial dysplasia, delayed puberty and
26 constitutional growth delay. However, systemic diseases were not considered as a factor in the included research so this cause remains unclear and require extra assessment.
It is not necessarily plausible to state that, dental development leads directly to PEIR.Since a relation was found in that study between PEIR and developmental delay [19], other oral changes may be considered the causative factors. It is recommended to perform a more in-depth research study in order to determine if a connection exists.
4. Supernumerary Teeth
In Al-Batayneh et al. [15], no PEIR lesions with supernumerary teeth were found. In several studies [16,19-21], there was no information about it. However, in two studies by Demirtas et al. [17,18], 10% and 5.1% of subjects had PEIR in supernumerary teeth, respectively. Further evaluations are needed for final determination.
PEIR and Systemic Factors
Three studies excluded subjects with medical conditions that are known to affect tooth development [16,19,21]. Three studies [15,17,18] did not include enough patients with medical conditions to determine connection between these conditions and PEIR defects.
Uzun et al. 2015 study [23], concluded that systemic conditions, such as herpes zoster, in the case of this research project, may be a causal factor in relation to PEIR. However, only two subjects were confirmed to have herpes zoster in the 2015 study, as a result further studies are necessary in order to determine if various systemic conditions can be considered as confirmed casual factors.
Radiography Type
Diagnosis recommendations was evaluated for each study. PEIR lesions were not found using Bitewing radiographs in the study conducted by Umansky et al. [16]. Bitewings do not present a proper image of anterior teeth and third molars and the orientation of the beam provide a complex view.
It is recommended to use bitewing to detect PEIR in primary dentition, although not many studies reported about PEIR in the literature in those teeth. Panoramic radiographs have been a more preferred method to investigate PEIR, in older populations where third molars have already started to develop. Nevertheless, from Bitewing and panoramic radiographs it is difficult to evaluate the crowns of an unerupted maxillary molar and premolar, compared to equivalent mandibular teeth that are more clearly defined in panoramic. Previous studies by Uzun et al. [23] and Al-Batayneh [24] stated said defects in those teeth may be missed, as a result, it is recommended to use more advanced tools for investigation. It was Demirtas et al. [17] who studied the prevalence of PEIR
27 using CBCT, which offers high resolution and three-dimensional views without superimposition. Another study by the same author [18] compared prevalence in the same population using
panoramic and CBCT as diagnostic tools for PEIR. They found the prevalence of patients
diagnosed with CBCT to be higher than panoramic. On one hand, CBCT can detect more cases of PEIR, while on the other hand, it results in higher radiation and cost.
To conclude, one should use panoramic for evaluation of PEIR, and limit the use of CBCT to state specific cases when simpler radiographs did not provide definite information [25].All panoramic radiographs should be routinely screened, with CBCT when available, for PEIR [24,26]. However, the regular use of CBCT for PEIR cases is not promoted, due to fact that it would be highly unlikely to change the course of action for affected teeth.
Proper and accurate diagnosis is of great importance as it can affect the prognosis. Since PEIR defects are often observed mistakenly on radiograph and not detected clinically [27], it is advised to follow several steps if this lesion is suspected:
During the initial stages, several radiographs of a patient with unerupted teeth should be taken on periodical visits [24,26,28]. If the screenings are not sufficient, periapical radiograph should be taken for better detection [29,30] and careful evaluation of ectopic position, impacted teeth or teeth with delayed eruption is necessary [25,30]. While finally, when treatment begins, take histological biopsy to confirm diagnosis [22,24].
Differential diagnosis of PEIR from caries, can be distinguished using radiography, observing a well-defined border and radiolucent in the intracoronal area near the amelo-dentinal junction [26,30], and histology, by the presence of chronic inflammatory cells [25,31-33].
If those lesions are missed by radiographic evaluations during routine visits, complication may get increasingly serious if it remains undiagnosed and lesions reach the pulp [25]. Another possible outcome is, if the tooth remains undiagnosed and erupt, oral microflora can quickly contaminate the tooth and the lesion becomes indistinguishable from a carious lesion [22,29].
Differentiated from occult caries, a defect which is also only detected radiographically, said lesion may be caused by bacterial invasion in erupted teeth. PEIR, if not diagnosed in its pre-eruptive stage, can be later discovered as occult caries, when the tooth erupts and communication with microorganism in the oral cavity has started. Not all the cases of occult caries have started from PEIR [31].
28 A total of six studies [15-19,21] satisfied the inclusion criteria in the risk assessment, whereas Konde et al. [20] provided less information regarding intracoronal resorption in pre-erupted teeth compared to the others. Still, we decided to include all the studies in our review, as Konde et al. [20] gave additional information regarding test subjects in India, whom were below 12 years of age, along with providing similar data with regards to size of lesions, common position on the crown and similarities in tooth type. Prevalence of PEIR has seemed to increase in recent years and more reports have described this phenomenon, therefore it has a great impact and influence in the field of dentistry and more specifically paediatrics’ dentistry [24].
There are several limitations in this systematic review that should be mentioned. Only a limited number of subjects were tested in Umansky et al. [16] and a larger sample size of patients could help to improve the significance of our investigation. Secondly, due to the limitation in inclusion and exclusion criteria of this review (regarding systemic diseases, medical conditions and dental anomalies), potential patients were excluded and this could explain further etiological causes or change the results of prevalence. The dental landmarks and investigation tools that were used throughout the articles are favourable, however there was no use of apical radiographs which should be considered. Therefore, we cannot state that there is a favourable tool as not all relevant methods have been analysed during the academic studies. Another consideration is that this review had a lack of randomized clinical trials, in our analysis most of the studies were retrospective studies. That, could show more randomized criteria and deduce information regarding different criteria.
29
CONCLUSIONS
1. Pre-eruptive intracoronal resorption was evaluated according to: prevalence by subject and tooth, tooth characteristics such as: jaw predominance, including teeth examination, presence of precursor primary teeth. Along with, number of defects present within the same individual; age, dentition stage, size of defect relative to the width of dentine thickness and location within the tooth crown. It seems that these lesions are more prevalent than they were thought before.
2. Possible causes may be related to: the conduct of study and teeth examination, radiologic technique used, diagnostic difficulties, sample size, local or systemic factors.
3. Panoramic radiographs should be routinely screened, with CBCT when available, for diagnosis of PEIR. If not enough information is available, apical radiographic should be used as well, along with the use of Bitewing for primary teeth.
PRACTICAL RECOMMENDATIONS
1. We encourage an increased recognition of the lesions existing in pre-erupted teeth, in addition to a raised awareness of the different radiographic imaging options, for the purpose of achieving an optimal diagnosis
2. Further information regarding the relation of PEIR and systemic diseases, ectopic position, developmental delay and supernumerary teeth is recommended for final evaluation.
30
REFERENCES
[1] Arthur J. Nowak JRC. . . MHW. Pediatric Dentistry. 6th edition. Vols. 12-dental caries. Elsevier; 2019. 169–179.
[2] K. L. Haney and K. S. Beavers, “Prevention of Dental Disease,” in Pediatric Dentistry, Elsevier, 2019, pp. 216–226.
[3] v. K. Prajapati RM and KMV. Pattern of mandibular third molar impaction and its association to caries in mandibular second molar: A clinical variant. Dental Research Journal. 2017;14(2):137–42.
[4] Schwimmer Y, Zeltser R, Moskovitz M. Deep caries due to Pre-eruptive
intracoronal resorption in a newly erupted primary molar. International Journal of Paediatric Dentistry. 2017 Jul 1;27(4):313–5.
[5] Moura BF, Silveira GR, Rodrigues-Junior SA. Diagnosis and clinical management of pre-eruptive intracoronal resorption – a case report. RSBO. 2017 May 4;13(2):109. [6] Ahn SS, Chu PK, Cisneros GJ. Non-cavitated dental radiolucent lesions: A
challenge for the dental healthcare provider. Seminars in Orthodontics. 2016 Sep 1;22(3):185–92.
[7] Ilha MC, Kramer PF, Ferreira SH, Ruschel HC. Pre-eruptive Intracoronal Radiolucency in First Permanent Molar. International Journal of Clinical Pediatric Dentistry. 2018 Apr;11(2):151–4.
[8] Timucin Ari. Management of “Hidden Caries”: A Case of Severe Pre-eruptive Intracoronal Resorption. Canadian Dental Association. 2014;80(59).
[9] Chouchene F, Hammami W, Ghedira A, Masmoudi F, Baaziz A, Fethi M, et al. Treatment of pre-eruptive intracoronal resorption: A scoping review. Vol. 21, European journal of paediatric dentistry. NLM (Medline); 2020. p. 227–34.
[10] Zilberman U, Milevski I, Yegorov D, Smith P. A 3000-year-old case of an unusual dental lesion: Pre-eruptive intracoronal resorption. Archives of Oral Biology. 2019 Jan 1;97:97–101.
[11] K.P. Counihan ACO. Case Report Pre-eruptive intra-coronal radiolucencies revisited. European Archives of Paediatric Dentistry. 2012;13:221–6.
[12] Currell SD, Cakar T. Incidental observation of pre-eruptive intracoronal resorption after seven years. Australian Dental Journal. 2019 Dec 1;64(4):376–9.
[13] Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for
systematic reviews and meta-analyses: The PRISMA statement. International Journal of Surgery. 2010;8(5):336–41.
31 [14] Munn Z MSLKRDTC. Methodological guidance for systematic reviews of
observational epidemiological studies reporting prevalence and incidence data. Int J Evid Based Healthc. 2015;13(3):147–53.
[15] Al-Batayneh OB, AlJamal GA, AlTawashi EK. Pre-eruptive intracoronal dentine radiolucencies in the permanent dentition of Jordanian children. European Archives of Paediatric Dentistry. 2014;15(4):229–36.
[16] Umansky M, Tickotsky N, Friedlander-Barenboim S, Faibis S, Moskovitz M, Oral H, et al. Age-Related Prevalence of Pre-Eruptive Intracoronal Radiolucent Defects in the Permanent Dentition. Vol. 40, The Journal of Clinical Pediatric Dentistry. 2016. [17] Demirtas O, Tarim Ertas E, Dane A, Kalabalik F, Sozen E. Evaluation of
pre-eruptive intracoronal resorption on cone-beam computed tomography: A retrospective study. Scanning. 2016 Sep 1;38(5):442–7.
[18] Demirtas O, Dane A, Yildirim E. A comparison of the use of cone-beam computed tomography and panoramic radiography in the assessment of pre-eruptive intracoronal resorption. Acta Odontologica Scandinavica. 2016 Nov 16;74(8):636–41.
[19] Al-Tuwirqi A, Seow WK. A controlled study of pre-eruptive intracoronal resorption and dental development. Journal of Clinical Pediatric Dentistry. 2017;41(5):374–80. [20] Konde S, Sri Darshini CS, Agarwal M, Peethambar P. Unrevealed caries in
unerupted teeth: A prevalence study. Contemporary Clinical Dentistry. 2018 Sep 1;9(6):S305–8.
[21] Manmontri C, Chompu-Inwai P, Mahasantipiya PM, Prapayasatok S. Prevalence of pre-eruptive intracoronal radiolucencies in Thai children and adolescents: A
retrospective study. Journal of investigative and clinical dentistry. 2018 May 1;9(2):e12303.
[22] Seow WK HD. Pre-eruptive resorption of dentin in the primary and permanent dentitions: case reports and literature review. Pediatr Dent. 1996;18(1):67–71. [23] Uzun I, Gunduz K, Canitezer G, Avsever H, Orhan K. A retrospective analysis of
prevalence and characteristics of pre-eruptive intracoronal resorption in unerupted teeth of the permanent dentition: A multicenter study. International Endodontic Journal. 2015 Nov 1;48(11):1069–76.
[24] Al-Batayneh OB, AlTawashi EK. Pre-eruptive intra-coronal resorption of dentine: a review of aetiology, diagnosis, and management. Vol. 21, European Archives of Paediatric Dentistry. Springer; 2020.
[25] Kane G, Cash A, Seehra J. Pre-eruptive coronal resorption of unerupted molar teeth in orthodontic patients. Journal of Orthodontics. 2019;
32 [26] Case report: Idiopathic pre-eruptive coronal resorption of a maxillary permanent
canine.
[27] Yamana A, Nakano K, Sasaki H, Okawa R, Fujita K, Matsumoto M, et al.
Radiolucent lesion identified in unerupted mandibular left first permanent molar: Case report and literature review. Pediatric Dental Journal. 2010;20(2):207–11.
[28] rutar1997.
[29] Seow WK. Pre-eruptive intracoronal resorption as an entity of occult caries. Pediatr Dent. 2000;22:370–6.
[30] Seow WK LPMLH. Prevalence of pre-eruptive intracoronal dentin defects from panoramic radiographs. Pediatr Dent. 1999;21(6):332–9.
[31] Satish V, CM P, KV H. Occult Caries: The Hidden Truth. International Journal of Clinical Pediatric Dentistry. 2010;3(3):225–9.
[32] Brunet-Llobet L, Sant H, de Déu J, Miranda-Rius J, Brunet-Llobet L, Lahor-Soler E, et al. Oral pain due to severe pre-eruptive intracoronal resorption in permanent tooth [Internet]. Vol. 15, European Archives of Paediatric Dentistry. Official Journal of the European Academy of Paediatric Dentistry. 2014. Available from:
https://www.researchgate.net/publication/266747335
[33] Le VNT, Kim JG, Yang YM, Lee DW. Treatment of pre-eruptive intracoronal resorption: A systematic review and case report. Vol. 15, Journal of Dental Sciences. Association for Dental Sciences of the Republic of China; 2020. p. 373–82.
[34] Enabulele JE, Obuekwe ON. Prevalence of caries and cervical resorption on adjacent second molar associated with impacted third molar. Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology. 2017 Jul 1;29(4):301–5.
ANNEXES
Annex 2: List of authors and full names of journal titles included in the study
Author/ year Journal
Al-Batayneh et al. 2014 [15] European Archives of Paediatric Dentistry M. Umansky et al. 2016 [16] Journal of Clinical Pediatric Dentistry
Demirtas et al. 2016a [17] Wiley Online Library
Demirtas et al. 2016b [18] Acta Odontologica Scandinavica Al-Tuweriqi and Seow 2017 [19] Journal of Clinical Pediatric Dentistry
S.Konde et al. 2018 [20] Contemporary Clinical Dentistry Manmontri et al. 2018 [21] Case Reports in Dentistry
Annex 3: Data extraction form for prevalence studies
Citation Details Authors: Title: Journal: Year: Issue: Volume: Pages:
Generic Study details Study design: Country:
Setting/Context:
Year/ timeframe for data collection:
Participant Characteristics (study inclusion/exclusion information): Condition and measurement method:
Annex 4: The Joanna Briggs Institute (JBI) critical appraisal checklist for studies reporting
prevalence data.
Article Author & Name: Yes No Unclear Unapplicable
1.Was the sample frame appropriate to address the target population?
2. Were study participants sampled in an appropriate way? 3.Was the sample size adequate
4.Were the study subjects and the setting described in detail? 5. Was the data analysis conducted with sufficient coverage of the identified sample?
6.Were valid methods used for the identification of the condition?
7.Was the condition measured in a standard, reliable way for all participants?
8.Was there appropriate statistical analysis?
9.Was the response rate adequate, and if not, was the low response rate managed appropriately?
Overall appraisal: Include? Exclude? Seek further info? Comments (Including reason for exclusion)
1. Was the sample frame appropriate to address the target population?
This question relies upon knowledge of the broader characteristics of the population of interest and the geographical area. If the study is of women with breast cancer, knowledge of at least the characteristics, demographics and medical history is needed. The term “target population” should not be taken to infer every individual from everywhere or with similar disease or exposure characteristics. Instead, give consideration to specific population characteristics in the study, including age range, gender, morbidities, medications, and other potentially influential factors. For example, a sample frame may not be appropriate to address the target population if a certain group has been used (such as those working for one organization, or one profession) and the results then inferred to the target population (i.e., working adults). A sample frame may be appropriate when it includes almost all the members of the target population (i.e., a census, or a complete list of participants or complete registry data).
2. Were study participants recruited in an appropriate way?
Studies may report random sampling from a population, and the methods section should report how sampling was performed. Random probabilistic sampling from a defined subset of the population (sample frame) should be employed in most cases, however, random probabilistic sampling is not needed when everyone in the sampling frame will be included/ analyzed. For example, reporting on all the data from a good census is appropriate as a good census will identify everybody. When using cluster sampling, such as a random sample of villages within a region, the methods need to be
clearly stated as the precision of the final prevalence estimate incorporates the clustering effect. Convenience samples, such as a street survey or interviewing lots of people at a public gatherings are not considered to provide a representative sample of the base population.
3. Was the sample size adequate?
The larger the sample, the narrower will be the confidence interval around the prevalence estimate, making the results more precise. An adequate sample size is important to ensure good precision of the final estimate. Ideally, we are looking for evidence that the authors conducted a sample size calculation to determine an adequate sample size. This will estimate how many subjects are needed to produce a reliable estimate of the measure(s) of interest. For conditions with a low prevalence, a larger sample size is needed. Also consider sample sizes for subgroup (or characteristics) analyses, and whether these are appropriate. Sometimes, the study will be large enough (as in large national surveys) whereby a sample size calculation is not required. In these cases, sample size can be considered adequate. When there is no sample size calculation and it is not a large national survey, the reviewers may consider conducting their own sample size analysis using the following formula: (Naing et al. 2006, Daniel 1999) n= Z2P(1-P) d2 Where: n= sample size Z = Z statistic for a level of confidence P = Expected prevalence or proportion (in proportion of one; if 20%, P = 0.2) d = precision (in proportion of one; if 5%, d=0.05)
Ref: Naing L, Winn T, Rusli BN. Practical issues in calculating the sample size for prevalence studies Archives of Orofacial Sciences. 2006;1:9-14.
Daniel WW. Biostatistics: A Foundation for Analysis in the Health Sciences. Edition. 7th ed. New York: John Wiley & Sons. 1999.
4. Were the study subjects and setting described in detail?
Certain diseases or conditions vary in prevalence across different geographic regions and populations (e.g., Women vs. Men, sociodemographic variables between countries). The study sample should be described in sufficient detail so that other researchers can determine if it is comparable to the population of interest to them.
5. Was data analysis conducted with sufficient coverage of the identified sample?
Coverage bias can occur when not all subgroups of the identified sample respond at the same rate. For instance, you may have a very high response rate overall for your study, but the response rate for a certain subgroup (i.e., older adults) may be quite low.
