|Year : 2018 | Volume
| Issue : 2 | Page : 156-158
Management of an endodontic-periodontal lesion attributable to palatogingival groove
Tarun Kumar, Sunandan Mittal, Vanita Keshav, Harpreet Kaur
Department of Conservative Dentistry and Endodontics, Dasmesh Institute of Research and Dental Sciences, Faridkot, Punjab, India
|Date of Web Publication||5-Dec-2018|
Dr. Tarun Kumar
Department of Conservative Dentistry and Endodontics, Dasmesh Institute of Research and Dental Sciences, Faridkot, Punjab
Source of Support: None, Conflict of Interest: None
To describe the management of endodontic-periodontal lesion attributable to palatogingival groove extending from crown to root surface, contributing to severe periodontal breakdown in relation to maxillary central incisor. Palatogingival groove may act as a nidus of plaque accumulation and contribute to the pathogenesis of endodontic-periodontal lesions. The management of such lesions requires an integrated interdisciplinary approach with careful application of endodontic and periodontal surgical procedures. In the present case, the patient presented with advanced bone loss and negative pulpal response in relation to left maxillary central incisor. The etiology of such isolated periodontal lesion could be attributed to palatogingival groove as there was no history of endodontic pathology or trauma. The treatment plan included endodontic treatment followed by surgical exploration, elimination, and sealing of palatogingival groove using biodentine.
Keywords: Biodentine, endodontic- periodontal lesion, palatogingival groove
|How to cite this article:|
Kumar T, Mittal S, Keshav V, Kaur H. Management of an endodontic-periodontal lesion attributable to palatogingival groove. Endodontology 2018;30:156-8
| Introduction|| |
Palatogingival groove, also termed as palatoradicular groove and radicular lingual groove,, has been described as an anatomical aberration most commonly affecting maxillary incisors. It has been suggested that these developmental grooves might result from an infolding of the enamel organ and the Hertwig's epithelial root sheath or from an attempt to form another root. It usually extends from crown to variable distance onto the root surface.
Due to inadequate plaque control in this area, it acts as a nidus of plaque accumulation leading to periodontal breakdown and might further communicate with the pulp canal system through accessory canals or apical foramina. As a result, the palatogingival groove contributes to the pathogenesis of endodontic-periodontal lesion.
The prognosis depends on the extent and depth of groove. The shallow grooves may be corrected by odontoplasty and periodontal treatment. However, when the groove is more advanced, surgical exploration, elimination, and sealing of groove are required. In the present case, a maxillary central incisor with a deep palatogingival groove attributing to pathogenesis of endodontic-periodontal lesion was successfully managed by endodontic and surgical periodontal therapy during which the groove was eliminated and sealed with biodentine.
| Case Report|| |
A 29-year-old male patient reported to Department of Conservative Dentistry and Endodontics with chief complaint of mobility and pus discharge in relation to left maxillary central incisor # 21 for the preceding 3 months. Intraoral examination revealed Grade I mobility # 21. The gingiva over the affected tooth was inflamed, and the tooth had a 10 mm probing defect on mesiopalatal aspect [Figure 1]a. Slight palpation of the palatal gingiva caused pus discharge through the mesiopalatal aspect of gingival sulcus of the concerned tooth. The patient had good oral hygiene and noncontributory medical history. The electric pulp testing and thermal tests revealed a negative pulpal response. An intraoral periapical radiograph revealed an advanced bony defect extending up to the apical third of the root [Figure 1]b. The deep pocket region was traced with gutta-percha to the origin of this pathological condition [Figure 1]c. Careful examination of the palatal aspect of tooth revealed the presence of a palatogingival groove on mesiopalatal aspect of the concerned tooth [Figure 1]d. The bony defect appeared to be a combined endodontic-periodontal lesion, and the palatogingival groove seems to be the only etiological factor.
|Figure 1: (a) 10 mm deep periodontal pocket associated with tooth #21. (b) Preoperative IOPA radiograph. (c) IOPA radiograph after Gutta percha tracing through periodontal pocket. (d) Preoperative view of palatogingival groove. (e) Working length determination radiograph. (f) Master cone radiograph. (g) Obturation. (h) Surgical exposure of Palatogingival groove. (i) 12 months follow up radiograph|
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The treatment plan included endodontic treatment followed by periodontal surgery for elimination of pocket and sealing of groove. The access opening was done and working length was established. Canal preparation was undertaken with Mtwo rotary files (VDW, Germany) to size 30 apically. After complete debridement and canal preparation, calcium hydroxide dressing was placed. Root canal treatment was completed after 1 week [Figure 1]e, [Figure 1]f, [Figure 1]g. The root canal was obturated with gutta-percha and AH 26 sealer (Dentsply Maillefer, Switzerland).
One week after endodontic treatment, the periodontal flap surgery was performed. A full thickness mucoperiosteal flap was reflected on the palatal aspect of the maxillary central incisor; an advanced bony defect was apparent which surrounded the palatal and mesial aspect of central incisor. The granulomatous tissue was removed from the bony defect with curettes, and the palatogingival groove was traced to the junction of coronal and middle third of root [Figure 1]h. Following root planing, the groove was isolated and sealed with biodentine [Figure 1]i, and bone graft was placed into the bony defect. Adequate healing was evident clinically and radiographically at 12-month follow-up visit [Figure 1]j.
| Discussion|| |
Palatogingival groove is a rare developmental anomaly with a prevalence of 2.8%–8.5% affecting maxillary anterior teeth most commonly. Radiographically, it may present as a radiolucent parapulpal line as also evident in this case. These grooves usually begin in the crown portion and extend to variable distance on the root surface often leading to the development of endodontic-periodontal lesions which were often untreatable by any means other than extraction in the past.
The prognosis of a tooth with a palatogingival groove depends mainly on the location and extension of the groove. The shallow palatogingival grooves can be eliminated by means of saucerization, while the deeper ones can be managed by surgical exploration, elimination, and sealing of groove, thus removing the nidus of plaque accumulation.
Materials, such as composite, glass-ionomer cement, and amalgam, have been used to fill the palatogingival groove. However, in this case, it was sealed with biodentine due to its excellent biocompatibility and superior handling characteristics. It has been reported that biodentine can be used in procedures requiring close approximation with the periodontal tissues and it caused gingival fibroblast reaction similar to that by mineral trioxide aggregate.
Elimination of etiological factor by sealing of the palatogingival groove can be considered as a key factor which may contribute to the success of such cases. Other factors include effective endodontic treatment with good coronal seal, placement of bone graft into the defect, and periodontal maintenance. This case reported the successful management of an endodontic-periodontal lesion precipitated by the presence of a deep palatogingival groove.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Everett FG, Kramer GM. The disto-lingual groove in the maxillary lateral incisor: A periodontal hazard. J Periodontol 1972;43:352-61.
Lee KW, Lee EC, Poon KY. Palato-gingival grooves in maxillary incisors. A possible predisposing factor to localised periodontal disease. Br Dent J 1968;124:14-8.
Simon JH, Glick DH, Frank AL. Predictable endodontic and periodontic failures as a result of radicular anomalies. Oral Surg Oral Med Oral Pathol 1971;31:823-6.
Meister F Jr., Keating K, Gerstein H, Mayer JC. Successful treatment of a radicular lingual groove: Case report. J Endod 1983;9:561-4.
Jeng JH, Lu HK, Hou LT. Treatment of an osseous lesion associated with a severe palato-radicular groove: A case report. J Periodontol 1992;63:708-12.
Ballal NV, Jothi V, Bhat KS, Bhat KM. Salvaging a tooth with a deep palatogingival groove: An endo-perio treatment – A case report. Int Endod J 2007;40:808-17.
Friedman S, Goultschin J. The radicular palatal groove – A therapeutic modality. Endod Dent Traumatol 1988;4:282-6.
Zhou HM, Shen Y, Wang ZJ, Li L, Zheng YF, Häkkinen L, et al
. In vitro
cytotoxicity evaluation of a novel root repair material. J Endod 2013;39:478-83.