Combined endodontic periodontic treatment of a palatal groove/ dental implant courses

“Combined Endodontic-
Periodontic Treatment of a
Palatal Groove: A Case Report”
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

CONTENTS
 INTRODUCTION
 TERMINOLOGY
 PREVALANCE OF PALATAL GROOVE
 CLINICAL IMPLICATIONS OF PALATAL GROOVE
 CLINICAL & RADIOLOGICAL FEATURES
 DIAGNOSIS
 TREATMENT MODALITIES
 CASE REPORT
 DISCUSSION
 CONCLUSION
 REFERENCES

INTRODUCTION

www.indiandentalacademy.comwww.indiandentalacademy.com
Indian Dental academy
• www.indiandentalacademy.com
• Leader continuing dental education
• Offer both online and offline dental
courses

TERMINOLOGY
 In 1965, Prichard described this anomaly as a groove
located on the lingual surface of the maxillary incisors, a defect
predisposed to the formation of periodontal pockets
 Lee and Poon (1968) --“the Palato-gingival groove”
 Defined as “a developmental groove in a root that, when
present, is usually found on the lingual aspect of maxillary
incisor teeth” (Glossary of Endodontic terms)

 Synonyms of palatal groove:
 Palato-gingival groove
 Developmental radicular anomaly
 Disto-lingual groove
 Radicular lingual groove
 Cingulo-radicular groove
 Variable in depth, distance and the direction traversed down the
root.

 They can occur on the mesial/distal surface as well as the facial
surface of central incisor which referred as “facial-radicular
groove”.
 Rarely -- Bilateral
DENS INVAGINATUS

Study Sites with palatal
groove/no. of
teeth
Prevalence (%)
Everett and Kramer 18/625 (LI) 2.8%
Withers et al 49/2099 8.5%
0.28% (CI) & 4.4%
(LI)
Kogon 47/1382 (CI) 3.4%
Bacic et al 11/1081
5/634
1.01%
0.79%
Pecora et al 10/500 (CI)
11/421 (LI)
2.0%
2.6%
Prevalence of palatal groove:
(CI: central incisors; LI: lateral incisor)
(Taken from: Quintessence international 2000, vol:31(5); pg:344)www.indiandentalacademy.com

Etiology
 Lee & Colleagues -- infolding of the enamel organ
and Hertiwig’s epithelial root sheath and parallels the
pathogenesis of dens invaginatus
 Unlike in dens invaginatus, here the infolding usually
is less extensive &creates external defect adjacent to
gingival crevice
 Ennes & lara – results from alteration of genetic
mechanisms

Clinical implications of palatal groove
 Lee & Poon (1968)  Junctional epethelium next to
defect will popably don’t attach to tooth surface
adequately
 Provides pathway for bacteria to penetrate into PDL area
 Provides nidus for progressive inflammation
 Once a breach occurs in PDL attachment & groove is
involved – localised periodontal pocket can develop
 Predisposing factor to localised periodontal disease due
to greater plaque accumulation & deeper pockets

 Withers etal (1981)
 Leknes KN (1984) & Bacic M etal (1990)
 Communication b/w pulp & periodontium can occur through the
accessory canals which can be formed in either crown or root
part of the groove resulting secondary pulpal involvement

Clinically:
 Higher plaque, gingival &periodontal disease
index scores than non grooved incisors
 Pulpal necrosis followed by apical
periodontitis is often the earliest manifestation
 Mobility, gingival recession resulting from
infrabony periodontal pocket

Radiographically:
Rarely , it can be seen – as parallel radiolucent
vertical line – “para-pulpal line”
 Represent the shadow of deep palatogingival
groove
 Mislead to misdiagnosis of Vertical root #
 Bone destruction related to groove path – seen
as a “pear shaped lesion”

Diagnosis
 Difficult- since it can manifest with symptoms of true
periodontal disease / true endodontic problem
 Careful examination of tooth surface close to gingiva
 Groove – often be hidden below the gums / plaque
 Periodontal probing
 Differential diagnosis: Long standing crack on
the crown, vertical root fracture

Treatment modalities
 When the groove terminates on crown – curettage,
odontoplasty & composite filling
 When groove extends on the root: Kerezoudis &
Siskos (1998)
 Surgical removal of granulation tissue& local
irritants
 Gingivectomy or apically repositioned flap
 Surgical exposure & groove flattening with or with
out GTR techniques
 Placing amalgam in groove
 orthodontic extrusion of tooth

 Palatal groove associated with periodontal
bone defects
 Scaling & root planning
 Odontoplasty
 Curettage with odontoplasty
 Amalgam restoration
 Extraction
 GTR with or without bone grafts – Groove
extending beyond the middle1/3rd
of root apex

 Endodontic treatment – due to secondary pulpal
involvement
 Deep radicular groove, extending to apical 1/3rd
of
root combined therapy – endodontic therapy,
intentional replantation, elimination of groove,
Emdogain therapy
 Periodontal breakdown continues -- Extraction

Case report
 Patient age: 28yrs sex: male
 No H/O trauma & pain
 C/F:
 facial parulis in alveolar mucosa irt #7
 No tenderness to percussion/ palpation
 Narrow 6mm pocket on palatal aspect associated with
a palatal groove
 Investigation:
 Pulp testing: Negative response
 IOPA : radiolucency irt apical 2/3rd
of root of #7

 Sinus tracing with GP:
cone pointing distal root of #7, mesially oriented main pulp
space, 2 narrow vertically oriented lines,
distal one – extending to apex
other – more centrally located extending only into cervical portion of
the root
 Provisional Diagnosis:
 pulp necrosis, Suppurative Periradicular
Periodontitis & Moderate Localized Periodontitis
Secondary to palatal groove irt #7
 Prognosis: Questionable long term prognosis

main canal located
(C-shaped) 2nd
canal located
distally
Ca(OH)2 paste
IRM for3wks
Treatment done:

 After 3months, pocket  2-3mm , no bleeding,
asymptomatic, persisted facial sinus tract
 Clindamycin 300mg, every 6hrs,10 days

facial sinus persisted,
pocket traceable up to
12mm
GP -- Apical
5mm
Flowable
composite
3wks later
Exploratory surgery-planned GP cone

Palatal defect
-10mm
Facial bony
fenestration
After odontoplasty& filling
with FDBA & Emdogain

6 months follow-up
Sinus tract closed-1wk; Biopsy report – granulation
tissue with acute & chronic inflammation & abscess

Discussion

Potential causes of pulp necrosis irt #7
 Previous trauma
 Palatal groove – periodontium adjacent to groove – lost its
attachment & developed a chronic periodontal defect on lingual
aspect resulting in retrogenic pulp infection
 Communication b/w palatal groove & canal could have caused
bacterial communication of pulp resulting in pulpal necrosis

Deep palatal groove presenting complex Endo-perio problem
6mm pocket

conclusion

 Palatal groove is a developmental anomaly that predisposes the
involved to severe periodontal defect
 When further complicated by pulp necrosis, they often present a
diagnostic and treatment planning challenge requiring
interdisciplinary approach
 This case report described successful collaborative
management of maxillary lateral incisor with extensive palatal
groove using combination of nonsurgical RCT, odontoplasty
&periodontal regenerative technique

References
 “A combined approach for treatment of developmental
groove associated with periodontal defect”.
J Periodontology’98, 69:601-7.
 Treatment of a palatal groove – related periodontal bone
defect”. Quint Int’2000, 31,#5:342.
 Successful treatment of a radicular groove by intentional
replantation and Emdogain therapy”.
Dental traumatology’04; 20:226-28.
 The palato-gingival groove – a cause of failure in root
canal treatment”. Dental traumatology’98; 85: 94-8.

Combined endodontic periodontic treatment of a palatal groove/ dental implant courses

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (10)

Similar to Combined endodontic periodontic treatment of a palatal groove/ dental implant courses

Similar to Combined endodontic periodontic treatment of a palatal groove/ dental implant courses (20)

More from Indian dental academy

More from Indian dental academy (20)

Recently uploaded

Recently uploaded (20)

Combined endodontic periodontic treatment of a palatal groove/ dental implant courses