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LABIOCERVICAL VERTICAL GROOVE
- 1. 1
- 2. 2
- 3. PERIO ENDO 3
- 4. INFOLDING OF ENAMEL ORGAN AND ‘HERS’ ABORTED ATTEMPT ENAMEL HYPOPLASIA RACIAL LINK NUTRITIONAL ISSUES TRAUMA OR INJURY 4
- 5. Severity of LCVG was ranked in three stages : Moderate groove Severe grooveMild groove 5
- 6. Prevalence : Labial surface of permanent Maxillary central incisors Labial surface of permanent Maxillary Lateral incisors - 43% of the grooves extended less than 5mm - 47% extended 6-10 mm - 10% over 10mm - Kogan et al - 1986 Complications The presence of LCVG may exacerbate some clinical aberrations, 1. Esthetic deficiency of the gingival marginal contour, 2. Accumulation of plaque , 3. Gingival pocket with bone loss as failure in endodontic and periodontal treatments. - Kozlovsky et al - 19886
- 7. This case report emphasis the harmful effects of labial cervical vertical groove and its successful management using BIODENTIN,PRF WITH BONE GRAFT AND AMNIOTIC MEMBRANE 7
- 9. 9 Name : Mr. K. Dhandapani Age : 29/ M C/O : Pain in upper front tooth region
- 10. 10 Root canal therapy was done and pre-operative radiograph reveals the angular bone defect in both mesial and distal aspect of 11 Splinting was done in relation to upper anteriors
- 11. 11
- 12. Sulcular Incision given in relation to 12 11 and 21 and a vertical incision given in distal to 12 Full thickness mucoperiosteal flap elevated and open flap debridement done 12
- 13. Saucerization done using diamond coated ultrasonic tip Manipulation of biodentin 13
- 14. Biodentin is placed in the groove 14
- 15. PLATELET RICH FIBRIN PRF + Bone graft placed in Defect 15
- 16. • Vascular endothelium growth factor (VEGF), • Platelet-derived growth factor (PDGF), • Fibroblast growth factor (FGF), • Epidermal growth factor (EGF), • Hepatocyte growth factor (HGF), • Insulin-like growth factor (IGF) • Transforming growth factor-β (TGF-β) These GFs include High concentrations of the collected platelets allow for the slow release of growth factors (GFs) from the platelet granules. TGF-β1 16
- 17. TGF-β1 is a bioactive molecule present in PRF. TGF-β1 induces osteoblastic proliferation, differentiates odontoblasts, and angiogenesis. TGF-β1 has been proved to induce mineralization and osteodentin-like matrix and also plays a role in regulating the stem cells from the apical papilla . The increase in TGF-β1 from PRF when layered with Biodentine will improve the healing. 17
- 18. - Simonpieri et al (2009) BIOLOGICAL CONNECTORS GRAFT SURVIVAL SUSTAINED HEALING SELF REGULATION 18
- 19. Amniotic membrane placed AMNIOTIC MEMBRANE 19
- 20. 20 Rich source of stem cells Physiologic “seal” Growth factors Host immunologic response LAMININ-5 Enhanced wound Healing Prevents Bacterial contamination Granulation tissue formation Decreases PMN Migration Gingival cell adhesion
- 21. Amniotic membrane - “Pro Life Paves Path For Life” Mesenchymal stem cells TIMPS – 123 and IL - 10 and IL – 1 RA IL- 4 and IL- 10 TNF – alpha and IFN 21
- 22. Independent sling suture placed Coe – pak placed 22
- 23. Pre - operative Post – op aftr 3 months 11 mm 4 mm 23
- 24. 24
- 25. DON’T WORRY if it’s DIFFERENT 25
- 26. THE MAXILLARY INCISOR REGION IS AN AREA OF EMBRYOLOGICAL HAZARD. Anatomic aberrations like root grooves can occur here, which form stagnant sites or ecological niches favoring the retention and growth of micro-organisms. Grooves may facilitate plaque growth by providing surface areas sheltered from cleaning efforts as well as host defense mechanisms. Later, bacterial selection and growth may be influenced by anaerobic conditions established inside the grooves. 26
- 27. A MILD RADICULAR GROOVE…..TREATMENT Terminates soon after crossing the cemento- enamel junction Periodontal disease can be conservatively managed with either gingivectomy or subgingival curettage 27
- 28. A MODERATE RADICULAR GROOVE - TREATMENT Effective management requires an appropriate combination of periodontal, endodontic, and operative procedures. To encourages sulcular reattachment and prevent bacteria from gaining access to the groove at the deeper level. "Saucerization" involves the elimination of the defect to the crestal bone level 28
- 29. PRF release factors at a sustained rate over a longer period, thereby optimizing wound healing. PRF has also been shown to stimulate the growth of osteoblasts and periodontal ligament cells WHY PRF ??? It contributes to the enhancement of healing through reduction of post operative scarring and subsequent loss of function and providing a rich source of stem cells. WHY AMNIOTIC MEMBRANE ??? 29
- 30. In the present study PRF with bone graft and amniotic membrane demonstrated better results in probing pocket depth reduction and clinical attachment level gain The probing depth was reduced from 10 mm – 3 mm and CAL From 7 mm to 5mm Periodontal condition was stable and bone regeneration was evident at grafted site. LCVG was sealed with glass ionomer cement (Fuji II; GC Corporation, Tokyo Japan) after a month BONE DEFECT DEPTH was initially about 11 mm and it is reduced to 4 mm and and BONE FILL was evident for about 7 mm 30
- 31. PRESENCE OF A LABIO GINGIVAL GROOVE DOES NOT ALWAYS IMPLY THAT PATHOLOGY WILL DEVELOP. Unless there is a breach in the epithelial attachment , the groove may continue to exist undetected. If their presence is suspected, they should be restored either preventively to restrain subsequent complications or under constant re-evaluation 31
- 32. 32
- 33. 33
- 34. Mishal P. Shah, Sheela K. Gujjari,1 Kinnari M. Shah - Labial- cervical-vertical groove: A silent killer-Treatment of an intrabony defect due to it with platelet rich fibrin. Journal of Indian Society of Periodontology - Vol 18, Issue 1, Jan-Feb 2014 Ashwini.S, Nisha Singh, Bhavya Shetty - Labial Cervical Vertical Groove: Hidden Route to Periodontal Destruction - Journal of Dental & Oro-facial Research Vol 12 Issue 1 Jan 2016 Chhaya Bansal, Vipin Bharti - Evaluation of efficacy of autologous platelet-rich fibrin with demineralized-freeze dried bone allograft in the treatment of periodontal intrabony defects - Journal of Indian Society of Periodontology - Vol 17, Issue 3, May-Jun 2013 34
- 35. Surekha Y. Bhedasgaonkar, Janak Kapadia, Neha A. Patil- Treatment of infrabony defects with platelet-rich fibrin along with bone graft: Case report - Journal of the International Clinical Dental Research Organization | January-June 2015 | Vol 7 | Issue 1 Dr. Maheaswari Rajendran, Dr. JeevaRekha M and Dr. Poorana K- Biodentine: Periodontal perspective - International Journal of Applied Dental Sciences 2017; 3(1): 12-16 Akanksha Gupta, Suresh D. Kedige, and Kanu Jain - Amnion and Chorion Membranes: Potential Stem Cell Reservoir with Wide Applications in Periodontics - International Journal of Biomaterials 35
- 36. 36
Editor's Notes
- Periodontal disease is a host modulated multifactorial infectious disease resulting in inflammation within supporting structures of the teeth, which leads to progressive attachment loss , bone loss and hence the loss of the tooth. Not only the local or systemic factors which may contribute to periodontitis but there are various diverse anatomic or morphological tooth anomalies are found in various shapes and textures. These features contribute to changes in dento-gingival relationships, thus making it more prone to harboring virulent periodontal pathogens leading to site specific localized periodontitis
- These anatomic variations are often overlooked as etiologic factor hence this case report describes the diagnosis and clinical management of a maxillary central incisor with localized periodontal destruction associated with a labial cervical vertical groove.
- --(1) a mild subgingival shallow groove below the marginal gingiva that can be felt only by probing (Fig 1); (2) a moderate groove that can be detected with the eyes, extending subgingivally as in (1), and additionally supragingivally on the labial crown surface, not more than 2 mm from the marginal gingiva in the incisal direction (Fig 2); and (3) a severe defect extending supragingivally more than 2 mm from the marginal gingiva on the labial crown surface and further subgingivally (Fig 3).
- As this groove provides nidus for accumlation of plaque and calculus, if left untreated may worson the periodontal conditions and result in periapical pathosis too.
- A 29 year-old male patient reported with a chief complaint of dull, gnawing, intermittent pain with respect to upper front teeth. On examination a localized gingival inflammation was present with the accumulation of plaque and calculus with respect to 11 Periodontal examination revealed a probing pocket depth of 10 mm on the mid labial aspect of 11. Intra oral radiograph examination revealed interdental bone loss with respect to both mesial and distal aspect of 11.
- When mixed with the graft, PRF fragments serve as a biological connector between bone particles. Moreover, the gradual release of cytokines plays a significant role in the self‑regulation of inflammatory and infectious phenomena within the grafted material. First,fibrin clot plays an important mechanical role in maintaining and protecting the graft and PRF fragments serve as biological connectors between bone particles. Second, fibrin network facilitates cellular migration, vascularization, and survival of the graft. Third, the growth factors (PDGF, TGF-β, IGF-1) are gradually released as the fibrin matrix is resorbed, thus creating a perpetual process of healing. Lastly, the presence of leukocytes and cytokines in the fibrin network can play an important role in the self-regulation of inflammatory and infectious phenomena within the grafted material.
- It not only maintains the structural and anatomical configuration but also contributes to the enhancement of healing through reduction of post operative scarring and subsequent loss of function and providing a rich source of stem cells. Amnion has shown an ability to form as an early physiologic “seal” with the host tissue precluding bacterial contamination Amnion tissue contains growth factors that may aid in the formation of granulation tissue by stimulating fibroblast growth and neovascularization It has an ability to decrease the host immunologic response via mechanisms such as localized suppression of polymorphonuclear cell migration LAMININ‑5 being the most prevalent plays a role in the cellular adhesion of gingival cells and concentrations of this glycoprotein is useful for periodontal grafting procedures. AM creates a natural scaffold for self-seeding in tissue engineering as the epithelium retains reservoir of stem cells. AM can modulate angiogenesis and promote wound healing. It also acts as a scaffold for cell proliferation and regeneration. Unlike other barrier membranes, AM is biologically active due to the presence of stem cells and growth factors that hasten granulation tissue formation and acts as a bioactive matrix that facilitates cell migration. The wound healing property is further enhanced by the physiological seal obtained with gingiva. amniotic membrane enhances gingival wound healing properties and reduces scarring laminin‑5 being the most prevalent. It plays a role in the cellular adhesion of gingival cells and concentrations of this glycoprotein in amniotic allograft may be useful for periodontal grafting procedures Amnion tissue contains growth factors that may aid in the formation of granulation tissue by stimulating fibroblast growth and neovascularization.[19] In addition, the cells found within tissue exhibit characteristics associated with stem cells and may enhance clinical outcomes. A recent resorbable amniotic membrane not only maintains the structural and anatomical configuration of regenerated tissues but also enhances gingival wound healing, provides a rich source of stem cells. The Mesenchymal Stem Cells (MSCs) in the AM decrease the secretion of proinflammatory cytokines like Tumor Necrosis Factor alpha (TNF-α) and Interferon (IFN) while increasing the production of anti-inflammatory cytokines interleukin-10 and interleukin-4. Various tissue inhibitors of metalloproteinases 1, 2, 3, and 4, interleukin-10, and interleukin-1 receptor antagonists and endostatin which inhibit endothelial cell proliferation, angiogenesis, and tumor growth are also expressed by human amniotic epithelial and mesenchymal cells Therefore, amniotic membrane is choice of material these days in augmenting the better results in various periodontal procedures.
- Advances in stem cell biology and regenerative medicine have presented opportunities for tissue engineering and gene-based approaches in periodontal therapy. These new approaches offers interesting alternatives to existing therapies for the repair and regeneration of the periodontium. The clinical application of amniotic membrane for guided tissue regeneration (GTR) while fulfilling the current mechanical concept of GTR, amends it with the modern concept of biological GTR. Amniotic membrane not only maintains the structural and anatomical configuration of regenerated tissues but also contribute to enhancement of healing.