This case report describes the treatment of a periodontal defect associated with a palato-radicular groove in tooth #10 using a combination of platelet-rich plasma (PRP) and hydroxyapatite. After non-surgical therapy and endodontic treatment, a surgical procedure was performed where PRP gel and hydroxyapatite were placed in the defect and the flaps were closed. Follow-up after 12 months found reduced probing depths and clinical attachment levels, as well as significant radiographic bone formation in the defect. The combination of PRP and hydroxyapatite helped stimulate new bone growth and stabilized the blood clot and graft material.

1. Use of Platelet-Rich PlasmaUse of Platelet-Rich Plasma
Combined With Hydroxyapatite inCombined With Hydroxyapatite in
the Management of a Periodontalthe Management of a Periodontal
Endosseous Defect Associated WithEndosseous Defect Associated With
a Palato-Radicular Groove:a Palato-Radicular Groove:
A Case RepoA Case Reportrt
REPORTER: Janine RumbaoaREPORTER: Janine Rumbaoa

2. Various root developmental
anomalies, such as
palato-radicular groove, have been
associated with worsening the
periodontal condition.

3. PALATO-RADICULAR GROOVE
•Palato-radicular groove (PRG) is one of the rare
developmental anomalies of maxillary incisor
teeth, primarily maxillary lateral incisor.
•It usually begins in the central fossa, crosses the
cingulum and extends to varying distance apically,
possibly reaching the root apex

4. There lack of epithelial closure which makes it an important
niche for microbes.

5. TERMINOLOGY
PLATERICH PLASMA
is blood plasma that has been enriched with platelets. As a
concentrated source of autologous platelets, PRP contains (and
releases through degranulation) several different growth factors and
other cytokines that stimulate healing of bone and soft tissue.
HYDROXYAPATITE

6. CASE PRESENTATION
• A 36-year-old Indian female
• Pain in the upper maxillary incisor region

7. Probing depth (PD) on the mesiopalatal
and mesiolabial aspect of tooth #10 was
7 mm
clinical attachment
level (CAL)was 9mmmesiolabially and
mesiopalatally
gingival recessionwas 2mm interproximally,
and no mobility was detected

8. On thepalatal aspect of tooth #10, there
was a deep palatoradicular
groove initiating from the cingulum of the
tooth and extending apically

9. CASE MANAGEMENT
Phase I periodontal therapy, endodontic
therapy of tooth
#10, and surgical periodontal therapy was
done
Endodontic
therapy of tooth #10 resulted in the
reduction of the periapical
lesion

10. For esthetic purposes, a
modified papilla
preservation technique
was used.

11. a full-thickness flap was raised,
and thorough debridement
and root planing was performed. The
palato-radicular
groove was restored with GIC

12. PRP Gel Preparation
blood were drawn from the antecubital
vein and collected in sterile plastic test
tubes
Test tubes were shaken gently and
retained at room
temperature for a minimum of 45 minutes
to minimize the
complement activity.
Subsequently, the citrated blood solution
was centrifuged, using a refrigerated
resulting in separation of three
fractions: erythrocytes at the bottom layer,
PRP in the middle
layer, and platelet-poor plasma (PPP) at
the top layer

13. Flaps
were approximated with interrupted sutures
of 3-0 black
Silk and periodontal dressing{ was placed.

14. Sutures were removed after 1 week. The 6-
month postoperative picture
shows uneventful healing.

15. Full ceramic crown on tooth #10
and construction of the
distal surface of tooth #9 with a
light-cured composite resin
restoration was done

16. CLINICAL OUTCOMES
Reexamination after
12 months revealed
reduction in PD
(from 7 to 2 mm) and
CAL (from 9 to 4 mm)
significant
radiographic bone
formation in the
periodontal
endosseous defect

17. DISCUSSION
PRP stimulates the proliferation of periodontal
ligament and osteoblastic cells, while at the
same time, epithelial cell proliferation is inhibited.
Because of its fibrinogen content,
PRP reactswiththrombin andinduces fibrin clot
formation, which in turn is capableof upregulating
collagen synthesis in the extracellular matrix and
provides a favorable scaffold
for cellularmigration and adhesion

18. • The fibrin component of PRP gel not only
works as a hemostatic agent aiding in the
stabilization of the graft material and the
blood clot,13 but also adheres to the root
surface and may impede the apical
migration of epithelial cells and connective
tissue cells from the flap