Palatogingival Groove Volume 1 Issue 2

September 2010

Case Report

“Palatogingival Groove” - An Endodontic Enigma

Dr. Jayashankara C.M.1, Dr. Kala M.2
1
Reader, Department of Conservative Dentistry and Endodontics, Sri Siddhartha
2
Dental College, Tumkur, Professor and Head, Department of Conservative
Dentistry and Endodontics, Government Dental College, Bangalore.

Abstract

Maxillary incisors are very susceptible to developmental anomalies that can

lead to periodontal and / or endodontic problems. One such developmental
anomaly is the palatogingival groove which often predisposes to pulpal
necrosis and the establishment of combined periodontal - endodontic lesions.
This report describes a case of palatogingival groove in an upper right
lateral incisor with periodontal complications. The management included a
combination of endodontic therapy and periodontal regenerative techniques.
Key Words: Palatogingival groove, Maxillary lateral incisor, Pulpal necrosis,
Periodontal regeneration.

Journal of Dental Sciences & Research 1:2: Pages 23-29

Introduction pulp is often the cause of pulpal

The anomalous tooth inflammation or tooth loss1.

development of crown and root It is uncommon why the

accounts for substantial number of different malformations occur

pulp death in upper anterior although there is evidence that

region. In such cases of most of the anomalous tooth

malformations bacterial invasion developments are genetically

and hence bacterial infection of the determined1.

23 Journal of Dental Sciences and Research

Palatogingival Groove Volume 1 Issue 2
September 2010

A mild dental anomaly to its unusual location the palatal

occurring in the region of maxillary groove has the potential to harbor
incisors is the radicular palatal bacteria and debris leading to local
groove. This malformation is also inflammatory reaction. This
described in the dental literature as anomaly often presents a
the distolingual groove, a radicular diagnostic and treatment planning
lingual group or palato gingival challenges due to the combined
groove. As the name implies this endodontic - periodontal lesion3.
malformation is actually a groove We herewith report a case of
which starts near the cingulam of maxillary lateral incisor with palato
the tooth and run towards the gingival groove associated with
cement enamel junction in an pulpal necrosis and localized
apical direction at various depths periodontitis. The clinical feature
along the root surface2, 5. and the management of the above
said anomaly are discussed.
The exact etiology of this
defect is not fully understood. Case Report:
Some clinicians believe that
A 25 years old male patient
radicular group presents the
reported to the Department of
mildest form of dens invaginatus.
Conservative Dentistry and
Other investigator claims that this
Endodontics, Government Dental
malformation results from an
College, Bangalore with a chief
attempt of the body to form
complaint of pus discharge from
another root on the affected tooth2.
the labial gingival in the maxillary
The majority of the radicular right lateral incisor region since 4
grooves are seen at palatal aspect months. There was no history of
of the maxillary lateral incisor and trauma and the medical history
rarely in the posterior teeth. Due was non contributory.

24 Journal of Dental Sciences and Research

Palatogingival Groove Volume 1 Issue 2
September 2010

Clinical examination revealed diameter at the apex the tooth and

a Sinus on the labial gingival radiolucent line running adjacent to
surface associated with maxillary the root canal on the distal aspect
right lateral incisor (Fig.1). (Fig.3).

Fig 1: Sinus with pus discharge in labial Fig3: Radiograph of 12 showing

gingiva w.r.t 12 palatogingival groove
On periodontal probing, a The diagnosis of combined
palatal groove was detected endodontic - periodontal lesion
associated with pocket of 10 mm in associated with palato gingival
depth (Fig.2). groove was made based on clinical
and radiographic finding. Our
treatment plan consisted of non
surgical root canal therapy followed
by surgical management of
periodontal defect.
The tooth was isolated with
Fig 2: Prominent palatal groove in 12 rubber dam, access cavity
The tooth had no significant prepared and pulp extirpation done
mobility. Thermal and Electrical using barbed broaches. The canal
Pulp Vitality Tests gave negative was debrided with 3% sodium
response. Periapical radiograph hypochlorite (Vensons, India).
showed circumscribed radiolucency Working length was determined
measuring 5 mm x 7 mm in following which the canal was
25 Journal of Dental Sciences a
and Research
Palatogingival Groove Volume 1 Issue 2
September 2010

cleaned and shaped using hybrid Tokyo, Japan). Patient was recalled
instrumentation with gates glidden after one month. At the follow-up
drills and NITI hand files (Dentsply, visit the Sinus tract was still
Maillefer, Switzerland). Copious present and there was pus
irrigation with 3% sodium discharge from the palatal gingival
hypochlorite was done at every adjacent to the groove. After
step of instrumentation. 17% EDTA consultation with the periodontist
was used to remove the smear and exploratory surgery was
layer. Canal was dried using paper planned. 2% Lidocaine
points following which calcium hydrochloride with 1:200000
hydroxide paste was placed as an epinephrine (Astra-Zeneca Pharma,
intra canal medicament and access India) was administered followed
was sealed with IRM. At the by reflection of palatal full
subsequent visit obturation was thickness flap that revealed
completed with cold lateral fenestration of the cortical plate on
compaction of gutta-percha and the palatal aspect. The bony defect
zinc oxide eugenol sealer (Fig.4). and granulation tissue was
debrided. Odontoplasty was
performed on the root surface to
eliminate the groove (Fig.5).

Fig 4: Radiograph of 12 after root canal

therapy

The access cavity was

restored with type II Glass Fig 5: Saucerization of the groove

Ionomer cement (GC Corporation,

26 Journal of Dental Sciences and Research

Palatogingival Groove Volume 1 Issue 2
September 2010

Then the defect

fect was sealed bacteria which are situated in the
with GIC type-II (Fig.6). radicular groove. Bacteria and their
products may enter the pulp
through the accessory foramina
fo
and lateral canals situated along
the floor or side walls of the
groove. Another route of bacterial
invasion into the pulp is via the

Fig 6: Restoration of the Defect with type exposed dentinal tubules on the
II Glass Ionomer Cement side of the groove where surface
The flap was replaced and resorption as a result of
sutured. Patient was prescribed inflammatory process may occur2.
antibiotics, analgesics and a mouth Different studies have
wash containing 0.2% chlorexidine revealed a prevalence rate for
gluconate. At the recall visit post palatal groove of about 2.8 to
surgical healing was satisfactory 8.5%, the most prevalent being
and Sinus tract had healed. the maxillary lateral incisor3.

DISCUSSION The treatment of palatal

groove presents a clinical challenge
Dysplastic radicular dentin
to the operator. The variability in
with numerous clefts are often
size and shape of this anomaly
considered to be an important
coupled with bacterial invasion
contributing factor for the
may affect both the periodontium
development of localized
and the pulp. Hence, conventional
periodontitis as it favours the
endodontic treatment alone will not
accumulation and proliferation of
be effective because the bacterial
bacterial plaque deep into the
etiology is residing extra radicularly
periodontium2.
taining lesion3.
as a self sustaining
The pulp is also affected by

27 Journal of Dental Sciences a

and Research
Palatogingival Groove Volume 1 Issue 2
September 2010

The reported long term connective tissue adherence to the

prognosis of the therapy appears Glass Ionomer Cement during the
to be related to the apical healing process, similar to the
extension of the groove. Shallow formation of long junctional
grooves may often be treated epithelium4.
successfully while a deep groove However, long term follow-up
presents complex endodontic is required for further clinical
periodontal problems with a poor evaluation of the lesion.
prognosis3. It is important to note CONCLUSIONS
that, it is the ability to adequately
* Deep radicular grooves can
treat the periodontal defect that
predispose to pulp necrosis
ultimately determines prognosis of
and the establishment of
these teeth. In the present case
combined endodontic
combined endodontic and
periodontal problems.
periodontal treatment was
performed to eliminate the irritants * Evaluation of clinical signs
causing inflammatory process. and appropriate diagnostic
Radiculoplasty was performed to tests are of paramount
eliminate the groove which often importance in order to
harbors bacteria and debris leading prevent deterioration of
to local inflammatory reaction. attachment of apparatus.

Here Glass Ionomer type II * Combined endodontic -

Cement has been used to seal the advanced periodontal
defect as it has chemical adhesion regeneration treatment
to the tooth structure providing modalities can help us to
good sealing ability. Clinical and salvage the problems
histological studies have shown associated with this
that there is an epithelial and developmental anomaly.

28 Journal of Dental Sciences and Research

Palatogingival Groove Volume 1 Issue 2
September 2010

REFERENCES Lateral Incisor: Case Report.

Braz Dent J 1995; 6: 143-146.
1. Scharfer E, Cankay R, Ott K.
6. Tom G. Gound, GlunnI. Maze.
Malformations in Maxillary
Treatment options for Radicular
incisors: case report of radicular
Lingual Groove; A review and
palatal groove. Endod Dent
discussion. Pract Periodont
Traumatol 2000; 16: 132-137.
Aesthet Dent 1998; 10: 369-
2. N.P. Kerezoudis, G. J. Siskos &
375.
V.Tsatsas. Bilateral buccal
radicular groove in maxillary
Address for correspondence:
incisors: case report. Int Endo
Dr. Jayashankara. C .M.
Jol: 2003; 36: 898-906.
#7/2, Mount Joy Road,
3. D. Rachana, Prasannalatha Hanumanthanagar,
Nadig, Gururaj Nadig. The Bangalore-560 019
palatal groove: Application of Mobile No: +91 9886327890
computed tomography in its E-Mail:cmjayashankar75@gmail.com
detection - A case report.
Journal of Conservative
Dentistry 2007; 10: 83-88
4. Manoj Kumar Hans,
Ramachandra S Srinivas,
Shashit B Shetty. Management
of Lateral Incisor with Palatal
Radicular Groove. Indian Journal
of Dental Research 2010; 21:
306-308.
5. Carlos Estrela, Helio Lopes
Pereira, Jesus Djalma Pecora.
Radicular Grooves in Maxillary

29 Journal of Dental Sciences and Research