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References

Goon WW, Carpenter WM, Brace NM, Ahlfeld RJ Complex facial radicular groove in a maxillary lateral incisor. J Endod. 1991; 17:244-248
Chicago, Ill: American Association of Endodontists; 2003
August DS The radicular lingual groove: an overlooked differential diagnosis. J Am Dent Assoc. 1978; 96:1037-1039
Kogon SL The prevalence, location and conformation of palato-radicular grooves in maxillary incisors. J Periodontol. 1986; 57::231-234
Johns DA, Shivashankar VY, Shobha K, Johns M An innovative approach in the management of palatogingival groove using BiodentineTM and platelet-rich fibrin membrane. J Conserv Dent. 2014; 17:75-79
Mayne JR, Martin IG The palatal radicular groove. Two case reports. Aust Dent J. 1990; 35:277-281
Lee KW, Lee EC, Poon KY Palato-gingival grooves in maxillary incisors. A possible predisposing factor to localised periodontal disease. Br Dent J. 1968; 124:14-18
Kerezoudis NP, Siskos GJ, Tsatsas V Bilateral buccal radicular groove in maxillary incisors: case report. Int Endod J. 2003; 36:898-906
Vasanth K, Kottoor J, Nandini S, Velmurugan N, Abarajithan M Palatogingival groove mimicking as a mutilated root fracture in a maxillary lateral incisor: a case report. Gen Dent. 2014; 62:e20-e22
Moule AJ, Kahler B Diagnosis and management of teeth with vertical root fractures. Aust Dent J. 1999; 44:75-87
Camilleri J, Pitt Ford TR Mineral trioxide aggregate: a review of the constituents and biological properties of the material. Int Endod J. 2006; 39:747-754
Sarkar NK, Caicedo R, Ritwik P, Moiseyeva R, Kawashima I Physicochemical basis of the biologic properties of mineral trioxide aggregate. J Endod. 2005; 31:97-100
Naik B, Karunakar P, Jayadev M, Marshal VR Role of platelet rich fibrin in wound healing: a critical review. J Conserv Dent. 2013; 16:284-293
Dohan Ehrenfest DM, de Peppo GM, Doglioli P, Sammartino G Slow release of growth factors and thrombospondin-1 in Choukroun's platelet-rich fibrin (PRF): a gold standard to achieve for all surgical platelet concentrates technologies. Growth Factors. 2009; 27:63-69
Simonpieri A, Del Corso M, Sammartino G, Dohan Ehrenfest DM The relevance of Choukroun's platelet-rich fibrin and metronidazole during complex maxillary rehabilitations using bone allograft. Part I: a new grafting protocol. Implant Dent. 2009; 18:102-111
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Schwartz SA, Koch MA, Deas DE, Powell CA Combined endodontic-periodontic treatment of a palatal groove: a case report. J Endod. 2006; 32:573-578
Hirsch JM, Ahlström U, Henrikson PA, Heyden G, Peterson LE Periapical surgery. Int J Oral Surg. 1979; 8:173-185
Kim B-J, Kwon T-K, Baek H-S, Hwang D-S, Kim C-H, Chung I-K A comparative study of the effectiveness of sinus bone grafting with recombinant human bone morphogenetic protein 2-coated tricalcium phosphate and platelet-rich fibrin-mixed tricalcium phosphate in rabbits. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012; 113:583-592

Combined endodontic-surgical management of a palato-gingival groove in a maxillary lateral incisor with two canals

From Volume 45, Issue 7, July 2018 | Pages 634-640

Authors

Nasil Sakkir

BDS, MDS, PGCOI

Assistant Professor, Department of Conservative Dentistry and Endodontics, Melaka-Manipal Medical College, Malaysia

Articles by Nasil Sakkir

Mohamed Asifulla

BDS, MDS

Registrar Endodontist, Central Security Hospital, Buryadah Al-Qassim, Saudi Arabia

Articles by Mohamed Asifulla

Khaleel Ahamed Thaha

BDS, MDS

Senior Lecturer, Department of Conservative Dentistry and Endodontics, Government Dental College, Thiruvananthapuram, Kerala

Articles by Khaleel Ahamed Thaha

Tony Francis

BDS, MDS

Assistant Professor, Department of Conservative Dentistry and Endodontics, Malaka-Manipal Medical College, Malaysia

Articles by Tony Francis

Abstract

Abstract: Maxillary lateral incisors often exhibit embryological variations and developmental anomalies. The palato-gingival groove (PGG) is a rare anomaly that can pose difficulties in accurate diagnosis and treatment planning. Its presence can predispose to localized periodontal involvement, pulpal necrosis and combined periodontal-endodontic lesions. This case report describes the combined endodontic and surgical management of a complex type of palato-gingival groove in a maxillary right lateral incisor with two canals which was diagnosed with the help of cone beam computed tomography (CBCT) and successfully managed using advanced bioactive materials.

CPD/Clinical Relevance: Clinicians should be familiar with the diagnosis and treatment planning in cases with a palato-gingival groove. Complex cases require combined endodontic and periodontal therapy. Autologous platelet rich fibrin (PRF) is a simple and cost-effective healing aid which helps in the regeneration of attachment apparatus.

Article

The close embryonic, anatomical and functional relationships exhibited by the pulp and periodontium encompass them as a system, where any channel of communication between the two (dentinal tubules, apical foramen, lateral canals, etc) can affect each other. Of them, the rarest is the palato-gingival groove (PGG) which can pose several diagnostic and treatment challenges.1 PGG is a developmental groove found on the palatal aspect of the root of maxillary incisor teeth.2 The defect originates in the vicinity of the cingulum and proceeds apically to varying distances on the root surface, frequently along the distal aspect as well.3 Kogon4 suggested a classification of PGG depending on its extension as:

Goon et al's classification of PGG,1 into simple and complex types, are characterized by partial unfolding of Hertwig's epithelial root sheath (HERS) without pulpal communication in the former, whereas the complex PGG communicates directly with the pulp, with an occasional minor accessory root containing a canal.5

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