Palatal groove associated with periodontal lesions: a systematic review illustrated by a decisional tree for management.

BACKGROUND: Palatal groove represents a relatively uncommon developmental root anomaly, usually found on the palatal aspect of maxillary incisors. While its origin is controversial, its presence predisposes to severe periodontal defects. AIM: This study aimed to provide a systematic review of the literature focusing on the varied diagnostic techniques and treatment modalities for periodontal lesions arising from the presence of palatal groove. Based on the existing evidence and knowledge, the study also provides a comprehensive decisional tree, guiding clinicians in the challenging decision-making process face to a palatal groove. METHODS: The literature search was conducted on Medline and Cochrane databases by two independent reviewers, who also performed the screening and selection process, looking for English written articles reporting on diagnosis and management (all treatment approaches) of periodontal lesion(s) associated with a palatal groove. Based on this literature, a comprehensive decisional tree, including a standardized palatal groove evaluation and tailored treatment approaches, is proposed. Moreover, a clinical case is described to demonstrate the practical application of the developed decisional tree. RESULTS: Over a total of 451 articles initially identified, 34 were selected, describing 40 patients with 40 periodontal lesions associated with palatal grooves. The case report illustrates a deep, large, circumferential intra-bony defect on the palatal side of the tooth #22 associated with a shallow, moderately long palatal groove in an 18-year-old male patient. Following reevaluation, a single flap surgery was deemed necessary, combined with a regenerative procedure. At 2 years post-treatment, the tooth #22 is healthy, in a functional and esthetic position. The decision-making process, based on local and systemic patient's conditions, should allow an early and precise diagnosis to prevent further complications and undertake an adequate treatment. CONCLUSION: Palatal grooves are relatively rare; however, they are frequently associated with severe periodontal defects. The identification, diagnosis, prompt, and tailored management of the associated lesion is essential to mitigate potential periodontal and endodontic complications related to the presence of palatal groove. SYSTEMATIC REVIEW REGISTRATION: [ https://www.crd.york.ac.uk/prospero/ ], identifier [C CRD42022363194].

Intentional replantation for the treatment of a double-rooted maxillary lateral incisor with periodontal-endodontic lesions: a case report and literature review / 口腔疾病防治

Objective@#To investigate the clinical characteristics, diagnosis and treatment of severe combined periodontal-endodontic lesions in a double-rooted maxillary lateral incisor with a palatal radicular groove and to provide a reference for clinical diagnosis and treatment.@*Methods@#A patient with a double-rooted left maxillary lateral incisor with a palatal radicular groove and severe combined periodontal-endodontic lesions underwent complete root canal therapy and intentional replantation, and a retrospective analysis of the management of this type of patient was performed based on the literature.@*Results@#The 3-year follow-up examination revealed no discomfort, good healing of the upper left lateral incisor, no pathological loosening, and a palatal gingival sulcus was found at a depth of approximately 1 mm. Review of the literature showed that the prognosis of the affected tooth and the choice of treatment plan were correlated with the length and depth of extension of the lingual groove toward the root, the periodontal condition and the pulpal status of the affected tooth. For minor PRGs or for affected teeth with no loss of pulpal viability, flap surgery and odontoplasty can be used to avoid endodontic treatment or retreatment. For deep or long lingual grooves that result in significant loss of periodontal tissue, endodontic treatment, odontoplasty, or closure of the grooves and guided tissue regeneration are needed. In the case of PRGs with double root formation, the affected tooth can be preserved via root canal therapy, removal of the small root and filling with apical restorative material, and intentional replantation.@*Conclusion@#In cases of severe combined periodontal-endodontic lesions due to palatal radicular grooves occurring in double-rooted maxillary lateral incisors, clinical presentation and imaging can prevent missed diagnoses, and appropriate treatment should be based on the length and depth of lingual grooves extending toward the roots, periodontal conditions, and pulpal status of the affected teeth.

Multi-disciplinary treatment of severe palatal radicular groove of maxillary lateral incisor: A case report and literature review. / 上颌侧切牙重度畸形舌侧沟多学科联合治疗1ä¾‹å¹¶æ–‡çŒ®å¤ä¹ .

Palatal radicular groove is a developmental malformation of maxillary incisors, lateral incisors in particular, which often causes periodontal destruction. This paper reports a case of combined periodontal-endodontic lesions induced by palatal radicular groove, which was initially misdiagnosed as a simple periapical cyst. After root canal therapy and periapical cyst curettage, the course of disease was prolonged, resulting in the absence of buccal and maxillary bone plates in the affected tooth area. After the etiology was determined, the affected tooth was extracted and guide bone tissue regeneration was performed at the same time, followed by implantation and restoration at the later stage, leading to clinical cure. The palatal radicular groove is highly occult, and the clinical symptoms are not typical. If the abscess of the maxillary lateral incisor occurs repeatedly, and the abscess of the maxillary lateral incisor has not been cured after periodontal and root canal treatment, cone-beam computed tomographic and periodontal flap surgery should be considered.

Multi-disciplinary treatment of severe palatal radicular groove of maxillary lateral incisor: A case report and literature review / 中南大学学报(医学版)

Palatal radicular groove is a developmental malformation of maxillary incisors, lateral incisors in particular, which often causes periodontal destruction. This paper reports a case of combined periodontal-endodontic lesions induced by palatal radicular groove, which was initially misdiagnosed as a simple periapical cyst. After root canal therapy and periapical cyst curettage, the course of disease was prolonged, resulting in the absence of buccal and maxillary bone plates in the affected tooth area. After the etiology was determined, the affected tooth was extracted and guide bone tissue regeneration was performed at the same time, followed by implantation and restoration at the later stage, leading to clinical cure. The palatal radicular groove is highly occult, and the clinical symptoms are not typical. If the abscess of the maxillary lateral incisor occurs repeatedly, and the abscess of the maxillary lateral incisor has not been cured after periodontal and root canal treatment, cone-beam computed tomographic and periodontal flap surgery should be considered.

Diverse microbiota in palatal radicular groove analyzed by Illumina sequencing: Four case reports.

BACKGROUND: A palatal radicular groove is an unusual developmental deformity of the tooth, which may serve as a channel linking the periodontal and periapical inflammation, and yet no literature could be obtained analyzing microbiota within the palatal radicular grooves. CASE SUMMARY: Four patients diagnosed with palatal radicular groove and concomitant periodontal-endodontic deformity in permanent maxillary lateral incisors were enrolled in this work. Twelve bacterial samples from 4 patients were collected from different parts of the palatal radicular groove during intentional replantation surgery. Illumina sequencing was performed to analyze the taxonomical composition and microbiome structure inside the palatal grooves, and 1162 operational taxonomic units were obtained. The phyla of Firmicutes and Proteobacteria predominated in most of the samples. An unknown genus from the Bacillaceae family, Lactococcus, and Porphyromonas were the most abundant genera identified. There was no difference in the microbiota richness and diversity in three sections of the groove. CONCLUSION: The unique ecological niches inside the palatal grooves harbored bacterial communities that shared some component features of both the endodontic and periodontal infections. The existence of palatal groove may play an interaction bridge between the root apex and tooth cervix and thus impair the outcome of traditional therapeutic methods such as root canal treatment and periodontal management.

[Intentional replantation for the treatment of palatal radicular groove with endo-periodontal lesion in the maxillary lateral incisor: a case report].

Palatal radicular groove leads to severe endo-periodontal lesion in lateral incisors. The groove occurs on the labial and lingual root surfaces, while the localized periodontal pocket develops along the lingual groove length. The complicated root canal system, extensively destroyed bone lamella, and persistent fistula pose a challenge for root canal therapy, tooth retention, and thorough infection control inside and outside of the root canal. Combining microscopic root canal therapy with intentional replantation and nano-biomaterial application facilitates infection control, tooth retention, and formation of newly periodontal attachment.

Palatal Radicular Groove Morphology of the Maxillary Incisors: A Case Series Report.

INTRODUCTION: Teeth with a palatal radicular groove are challenging to diagnose, treat, and save. We classified this condition using cone-beam computed tomographic (CBCT) cross-sectional configurations combined with radiographic and morphologic observations during an intentional replantation procedure to identify and analyze the characteristics of palatal radicular grooves comprehensively as a reference for diagnosis, treatment planning, and prognosis evaluation of this condition. METHODS: Eight cases with palatal radicular grooves present in permanent maxillary incisors were investigated by radiography and CBCT imaging before intentional replantation. RESULTS: The palatal radicular grooves were classified into 3 types based on groove depth and cross-sectional shape on CBCT images: type I, with a shallow groove depth, corresponding to a normal, simple, and single root canal; type II, with a medium groove depth, corresponding to a C-shaped canal system; and type III, with a deep groove depth, almost bisecting the root of the tooth, simultaneously present with 2 independent root canals and an apex with normal shape, corresponding to a labial groove connecting with a palatal groove. The extracted teeth and their radiographic images showed corresponding characteristics. CONCLUSIONS: The CBCT cross-sectional images allowed the best visualization of the depth of the grooves and highlighted the difficulties entailed in treating such teeth. Intentional replantation is an effective therapeutic decision for this type of deformity and can provide better prognosis estimation, especially in teeth with type II and III grooves.

Intentional replantation for the treatment of palatal radicular groove with endo-periodontal lesion in the maxillary lateral incisor: a case report / 华西口腔医学杂志

Palatal radicular groove leads to severe endo-periodontal lesion in lateral incisors. The groove occurs on the labial and lingual root surfaces, while the localized periodontal pocket develops along the lingual groove length. The complicated root canal system, extensively destroyed bone lamella, and persistent fistula pose a challenge for root canal therapy, tooth retention, and thorough infection control inside and outside of the root canal. Combining microscopic root canal therapy with intentional replantation and nano-biomaterial application facilitates infection control, tooth retention, and formation of newly periodontal attachment.