Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contact us Login 
  • Users Online:929
  • Home
  • Print this page
  • Email this page


 
 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 7  |  Issue : 2  |  Page : 240-242

Radicular lingual groove: A contributory factor in periodontal pathology


1 Dental Hospital and Implant Centre, Mehatpur, Himachal Pradesh, India
2 Dental Hospital and Implant Centre, Mohali, Punjab, India
3 Department of Periodontics, Himachal Institute of Dental Sciences, Paonta Sahib, Himachal Pradesh, India

Date of Submission21-Aug-2019
Date of Decision18-Oct-2019
Date of Acceptance21-Oct-2019
Date of Web Publication16-Dec-2019

Correspondence Address:
Dr. Gaurav Didhra
Dental Hospital and Implant Centre, Opp. UCO Bank Main Bazar, Mehatpur - 174 315, Himachal Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_115_19

Rights and Permissions
  Abstract 


Radicular gingival groove is a developmental anomaly most commonly occurring in the maxillary anterior teeth that acts as a hidden trap in the tooth which accumulates plaque and periodontal pathogens, leading to the formation of periodontal pocket with or without pulpal involvement. The diagnosis of these grooves in terms of radiographic images is very difficult to predict and can only be appreciated as per patient's chief complaint along with clinical examination of periodontal pocket depth with probing and endodontic treatment of tooth if pulpal involvement is present.

Keywords: MTAD BioPure, radicular lingual groove, root conditioning


How to cite this article:
Didhra G, Singh J, Gupta R, Dahiya P. Radicular lingual groove: A contributory factor in periodontal pathology. Arch Med Health Sci 2019;7:240-2

How to cite this URL:
Didhra G, Singh J, Gupta R, Dahiya P. Radicular lingual groove: A contributory factor in periodontal pathology. Arch Med Health Sci [serial online] 2019 [cited 2020 Oct 29];7:240-2. Available from: https://www.amhsjournal.org/text.asp?2019/7/2/240/273051




  Introduction Top


Palatogingival groove or radicular lingual grooves are developmental malformations that were described by Everett and Kramer (1972) and Robison and Cooley (1988). They are usually found on the lingual surface of maxillary lateral incisors.[1] They have an incidence rate ranging from 2.8% to 18%.[2] They originate when the central fossa crosses the cingulum and extend toward root portion in apical direction.[3] They act as a shelter for bacterial plaque and calculus accumulation, which makes it difficult for both the patient and the professional to clean it, resulting in the development of inflammation in the periodontal tissues adjacent to the groove, leading to the detachment of junctional epithelium, periodontal destruction, pocket formation, and alveolar bone loss.[4] The prognosis of tooth in such cases depends on both periodontal and endodontic treatment approaches as in most cases, the microbial flora of plaque may extend toward the pulp, leading to necrosis of the pulp with periapical pathologies. Accessory canals are the main source of communication between pulp and periodontium of incisors with radicular lingual grooves.[5]

The present case report demonstrates the management of a maxillary lateral incisor with radicular groove in the midpalatal region involving both endodontic and periodontal approaches along with the use of MTAD BioPure™ as a newly introduced material in periodontics for root conditioning.


  Case Report Top


A 36-year-old male patient reported to the clinic with the complaint of pain in the maxillary right lateral incisor for the last 2 weeks. Dental history revealed no previous trauma or any relevant finding. On clinical examination, the tooth was intact with no mobility and was tender on percussion with periodontal pocket depth of around 10 mm in the midpalatal region measured by a UNC-15 Periodontal probe [Figure 1]. Electronic pulp testing revealed no response showing the presence of nonvital pulp that may have necrosis with time due to the extension of periodontal pathology. Intraoral periapical radiograph showed the presence of lateral and periapical radiolucency [Figure 1]. Based on these findings, the tooth was found to have a radicular lingual groove with localized periodontitis along with necrotic pulp.
Figure 1: Clinical evaluation with periodontal probing and radiographic findings

Click here to view


A combined endodontic and periodontal approach was planned. In the first phase of the treatment, root canal treatment of the tooth was performed using 5.2% sodium hypochlorite with subsequent calcium hydroxide (Ca(OH)2) dressings after 1 week for 2 times followed by obturation. Then, localized flap surgery was performed over the area using intrasulcular incision showing a large palatogingival groove with calculus deposits along with bony defect [Figure 2]. Thorough scaling and root planing of the area was done along with debridement by using Gracey curette number 1/2 (Hu-Friedy). After this, odontoplasty of the groove was done using a round diamond bur to make it a smooth polished surface [Figure 2].
Figure 2: Clinical situation after flap reflection and after root planing and odontoplasty

Click here to view


The final step involved the root conditioning of the tooth surface with MTAD BioPure (mixture of tetracycline, citric acid, and detergent) [Figure 3]. After this, the flap was sutured back and covered with periodontal dressing (COE-PAK™ by GC) [Figure 3].
Figure 3: MTADTM (mixture of tetracycline, citric acid, and detergent), surgical site covered with periodontal dressing

Click here to view


The patient was recalled after 1 week, and his clinical condition was assessed with removal of periodontal dressing and sutures and was kept under observation. After 1 month, the periodontal condition of the tooth was assessed clinically by probing and much improvement was seen in terms of probing depth which was reduced to 4 mm with a clinical attachment gain of 6 mm (earlier, the probing depth was 10 mm) [Figure 4].
Figure 4: Clinical evaluation after 1 month

Click here to view



  Discussion Top


Radicular lingual groove is one of the developmental anomalies of maxillary incisors that occurs as a result of infolding of the inner enamel epithelium and Hertwig's epithelial root sheath that creates a groove passing from the cingulum of the incisors toward apical direction onto the root; as a result, later on, this anomaly creates a niche for plaque and bacterial accumulation, leading to both pulpal and periodontal problems.[6] Recognizing palatogingival groove is not easy always as it may involve symptoms of true periodontal lesion or true endodontic lesion or a combination of both; the final diagnosis is made based on clinical examination and detecting a notch in the lingual surface of crown. More than 50% of the palatogingival grooves are seen to extend beyond the cemento-enamel junction onto the root surface. Among these grooves traversing the root, 43% have shown to extend apically <5 mm in distance, 47% between 6 and 10 mm, and 10% have shown extension beyond 10 mm.[1] Based on the invagination of the groove toward the pulp cavity, these have been termed as shallow/flat (<1 mm), deep (>1 mm), and a closed tube.[7]

Radicular lingual grooves are classified as simple and complicated. Simple grooves are less likely to communicate with pulp as they are shallow and represent only minute folding of Hertwig's epithelial root sheath, whereas complicated grooves are deep and more likely to communicate with the pulp, causing combined endodontic and periodontal lesion.[8] The final diagnosis of such combined lesions is aided by detecting notch in the tooth crown and periodontal probing.[9]

In the present case, the exploration of the lingual fossa of the tooth revealed fissure-shaped defect that was covered by plaque and calculus, and periodontal examination revealed a deep pocket depth of 10 mm in the midpalatal region. The pulp was also nonvital, with radiographs showing periapical and lateral radiolucency. First, endodontic therapy was completed; later on, periodontal therapy was initiated involving open flap debridement involving scaling and root planing with odontoplastly of the groove. After root planing, a smear layer is formed that serves as a physical barrier between the periodontal tissue and the root surface and may inhibit the formation of new connective tissue attachment to the root surface.[10] For this purpose, MTAD BioPure was used as a root-conditioning agent which showed excellent results in terms of clinical pocket depth reduction with gain in periodontal attachment levels. The patient was kept under observation and follow-up visits and showed excellent improvements in pocket depth reduction from 10 mm early to around 4 mm.

BioPure MTAD (Dentsply Tulsa Dental, USA) is a material originally developed as a final irrigant for endodontics. It is a mixture of doxycycline (a tetracycline isomer), citric acid, and polysorbate-80 (a detergent). MTAD has been reported to remove the smear layer effectively, eliminate microbes that are resistant to conventional endodontic irrigants and dressings, and provide sustained antimicrobial activity. Studies have shown better smear layer removal and enhanced fibroblastic attachment to the tooth surface of MTAD as compared to other root conditioners. This is in accordance with the study done by Zia et al., 2014,[11] and Tandon et al., 2015.[12]


  Conclusion Top


It is, therefore, concluded that an interdisciplinary approach is required in such type of cases following both endodontic therapy and periodontal treatment. Here, we tried using MTAD which is a newly introduced product in the branch of periodontics as a root-conditioning agent that showed excellent results clinically.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lee KW, Lee EC, Poon KY. Palato-gingival grooves in maxillary incisors. A possible predisposing factor to localised periodontal disease. Br Dent J 1968;124:14-8.  Back to cited text no. 1
    
2.
Hou GL, Tsai CC. Relationship between palato-radicular grooves and localized periodontitis. J Clin Periodontol 1993;20:678-82.  Back to cited text no. 2
    
3.
Withers JA, Brunsvold MA, Killoy WJ, Rahe AJ. The relationship of palato-gingival grooves to localized periodontal disease. J Periodontol 1981;52:41-4.  Back to cited text no. 3
    
4.
Kerezoudis NP, Siskos GJ, Tsatsas V. Bilateral buccal radicular groove in maxillary incisors: Case report. Int Endod J 2003;36:898-906.  Back to cited text no. 4
    
5.
Gao ZR, Shi JN, Wang Y, Gu FY. Scanning electron microscopic investigation of maxillary lateral incisors with a radicular lingual groove. Oral Surg Oral Med Oral Pathol 1989;68:462-6.  Back to cited text no. 5
    
6.
Gupta KK, Srivastava A, Srivastava S, Gupta J. Palatogingival groove - a silent killer: Treatment of an osseous defect due to it. J Indian Soc Periodontol 2011;15:169-72.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Kogon SL. The prevalence, location and conformation of palato-radicular grooves in maxillary incisors. J Periodontol 1986;57:231-4.  Back to cited text no. 7
    
8.
Goon WW, Carpenter WM, Brace NM, Ahlfeld RJ. Complex facial radicular groove in a maxillary lateral incisor. J Endod 1991;17:244-8.  Back to cited text no. 8
    
9.
Kim H, Noh YS, Chang HS, Ryu HW, Min KS. The palato-gingival groove - anatomical anomaly occurred in maxillary lateral incisors: Case reports. J Kor Acad Cons Dent 2007;32:483-90.  Back to cited text no. 9
    
10.
Hanes PJ, O'Brien NJ, Garnick JJ. A morphological comparison of radicular dentin following root planing and treatment with citric acid or tetracycline HCl. J Clin Periodontol 1991;18:660-8.  Back to cited text no. 10
    
11.
Zia A, Andrabi SM, Bey A, Kumar A, Fatima Z. Endodontic irrigant as a root conditioning agent: Anin vitro scanning electron microscopic study evaluating the ability of MTAD to remove smear layer from periodontally affected root surfaces. Singapore Dent J 2014;35:47-52.  Back to cited text no. 11
    
12.
Tandon C, Govila V, Pant VA, Meenawat A. Comparativein vitro SEM study of a novel root canal irrigant-MTAD and conventional root biomodifiers on periodontally involved human teeth. J Indian Soc Periodontol 2015;19:268-72.  Back to cited text no. 12
[PUBMED]  [Full text]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Report
Discussion
Conclusion
References
Article Figures

 Article Access Statistics
    Viewed591    
    Printed68    
    Emailed0    
    PDF Downloaded100    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]