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Table of Contents
CASE REPORT
Year : 2011  |  Volume : 1  |  Issue : 2  |  Page : 125-128

Platelet rich plasma in management of palato gingival groove


1 Department of Periodontia, KSR Institute of Dental Sciences and Research, Tiruchengode, India
2 Department of Conservative Dentistry, KSR Institute of Dental Sciences and Research, Tiruchengode, India
3 Private Practice, Rajaji Nagar, Pallavaram, Chennai, Tamil Nadu, India

Date of Web Publication17-Sep-2011

Correspondence Address:
S Elanchezhiyan
Department of Periodontia, KSR Institute of Dental Sciences and Research, Tiruchengode
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5194.85036

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   Abstract 

Accurate diagnosis will be prime aspect in any clinical pathology which helps in effective treatment plan. Improper diagnosis could drastically alter the treatment outcome. Dental developmental anomalies in various forms are often unrevealed things in clinical diagnosis. Unrevealed anomalies could be the hindrance in treatment and may lead into loss of structures. One such most often missed developmental anomaly in periodontal aspect is radicular lingual groove. This article is dealing with a salvaging of radicular lingual groove in 22 with inter disciplinary approach using bone grafts and platelet- rich plasma.

Keywords: Developmental anomaly, radicular lingual groove, often missed, proper diagnosis


How to cite this article:
Elanchezhiyan S, Harikaran J, Bhim B. Platelet rich plasma in management of palato gingival groove. J Interdiscip Dentistry 2011;1:125-8

How to cite this URL:
Elanchezhiyan S, Harikaran J, Bhim B. Platelet rich plasma in management of palato gingival groove. J Interdiscip Dentistry [serial online] 2011 [cited 2019 Oct 13];1:125-8. Available from: http://www.jidonline.com/text.asp?2011/1/2/125/85036


   Introduction Top


Dental anomalies are the developmental defects or deformities which are often unnoticed in diagnosing of pathology. The radicular lingual grooves, otherwise called as palatal radicular grooves, radicular palatal grooves, distolingual grooves, radicular gingival grooves, are developmental anomalies that represent an infolding of the enamel organ and the epithelial sheath of Hertwig. These grooves are locus for plaque accumulation, which destroys the surrounding tissues and the pulpal tissues, hence causing the localized periodontal defect. [1]

The incidence of these grooves is nearly 11%, while the lateral incisors are most affected. According to Mitchell et al. 1892, the region in which the lateral incisors are located is considered to be an area of embryological risk, where number of malformations occur. [2] These developmental anomalies are very often missed while diagnosing of localized periodontal pathology. [3] This article deals with a case report of radicular lingual groove, which treated successfully with interdisciplinary approach.


   Case Report Top


A 38-year-old male visited our hospital with complaints of pain and pus discharge in the left upper front region of jaw for past 6 years. History revealed that pain is mild and intermittent. On soft tissue examination there was an intraoral sinus with pus discharge in relation to labial mucosa of 22. On periodontal examination, the gingiva on the palatal aspect of 22 was inflamed and edematous, bleeding on probing, pus discharge from gingival sulcus area and pocket depth of 9 mm was present. On hard tissue examination, a mild pain on percussion was elicited with grade II mobility of tooth 22 and pulpal vitality tests showed no response to the tooth 22. On radiographic examination a circumscribed radiolucent area with irregular borders with wide periodontal ligament space cervically with crestal bone loss was present [Figure 1]. The case was diagnosed as periapical abscess in relation to 22 with intraoral sinus and localized chronic periodontitis.
Figure 1: Radiographical examination-circumscribed radiolucent area with irregular border with wider periodontal ligament space cervically with crestal bone loss. Diameter of the lesion was 7.6 mm mesiodistally

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Etiology

But in this case there was no history of trauma or caries but, since the tooth had pulpal pathology with an abscess it was difficult to identify the etiologic factor.

On careful examination of the tooth 22, "Radicular lingual groove" [Figure 2] was found on the palatal aspect of tooth 22.
Figure 2: Preoperative photo showing radicular lingual groove

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   Discussion Top


A radicular lingual groove may also be called as palatogingival groove or radicular developmental anomaly or distolingual groove. It is a developmental anomaly showing alterations in the growth and infolding of inner enamel epithelium and Hertwigs epithelial root sheath creating a groove that passes from cingulum of maxillary incisors apically on to the root. [4],[5]

They involve primarily the maxillary lateral incisors and their incidence was found to be 11% of the population. It represents an aborted attempt to form an additional root. These grooves can create periodontal and pulpal pathology. The groove may be considered as important etiological factor for localized periodontaitis. The prevalence in lateral incisors is 11% according to Albericci et al. In this prevalence in lateral incisors, nearly 9-10% of radicular grooves reached the root apex, while others are considered to be flat. [2] These grooves generally begin in the central fossa, cross the cingulam and extend on the root surface with various depths and directions. The fold usually extended as a twisting defect into the surface of the root to a depth of 2-3 mm. It could be seen as radiolucent parapulpal line in the X-ray. Bacterial ingress into the pulp space could be through the accessory canals which connecting to the pulp in the depth of the grooves. The pulpal involvement could result due to bacterial toxin entering through channels between the root canal system and the groove These bacterial organisms could originate from the plaque accumulated on the groove surface. The pulpal involvement makes the pulp into nonvital and the necrotic contents of the pulp could spread into the surrounding periodontal supporting structures and it usually causes the formation of localized periodontal pathology.

Theoretically this is a Perio-Endo lesion showing a classification of "Primary Periodontic and Secondary Endodontic lesion", where microbial plaque retention followed by gingival irritation caused a break in the epithelial attachment creating a periodontal pocket, there by spreading the inflammation to the pulp through the groove and there by involving the apex. [5]

The cleansing of the region by the patient is impossible causing consequent periodontal pocket formation. The region in which the lateral incisors are located is considered an area of embryological risk, where a number of malformations occur. So the etiology was identified as "radicular lingual groove."

Treatment done

Primary endodontic and conservative management followed by periodontal management. [6] Initially oral prophylaxis and root canal treatment was done after the regress of the symptoms. "Saucerization" [Figure 3] of the groove [7],[8] (grinding it out to its depth using a small round diamond bur) was accomplished by elevation of full thickness mucoperiosteal flap using internal bevel incision [Figure 4], root planning to debride the root surface near the groove area was done and the groove was closed with conventional glass ionomer cement [Figure 5]. [5],[9]
Figure 3: Saucerization of the groove with small round diamond burs

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Figure 4: Elevation of mucoperiosteal flap after root canal treatment revealing the groove

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Figure 5: The groove is closed with conventional glass ionomer cement

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The root apex was infected with abscess, more accessory root canals and ramifications were present at the apical one-third, and "Apicectomy" [Figure 6] was performed to prevent the recurrence of the pathology. This procedure was carried out by removing 2 mm of apical third of root with a straight diamond bur and retrofilled with glass ionomer cement. [10],[11] The granulation tissue in the sinus was removed and irrigated with saline.
Figure 6: Apicectomy

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Root conditioning was done with citric acid and platelet rich plasma [Figure 7] was packed in the defect associated with and flaps approximated with sutures [Figure 8]. [12],[13],[14] Following this, postoperative instructions were given.
Figure 7: Platelet-rich plasma was packed in the defect

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Figure 8: Suturing

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Postoperative examination revealed healing was satisfactory and clinically there was reduction in the pocket depth of 5 mm in 6 months interval and the patient is asymptomatic with a 4 mm nonbleeding sulcus present on the palatal aspect [Figure 9]. Radiographically; a reduction in diameter of the lesion of 4.1 mm was found [Figure 10]. [15]
Figure 9: Postoperative probing depth of 4 mm with nonbleeding sulcus

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Figure 10: Postoperative radiograph shows the diameter of the periapical lesion was 4.2 mm mesiodistally

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   Conclusions Top


The knowledge of tooth anatomy and the etiology offers a strong base for establishing a perfect diagnosis. The radicular lingual groove if most often missed out during oral examination, so dentist must be cautious in diagnosing this developmental defect also.

Now by the above treatment protocol, a single tooth can now be diagnosed correctly and treated successfully with a predictable prognosis.

 
   References Top

1.Didilescu A, Iiescu R, Rusu D, Strtul S. Current concepts on the relationship between pulpal and periodontal diseases. TMJ 2008;58:98-103.  Back to cited text no. 1
    
2.Albaricci MF, de Toledo BE, Zuza EP, Gomes DA, Rosetti EP. Prevalence and features of palato-radicular grooves: An in-vitro study. J Int Acad Periodontol 2008;10:2-5.   Back to cited text no. 2
    
3.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. 3
    
4.Gound TG, Maze GI. Treatment options for the radicular lingual groove a review and discussion. Pract Periodontics Aesthet Dent 1998;10:369-75.  Back to cited text no. 4
    
5.Fabra-Campos H. Failure of endodontic treatment due to a palatal gingival groove in a maxillary lateral incisor with talon cusp and two root canals. J Endod 1990;16:342-5.  Back to cited text no. 5
    
6.Khojastehpour L, Khajat A. Maxillary central incisor with two roots: A case report. Journal of Dentistry. Vol. 2. Tehral, Iran: Tehran University of Medical Sciences; 2005.  Back to cited text no. 6
    
7.Rachana D, Nadig P, Nadig G. The palatal groove: Application of computed tomography in its detection - a case report. J Conserv Dent 2007;10:83-8.  Back to cited text no. 7
  Medknow Journal  
8.Vitaya CT. Management of developmental anomalies in maxillary incisor: Case report. J Dent Assoc Thai 1990;40:269-76.  Back to cited text no. 8
    
9.Meister F Jr, Keating K, Gerstein H, Mayer JC. Successful treatment of a radicular lingual groove: Case report. J Endod 1983;9:561-4.  Back to cited text no. 9
    
10.Barkhordar RA, Pelzner RB, Stark MM. Use of glass ionomers as retrofilling materials. Oral Surg Oral Med Oral Pathol 1989;67:734-9.  Back to cited text no. 10
    
11.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. 11
    
12.Daly CG. Anti-bacterial effect of citric acid treatment of periodontally diseased root surfaces in vitro. J Clin Periodontol 1982;9:386-92.  Back to cited text no. 12
    
13.Ouyang XY, Qiao J. Effect of platelet-rich plasma in the treatment of periodontal intrabony defects in humans. Chin Med J (Engl) 2006;119:1511-21.  Back to cited text no. 13
    
14.Cecília MS, Lara VS, de Moraes IG. The palato-gingival groove. A cause of failure in root canal treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85:94-8.  Back to cited text no. 14
    
15.Ballal NV, Jothi V, Bhat KS, Bhat KM. Salvaging a tooth with a deep palatogingival groove: An endo-perio treatment-a case report. Int Endod J 2007;40:808-17.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]



 

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