|Year : 2012 | Volume
| Issue : 1 | Page : 41-43
Bilateral facial radicular groove in maxillary incisors
TS Srinivas1, NT Pradeep2
1 Department of Periodontology, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh, India
2 Department of Conservative and Endodontics, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh, India
|Date of Web Publication||22-Mar-2012|
T S Srinivas
Department of Periodontology, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Radicular grooves are developmental anomalies of maxillary incisors, which contribute to localized periodontitis resulting in loss of anterior teeth. Radicular grooves, when present, act as a site for plaque accumulation and causes periodontal destruction. The clinician has to be check for variations in the anomalies of the tooth and treat them. This case report of describes the diagnosis and management of bilateral radical groove maxillary central incisors.
Keywords: Glass ionomer cement, localized periodontitis, maxillary central incisor, periodontal pockets
|How to cite this article:|
Srinivas T S, Pradeep N T. Bilateral facial radicular groove in maxillary incisors. J Interdiscip Dentistry 2012;2:41-3
| Introduction|| |
The radicular groove is a rare developmental anomaly with important clinical implications. As the name implies, this malformation is actually a groove, which starts near the cervical one-third of tooth and runs toward the cemento enamel junction (CEJ) in an apical direction of various depths along the root surface.
The etiology of this defect is not understood; the defect apparently arises from the infolding of the enamel epithelium and Hertwig's root sheath during odontogenesis,  some have speculated that this is an attempt to form another root,  some believe that this represents the mildest form of dens invaginatus. 
The clinical presentation of the defect is often on the lingual/palatal root surface, but on occasion, the facial aspect can be involved and it is very rare.  Only four cases of incisors with buccal radicular grooves have been reported, describing bilateral location. ,,,,
Pecora et al. studied the incidence of radicular grooves in maxillary incisors; these were present in 39% of the patients and most were present on palatal surface of maxillary lateral incisors 3%; maxillary central incisors showed an incidence of 0.9% of radicular grooves. In this report, a clinical case is presented in which bilateral facial radicular grooves on maxillary incisors were noted, which were associated with formation of periodontal pockets and bone loss.
| Case Report|| |
A 24-year-old man reported to Department of periodontology and Implantology, Bapuji Dental College and Hospital Davangere, with a chief complaint of bleeding gums in upper front teeth. The medical history was noncontributory. Intraoral examination revealed a 7-mm and 5-mm periodontal pocket associated with mid buccal surface of #11 and #21, respectively [Figure 1] and [Figure 2]. Vitality test gave a positive response, indicating that the tooth was vital. An invagination was present, starting coronal to the free marginal gingiva, which crossed the CEJ and extended to the root in the form of groove. The gingiva was well adapted into this invagination present on the crown. Radiographic examination revealed horizontal bone loss i.r.t #11 and #21 [Figure 3].
|Figure 2: Photograph showing periodontal pocket associated with mid buccal surface of #11 and #21|
Click here to view
|Figure 3: Radiographic image showing horizontal bone loss i.r.t #11 & #21|
Click here to view
It was decided to treat the periodontal pocket using modified flap procedure  under local anesthesia (2% Xylocaine HCL with 1: 80 000 adrenaline). This technique was utilized to minimize the postoperative recession and maintain esthetics. After completion of Phase I therapy, the flap was reflected to expose the facial invagination extending from enamel along the root to the level of the bony crest. A bony dehiscence-like defect was observed on the facial aspect of #11 and #21 and extending from facial invagination in the enamel along the root to the level of the bony crest [Figure 4].
|Figure 4: Photograph showing a bony dehiscence-like defect was observed on the facial aspect of #11 and #21|
Click here to view
All local irritants which were present in vertical grooves were scaled, the root was carefully planned, and the defects were curetted. After thorough irrigation with saline, the area was inspected for calculus and granulation tissue. It was then decided to eliminate the grooves with Glass Ionomer cement(GIC) filling. The filling was polished thoroughly and flap was sutured back to its original position. A periodontal dressing was placed for a period of one week. Healing was uneventful [Figure 5].
| Discussion|| |
There are numerous morphologic anomalies that can predispose to periodontal diseases, examples: cervical enamel projection, palatoradicular grooves, etc. It has been suggested that palatal grooves on maxillary incisor teeth are predisposing factor to localized severe periodontal destruction. The maxillary facial grooves probably act in a similar manner, as in the present case.  The radicular groove involves the external surface of both the crown and root; this unique clinical feature allows localized periodontal disease to develop readily and breakdown the fragile sulcular attachment adjacent to the defect.  The groove can vary in depth, extent, and complexity; mild grooves are gentle depression of the coronal enamel which terminate at or immediately after crossing CEJ.  Moderate grooves continue to extend some distance apically along the root; even in our present case, the moderate type of groove was present.
A variety of histological appearances are nevertheless seen as the radicular groove. Mild involved specimens reveal a gentle depression of the radicular dentin lined with cementum. Moderately involved specimens showed a deep dental defect with varying amount of cementum; surface root resorption into the base of the groove is evident in specimens with granulation tissue contacting the defect. 
Diagnosis of radicular groove is not always easy. This is because the defect may manifest itself with symptoms of true periodontal disease. Differential diagnosis must include a long-standing crack on the crown or a vertical root fracture;  the final diagnosis is greatly aided by the detection of the notch in the crown, but it is not easy to detect this notch as it may be hidden below by the gingival margin or plaque.
The prognosis of teeth with radicular grooves depends on the severity of the periodontal problem, accessibility of the defect, and the type of groove (shallow-deep short/long); based on this, the following different treatment modalities have been proposed 
As the defect was of a moderate type, in the present case, restoration was done by using Glass ionomer cement, which is biocomptable and does not hamper the esthetics.
- Gingivectomy or subgingival curettage.
- Conservative treatment by eliminating the grooves with restorative materials.
- Combined endodontic and periodontal treatment in severe cases.
- Orthodontic extrusion.
| Conclusion|| |
This case reports the successful treatment of localized periodontal lesion on maxillary central incisors associated with facial radicular grooves. These defects may provide seat for local factors to accumulate. Deep radicular grooves may predispose to pulp necrosis and establishment of combined endodontic periodontal lesions. Eliciting the clinical signs at the earliest, by careful examination, is of paramount importance in the treatment of radicular grooves.
| References|| |
|1.||Lee KW, Lee EC, Poon KY. Palatogingival grooves in maxillary incisor. A possible predisposing factor to localized periodontal disease. Br Dent J 1968:124:14-8. |
|2.||Peikoff MD, Trott JR. An endodontic failure caused by an unusual anatomic anomaly. J Endod 1977;3:356-9. |
|3.||Kozlovsky A, Tal H, Yechezkiely N, Moses O. Facial Radicular groove in maxillary central incisor: a case report. J Periodontol 1988;59:615-7. |
|4.||Pecora JD, Sousaneto MD, Santos TC, Saquy PC. In vitro study of the incidence of Radicular grooves in maxillary incisors. Br Dent J 1991:2:69-73. |
|5.||Goon WW, Carpenter WM, Brace NM, Ahlfeld RJ. Complex facial radicular groove in a maxillary lateral incisor. J Endod 1991;17:244-8. |
|6.||Kerezoudis NP, Siskos GJ, Tsatsas V. Bilateral buccal Radicular groove in maxillary central incisors: case report. Int Endod J 2003;36:898-906 |
|7.||Joshi NV, Marawar PP, Deshmukh J. Treatment of periodontal lesion associated with bilateral facial radicular groove in maxillary incisors: A case report. J Indian Soc peridentol 2005;8:19-22. |
|8.||Kirkland O. The suppurative periodontal pus pocket: its treatment by modified flap operation. JADA 1935;18:1462-70. |
|9.||Everett FG, Kramer GM. The distolingual groove in maxillary lateral incisor; a periodontal hazard. J Periodontol 1972;43:352-61. |
|10.||Withers JA, Brunsvold MA, Killoy WJ, Rahe AI. The relationship of Palatogingival grooves to localized periodontal disease. J Periodontol 1981;52:41-4. |
|11.||Prichard JS. Advanced periodontal therapy, 1st ed. Philadelphia:, W.B. Saunders co; 1965. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]