|Year : 2011 | Volume
| Issue : 2 | Page : 125-128
Platelet rich plasma in management of palato gingival groove
S Elanchezhiyan1, J Harikaran2, Boris Bhim3
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 Publication||17-Sep-2011|
Department of Periodontia, KSR Institute of Dental Sciences and Research, Tiruchengode
Source of Support: None, Conflict of Interest: None
| 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
| Introduction|| |
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. 
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.  These developmental anomalies are very often missed while diagnosing of localized periodontal pathology.  This article deals with a case report of radicular lingual groove, which treated successfully with interdisciplinary approach.
| Case Report|| |
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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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.
| Discussion|| |
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. ,
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.  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. 
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."
Primary endodontic and conservative management followed by periodontal management.  Initially oral prophylaxis and root canal treatment was done after the regress of the symptoms. "Saucerization" [Figure 3] of the groove , (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]. ,
|Figure 4: Elevation of mucoperiosteal flap after root canal treatment revealing the groove|
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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. , The granulation tissue in the sinus was removed and irrigated with saline.
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]. ,, Following this, postoperative instructions were given.
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]. 
|Figure 10: Postoperative radiograph shows the diameter of the periapical lesion was 4.2 mm mesiodistally|
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| Conclusions|| |
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.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]