Relationship between palato-radicular grooves and localized periodontitis

Cone-beam computed tomographic evaluation to estimate the prevalence of palatogingival groove in the maxillary anterior teeth and its radiographic characteristics: An institutional retrospective study

Aim

The purpose of the study was to radiographically evaluate the prevalence of palatogingival groove (PG) in the East Indian population in the maxillary anterior teeth in different genders, its unilateral/bilateral presentation, classified based on its radiographic characteristics, to determine the prevalence of different types, which could help in future treatment planning.

Study Design

The design of the study was a retrospective study.

Materials and Methods

Analysis of 429 maxillary anterior teeth (144 central incisors, 145 lateral incisors, and 139 canines) in 72 cone-beam computed tomography scans was done (31 males and 41 females, mean age 27.3 ± 7.63). Demographic details of patients and characteristics of PG, i.e. location, extension, depth, and type, were recorded. The presence of alveolar bone loss and periapical pathology was noted.

Results

An overall prevalence of PG was found to be 2.33% (n = 10), with PG being detected in 2 (1.388%) central incisors, 8 (5.51%) lateral incisors, and 0 (0%) canines. Eight of the patients had a unilateral presence, while one patient reported with bilateral presence, implying a significantly higher predilection of unilateral occurrence (P = 0.02). The prevalence was found to be higher in females (n = 8). The teeth were categorized as either having Type I (6 teeth), Type II (3 teeth), or Type III (1 teeth). Three of the 10 PGs were present in the mesial, six in the mid-palatal, and one in the distal portion of the palatal surface.

Conclusions

The prevalence of PG in the maxillary incisors in this cohort is 2.33%. The maxillary lateral incisors are the most affected teeth. Unilateral presentation is more common.

Prevalence of palatogingival groove affecting maxillary anterior teeth in Saudi subpopulation: A cone-beam computed tomographic study with literature review

Aim

To investigate the prevalence of palatogingival groove (PGG) affecting maxillary anterior teeth, bilateral occurrence, and distribution among sex in the Saudi subpopulation and to review the literature on the prevalence of PGG.

Introduction

Palatogingival groove (PGG) primarily affects maxillary lateral incisors and, when present, may contribute to the pathogenesis of periodontal and endodontic lesions.

Materials & methods

A total of 509 CBCT scans of Saudi patients with 2747 maxillary anterior teeth were included in the study. Patients' information, the tooth type, the presence/absence, the unilateral/bilateral distribution, and the type of PGG according to Gu's classification (type I, II, or III) were recorded.

Results

The prevalence of the PGG in maxillary anterior teeth was 1.3%, affecting 32 (6.3%) patients. The PGGs were mostly detected in lateral incisors 25 (2.77%). The PGG was found to be unilateral in most patients (96.9%), with higher frequency in males than in females without significance for sex.

Conclusion

PGG is not a rare anomaly in the Saudi population and is most frequently found in maxillary lateral incisors. Type I Gu's classification was mostly detected.

Management of Palatogingival Groove in Maxillary Lateral Incisor: A Report of a Rare Case With a Brief Review of Literature

Several morphological abnormalities may occur during tooth development and may be a predisposing factor for periodontal destruction. Palatogingival groove (PGG) is a developmental deformity that may cause localized periodontitis and endodontic complexities. The groove usually originates as a root indentation in the central fossa of the palatal root of maxillary lateral incisors. Cone beam computed tomography (CBCT) is an excellent radiographic imaging technique capable of identifying PGGs and provides details about the exact site, extent, and depth characteristics of this deformity. Early diagnosis and management of PGGs are of utmost importance, particularly due to their diagnostic intricacies that can pose both clinical and therapeutic challenges. This article aims to report a rare case of palatogingival groove associated with an on-and-off discharge from the maxillary left lateral incisor tooth (#22). Nonsurgical endodontic treatment was carried out with #22, and the palatogingival groove was sealed with composite restoration after a deep curettage. Excellent radiographic healing was observed after a six-month follow-up.

Interdisciplinary management of combined periodontal-endodontic lesions with palatogingival grooves of the maxillary lateral incisors: a case report

A palatogingival groove of the maxillary lateral incisor is an anatomic malformation, which always predisposes the tooth to pulpal and periodontal disease. The diagnosis and treatment planning become complicated, with uncertain prognosis. Herein, we present an effective interdisciplinary management of a case of combined periodontal-endodontic lesions caused by palatogingival grooves. A series of treatment modalities were undertaken to preserve the two teeth, including root canal treatment, periodontal initial therapy, splinting the mobile teeth, occlusal adjustment, apical microsurgery, grinding and sealing grooves, and guided tissue regeneration. An apparent healing of the lesions was visible after 12 months. Therefore, interdisciplinary management of combined periodontal-endodontic lesions with palatogingival grooves of the maxillary lateral incisors is necessary for a favourable long-term outcome.

The incidence of radicular groove on maxillary lateral incisors of Saudi population: CBCT evaluation

BACKGROUND

The radicular groove (RG) is one of the developmental anomalies that is commonly found in maxillary incisors. The formation of radicular groove is initiated around the cingulum and can reach the root at different levels. The incidence of radicular grooves was reported in different countries but there was no published data about the incidence of RG in Saudi Arabia. Therefore, this study aimed to evaluate the incidence of radicular grooves on maxillary lateral incisors in the Saudi population using cone-beam computed tomography (CBCT).

METHODS

The dental records of 490 patients (N = 490) with CBCT images of maxillary anterior teeth were screened for inclusion criteria. Then 264 included cases were evaluated independently by two Endodontists. The evaluation was performed on CBCT images in the axial, sagittal, and coronal sections using Planmeca Romexis® software. The following data were recorded for each patient: Patients' age and gender, radicular groove presence or absence, and if it is bilateral or unilateral. The type of radicular groove was recorded according to Gu's classification (type I, II, or III).

RESULTS

The incidence rate of radicular grooves in maxillary lateral incisors was 4.9%. RG was found to be unilateral in 61.5% and bilateral in 38.5%. The majority of RG were classified as type I in 69.2%, followed by type II in 15.4%, and type III was found in 15.4%.

CONCLUSION

4.9% of the Saudi population has RG in the upper lateral incisor. This anatomical variation is mostly present as type I on one side only (unilateral).

Combined Periodontal and Endodontic Management of Palatal Radicular Groove with Platelet-Rich Fibrin and Biodentine®

Palatal radicular groove (PRG) is developmental anomaly of root, which when present is associated with periodontal and endodontic problems. Different treatment modalities are available for its management, such as periodontal flap surgery, endodontic management, sealing of PRG with various cements, bone graft procedure for intrabony defect, extraction with intentional replantation after sealing or removal of a PRG, and endodontic treatment as well as the use of various growth factors. Success of the therapy depends on the type, depth, and extent of PRG, presence or absence of intrabony defect, vitality of involved tooth, and types of materials used to seal PRG. This study reports management of PRG with Biodentine® and platelet-rich fibrin in a 44-year-old systemically healthy female patient.

Prevalence and Periodontal Conditions of Developmental Grooves in an Italian School of Dentistry and Dental Hygiene: A Cross-Sectional Study

Background: The aim of this cross-sectional study was to (i) determine the prevalence and distribution of developmental grooves in a young population and (ii) to evaluate the local periodontal conditions. Methods: Two hundred and fifty-one students with a mean age of 22.9 ± 4.7, attending the School of Dentistry and Dental Hygiene of Vita-Salute San Raffaele University (Milan, Italy) were included. The subjects underwent a clinical evaluation by two calibrated examiners. The following clinical parameters were recorded for each site presenting a radicular groove and for each corresponding site on an adjacent tooth used as control: probing pocket depth, plaque index, bleeding on probing, recession depth. Results: The prevalence of radicular grooves at patient and tooth level was 15.9% and 5%, respectively. When compared to control sites, the number of teeth with a radicular groove that presented plaque and bleeding on probing was higher. The logistic regression analysis showed that the presence of radicular grooves was significantly associated with the presence of plaque (OR, 6.14, p < 0.001) and of bleeding on probing (OR, 2.91, p = 0.01). Conclusions: The presence of radicular grooves increases the possibility of developing gingival inflammation by acting as a plaque retentive factor.

Palatogingival grooves associated with periodontal bone Loss of maxillary incisors in a Chinese population

This study aimed to investigate the prevalence of palatogingival grooves (PGGs) in a Chinese population and the relationship between different types of PGGs and periodontal bone loss. CBCT images of 1715 patients were included in the study. The prevalence of PGGs of the maxillary incisors by sex and tooth type was analysed. The severity of alveolar bone loss in different types of PGGs was assessed. The reasons for taking the CBCT from patients with PGGs were collected. The frequency of PGGs in males (10.16%) was higher than that in females (7.05%) (P < 0.05). PGGs were present more often in maxillary lateral incisors (4.5%) than in maxillary central incisors (0.29%). Compared with other types of PGGs, the type I PGGs were the most prevalent configuration and accompanied with less severity of alveolar bone loss (P < 0.05). Less than half of PGGs cases (47.9%) were prescribed CBCT examination because of the PGGs observed or suspected clinically. The prevalence of PGGs in a Chinese population was higher in males than in females. The different types of PGGs might lead to different severity of periodontal bone destruction. Clinicians should be aware of the presence of PGGs in maxillary incisors, particularly maxillary lateral incisors.

Prevalence and radiological characteristics of palatogingival groove: A retrospective cone-beam computed tomography study in an Indian cohort

Aim:

This study aims to investigate the prevalence of palatogingival groove (PG) in anterior maxillary teeth in an Indian cohort using cone beam computed tomography (CBCT) scans.

Study Design:

Retrospective study.

Materials and Methods:

Analysis of 119 CBCT scans (64 males, 55 females, and mean age 31.6 ± 13.5 years) was performed. The data of 636 anterior maxillary teeth (220 canine, 212 lateral incisor, and 204 central incisor teeth) were studied for PG's presence. Demographic details of patients and characteristics of PG, i.e., location, extension, depth, and type were recorded.

Results:

Out of the 636 anterior maxillary teeth studied, PGs were detected in 12 (1.88%) teeth (3 [1.47%] central incisors, 9 [4.2%] lateral incisors, and 0 canines). All the teeth were categorized as having either type I (Seven teeth) or type II (Five teeth) radicular groove. Two of the 12 PGs were present in the mesial, six in the mid-palatal, and four were present in the distal portion of the palatal surface of the teeth.

Conclusions:

The prevalence of PG in maxillary incisors in this Indian cohort is 2.88%. Maxillary lateral incisors are the most affected teeth.

Palatogingival groove and root canal instrumentation

AIM

To evaluate the morphology and impact of root canal preparation in maxillary incisors with palatogingival grooves (PGG).

METHODOLOGY

Twenty extracted human maxillary incisors with PGG were subjected to macroscopic analysis and scanning electron microscopy analysis (SEM). The following characteristics of the PGG were evaluated: depth, point of origin in the cingulum, extension and position on the lingual surface. Furthermore, the presence of calculus, communications between the root canal system and the PGG, and root resorptions were investigated. The root canals were subsequently instrumented with K-files of three consecutive sizes. The teeth were sectioned, and the axial plane of each tooth section was imaged using SEM before and after instrumentation. The distance between the root canal walls and the PGG was calculated according to the location. Additionally, the distance between canal walls and cementum was measured at three different sites, to verify if instrumentation influenced dentine removal on a specific wall in teeth with PGG. Statistical analysis was performed using the Mann-Whitney or Student's t-test (P < 0.05).

RESULTS

Macroscopic analysis revealed that a deep groove was most frequently observed (75%), followed by a depression/shallow groove (25%) (P < 0.05). PGG typically originated in the distal margin ridge of the cingulum (65%) (P < 0.05), extending only to the middle (45%) or up to the apical (50%) third of the root (P < 0.05). Additionally, PGGs were typically located on the distal aspect of the lingual surface (70%) (P < 0.05). Calculus was concentrated on the surface of the crown and cementum-enamel junction (P < 0.05). Communication between the root canal and PGG was present in 35% of teeth, and root resorptions were noted in 50% of teeth. The distance between the external root surface and the pulp cavity was significantly narrower after instrumentation (P < 0.05); however, root canal preparation did not influence dentine removal on the specific wall associated with the groove (P > 0.05).

CONCLUSIONS

Palatogingival grooves were characteristically deep and originated from the distal margin of the cingulum. Although it has been associated with a thinner root wall, root canal preparation did not influence the thickness of the specific wall in the maxillary incisors with PGG.

Periodontal Regenerative Treatment of Intrabony Defects Associated with Palatal Grooves: A Report of Two Cases

A palatal radicular groove (PRG) is a morphological deformity, occurring during tooth development. It is usually located on the palatal aspect of maxillary incisors and frequently associated with periodontal or endodontic-periodontal lesions. Some treatment options were described for such lesions, including primary endodontic treatment and periodontal surgery and extraction with intentional replantation after removal of a PRG and endodontic treatment. The present paper reported two cases of PRG-associated deep intrabony defects, successfully treated with periodontal surgery with enamel matrix derivative (EMD) application and mechanical removal of PRGs, avoiding endodontic treatment or retreatment. The complexity of the diagnostic process was also discussed.

Successful Surgical Management of Palatogingival Groove Using Platelet-rich Fibrin and Guided Tissue Regeneration: A Novel Approach

Palatogingival groove also known as radicularlingual groove is a developmental anomaly involving the lingual surface of the maxillary incisors. They are inconspicuous, funnel-shaped, extend for varying distances on root surface and occur due to infolding of the hertwigs epithelial root sheath. This encourages adherence of microorganisms and plaque to levels significant for pathological changes resulting in endodontic and periodontal lesions. The variations in anatomy of the tooth as a cause of pulp necrosis in teeth of anterior maxillary segment should be considered by the clinician when other etiological factors are ruled out. Recognition of palatogingival groove is critical, especially because of its diagnostic complexity and the problems that may arise if it is not properly interpreted and treated. Regeneration is a new emerging approach in endodontics. Choukroun et al. were among the pioneers for using platelet-rich fibrin (PRF) to improve bone healing. PRF is rich in platelet cytokines and growth factors. Numerous techniques have been used to eliminate or seal the groove and regenerate endodontic and periodontal tissues. In this case report of two cases, a novel combination therapy involving ultrasonics, blend of PRF with bone graft, guided tissue regeneration membrane was used in the treatment of a palatogingival groove with an endoperio lesion to ensure arrest of disease progression and promote regeneration. The groove was cleaned and prepared ultrasonically and sealed with a bioactive dentin substitute.

Recognition and management of palatogingival groove for tooth survival: a literature review

Palatogingival groove (PGG) is an anomaly in the maxillary anterior teeth, often accompanied by the area of bony destruction adjacent to the teeth with no carious or traumatic history. The hidden trap in the tooth can harbor plaque and bacteria, resulting in periodontal destruction with or without pulpal pathologic change. Related diseases can involve periodontal destruction, combined endodontic-periodontal lesions, or separate endodontic and periodontal lesions. Disease severity and prognosis related to PGG depend on several factors, including location, range, depth, and type of the groove. Several materials have been used and recommended for cases of extensive periodontal destruction from PGG to remove and block the inflammatory source and recover the health of surrounding periodontal tissues. Even in cases of severe periodontal destruction, several studies have reported favorable treatment outcomes with proper management. With new options in diagnosis and treatment, clinicians need a detailed understanding of the characteristics, treatment, and prognosis of PGG to successfully manage the condition.

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.

Papillary reconstruction and guided tissue regeneration for combined periodontal-endodontic lesions caused by palatogingival groove and additional root: a case report

We described a combined periodontal–endodontic lesion, which was caused by a palatogingival groove and an additional root. An interdisciplinary approach involving endodontic therapy, mineral trioxide aggregate (MTA) filling, root resection, guided tissue regeneration, and papillary reconstruction was used for the case. The tooth presents morphologically and functionally normal except tooth discoloration caused by MTA.

Combined Endodontic-Periodontal Treatment of a Palatogingival Groove

A palatogingival groove is a developmental anomaly that predisposes the involved tooth to develop a severe periodontal lesion. These grooves often present a clinical challenge because diagnosis and treatment planning require an interdisciplinary approach. This case report describes the successful management of a right maxillary lateral incisor with a deep palatogingival groove in combination with an extensive periodontal pocket and pulp necrosis of the involved tooth. Collaborative management used a combination of endodontic treatment, periodontal therapy, odontoplasty, and a periodontal regenerative procedure using protein complex derived from enamel matrix (Emdogain; Straumann, Basel, Switzerland). Despite a predicted poor prognosis, the tooth lesion healed. This report also discusses the rationale behind the treatment modalities.

Surgical management with intentional replantation on a tooth with palato-radicular groove

A palato-radicular groove (PRG) is a developmental anomaly primarily found in the maxillary lateral incisors. It is a potential communication path between the root canal and the periodontium that decreases the survival prognosis of the affected tooth, therefore compromising the stability of the dental structure in the oral cavity. The aim of this case report is to present an original technique where a PRG was treated by means of intracanal disinfection, PRG sealing with glass ionomer, replantation with intentional horizontal 180 degree rotation of the tooth, and an aesthetic veneer placed to provide adequate tooth morphology. The clinical and biological benefits of this novel technique are presented and discussed.

Treatment of combined endodontic: periodontic lesion by sealing of palato-radicular groove using biodentine

Introduction:

Palatoradicular groove is a developmental anomaly which is predominantly found in maxillary lateral incisors. It provides a susceptible alcove for the progression of localised periodontal inflammation which can further cause pulpal involvement. This case report describes the successful treatment of a large periodontic – endodontic lesion usingnon surgical endodontic therapy and biodentine for the sealing of the palatoradicular groove.

An innovative approach in the management of palatogingival groove using Biodentine™ and platelet-rich fibrin membrane

Palatogingival groove is an anatomical malformation that often causes severe periodontal defects. Treatments of such an anomaly present a clinical challenge to the operator. Careful endodontic and periodontal procedures may restore the form and function. In the present case; root canal therapy, apicectomy, and sealing of the groove with Biodentine™ were done. Bone graft was placed followed by platelet-rich fibrin (PRF) membrane. This treatment modality resulted in gain in attachment, reduction in pocket depth, and deposition of bone in the osseous defect. A 24 month follow-up is included.

Treatment of an intrabony osseous lesion associated with a palatoradicular groove

Various root developmental anomalies like palatoradicular groove (PRG) have been associated with worsening of periodontal condition. The aim of the present case report is to describe the regenerative surgical treatment of periodontal and osseous lesion associated with the subgingival extension of PRG. A 23-year-old female patient reported with pain in upper incisor teeth region. On clinical and radiological examination, a deep endosseous defect was found distal to maxillary right lateral incisor that was etiologically associated with the presence of a PRG. Treatment procedures consisted of: Regenerative periodontal therapy using Guided tissue regeneration (GTR) and hydroxyapatite (HA) bone graft and 2) flattening of the radicular portion of the palatal groove. The clinical examination at 1 year revealed shallow residual probing depth (3 mm) and no increase in gingival recession. The radiographic examination showed reduction in the radiolucency suggesting bone fill. A PRG may serve as a pathway for the development of a periodontal osseous defect. The combination of GTR and HA may be clinically and radiographically efficacious in the treatment of such a defect.

Use of Platelet-Rich Plasma Combined With Hydroxyapatite in the Management of a Periodontal Endosseous Defect Associated With a Palato-Radicular Groove: A Case Report

INTRODUCTION

Various root developmental anomalies, such as palato-radicular groove, have been associated with worsening the periodontal condition. Platelet-rich plasma (PRP), an autologous concentration of platelets, has been reported to significantly enhance bone and soft-tissue healing and the combination of PRP and a hydroxyapatite (HA) osseous graft has been demonstrated to be efficacious in the treatment of periodontal endosseous defects. Here, we present a 1-year follow-up report of such a clinical case, treated by the combined use of PRP and HA osseous graft for periodontal regeneration and, finally, restorative therapy.

CASE PRESENTATION

A 36-year-old Indian female reported with pain in the upper maxillary incisor region. On clinical and radiologic examination, a deep 3-wall periodontal endosseous defect was found mesial to the maxillary left lateral incisor that was etiologically associated with the presence of a palato-radicular groove, leading to the development of a periapical lesion. Endodontic therapy, non-surgical periodontal therapy, and surgical periodontal therapy with a mixture of PRP gel and HA were performed. One-year examination showed uneventful healing and complete elimination of the periodontal pocket.

CONCLUSIONS

A palato-radicular groove may serve as a pathway for the development of a periodontal endosseous defect and for pulpal involvement. The combination of PRP and HA may be efficacious in the treatment of such a periodontal endosseous defect. Additional research should be performed to evaluate the efficacy of PRP and HA in the treatment of periodontal endosseous defects.

Palatogingival groove - a silent killer: Treatment of an osseous defect due to it

A male patient of 21 years of age reported to the Department of Periodontology and Implantology with a chief complain of pus discharge in both right and left upper lateral incisors. On clinical examination a deep pocket of about 10–14 mm was noticed in both lateral incisors. Radiographic interpretation shows a teardrop-shaped radiolucency in both the laterals giving suspicion of palatogingival groove, which was later discovered and treated surgically.

A morphological survey of root grooves and their influence on periodontal attachment loss

Periodontal health reflects a balance between harmful and protective elements in the gingival marginal area. The total plaque mass, specific periodontopathogens, the tooth morphology, and local environmental factors may challenge this balance. The periodontal ligament attachment loss shifts this balance adversely toward the periodontal disease.

OBJECTIVES

The aim of this retrospective study was to determine the significance of proximal root grooves as a risk factor in the periodontal attachment loss; the effect of their dimensions and locations has been evaluated.

MATERIALS AND METHODS

One hundred (100) extracted formalin stored single rooted permanent anterior teeth were studied by staining with 0.1% toludine blue to visualize attached periodontal ligament remnants. On each tooth, the loss of attachment was measured from the cemento-enamel junction to the most coronal level of the stained periodontal ligament remnants.

RESULTS

The prevalence of proximal root grooves was found to be 81% and a statistically significant greater loss of attachment was present on grooved than on non-grooved surfaces (p < 0.01).

CONCLUSIONS

Generally, there was direct relationship between groove location, its dimensions, and maximum loss of attachment. The results suggest that proximal root grooves should be considered in periodontal diagnosis, prognosis, and treatment planning.

Labial cervical vertical groove (LCVG) distribution and morphometric characteristics

OBJECTIVE

Labial cervical vertical groove (LCVG), a dental anomaly found at the cervical region of upper permanent incisors, can be of esthetic, periodontal and prosthetic concern. The aim of this study was to define the prevalence and characteristics of LCVG.

DESIGN

Of the 1250 examined subjects, 66 exhibited an LCVG. This group (age 19.7+/-11.4 years) was then compared with a matched No-LCVG (control) group of 49 subjects (age 17.9+/-5.7 years). Six LCVG characteristics were examined: distribution, severity and location of LCVG in central (I(1)) and lateral (I(2)) permanent maxillary incisors, Angle's classification, gender and presence of LCVG in siblings.

RESULTS

Total LCVG prevalence was 5.3% (single 3.76%; multiple 1.53%), found predominantly in I(1) (93.9%) compared with I(2) (p=0.001). The anomaly presented mostly as a single configuration (71.21%); double configuration was predominantly homological bilateral, i.e., I(1)+I(1), or I(2)+I(2) (88%). LCVG in I(2) was mainly associated with multi-configuration (75%). The severe form occurred only in I(1). A mid-crown LCVG allocation was distinctive in I(1) (62.2%, p=0.001) and mesial-crown in I(2) (66.7%, p=0.038). LCVG was found mostly in males (p=0.045). In the LCVG group 16.7% were siblings.

CONCLUSIONS

LCVG primarily involved I(1) in single configuration as the target assaulted tooth and secondarily I(2) mostly as a multi-configuration. The genetic impact on LCVG formation was primarily supported by the high prevalence in siblings and secondarily by the favourable occurrence in males, exclusive pattern of allocation within the crown and high occurrence of bilateral double-configuration LCVG.

Mandibular Disto-Lingual Root: A Consideration in Periodontal Therapy

BACKGROUND

Developmental and morphological abnormalities may contribute to the progression of localized periodontal disease. Although the presence of a disto-lingual root in the mandibular first molar is rare, its role in periodontal destruction has not been examined. The purpose of this study was to evaluate whether the presence of this root contributes to localized periodontal destruction.

METHODS

The presence of the disto-lingual root was identified by examination of two periapical radiographs in each of 197 Taiwanese patients with 332 mandibular first molars. Regression analysis was used to evaluate the relationship between the presence of the root and probing depth, gingival recession, and periodontal attachment loss at the disto-buccal and disto-lingual sites of the molars. The adjusted variables included patient characteristics (age, gender, diagnosis, and general periodontal conditions), tooth (right and left location, tooth mobility, and periodontal category of the molar), and site (bleeding on probing and adjacent furcation involvement).

RESULTS

A disto-lingual root was present in 26.9% of patients and in 21.7% of molars examined. A significant interaction between periodontal category and the presence of disto-lingual root on probing depth and attachment loss at disto-lingual but not disto-buccal sites was observed. Multivariable regression analysis showed a significantly higher probing depth and attachment loss at the disto-lingual site in molars with the disto-lingual root than in molars without the root in teeth classified as having advanced periodontitis.

CONCLUSIONS

Greater probing depth and attachment loss occurred at disto-lingual sites of molars with the roots. The presence of a disto-lingual root may contribute to localized periodontal destruction.

The papilla amplification flap for the treatment of a localized periodontal defect associated with a palatal groove

BACKGROUND

Teeth with a palatal groove often present with severe localized periodontal attachment loss including pocket formation and alveolar bone loss. The aim of the present case report was to describe the regenerative surgical treatment of periodontal and bone lesions associated with the subgingival extension of a palatal groove affecting a maxillary lateral incisor.

METHODS

The left maxillary lateral incisor of a systemically healthy young subject presented with a palatal probing depth of 10 mm with no gingival recession at the buccal and palatal surfaces; the neighboring interdental papillae were intact. The radiograph showed a radiolucency area distal to the affected tooth. Treatment procedures consisted of: 1) the papilla amplification flap with the use of enamel matrix proteins as the regenerative periodontal material; 2) the elimination/flattening of the radicular portion of the palatal groove; and 3) the sealing of the coronal portion of the groove with composite flow.

RESULTS

The clinical examination at 1 year revealed a clinical attachment gain (8 mm) with a shallow residual probing depth (2 mm) and no increase in gingival recession. The radiographic examination showed the complete disappearance of the radiolucency area suggesting bone fill.

CONCLUSIONS

The present study indicated that localized periodontal defects associated with a palatal groove can be successfully treated by means of the papilla amplification flap with the use of enamel matrix protein as the regenerative material. The long-term stability of such successful results needs to be determined.

Combined Endodontic-Periodontic Treatment of a Palatal Groove: A Case Report

The palatal groove is a developmental anomaly that predisposes the tooth involved to a severe periodontal defect. When further complicated by pulp necrosis, these grooves often present a diagnostic and treatment planning challenge that requires an interdisciplinary treatment approach. This case report describes the successful collaborative management of a maxillary lateral incisor with an extensive palatal groove using a combination of nonsurgical endodontic therapy, odontoplasty, and periodontal regenerative techniques.

Modulation of clinical expression of plaque-induced gingivitis. I. Background review and rationale

OBJECTIVES

The purpose of this article is to provide the necessary background and rationale for the accompanying studies, which are ultimately aimed at identifying genetic and environmental factors determining gingivitis susceptibility.

MATERIALS AND METHODS

The literature on factors reported to modify the clinical expression of gingivitis, i.e., factors that determine individual variability in gingival inflammatory response to plaque, is presented.

RESULTS

Clinical evidence suggests that the gingival inflammatory response to plaque accumulation may differ substantially among individuals. However, most of the available studies are of small scale and not purposely designed to address the issue. Systemic factors implicated in modulation of the clinical expression of gingivitis include metabolic, genetic, environmental and other factors. The significance of such factors in designing and conducting a large-scale experimental gingivitis trial and means to account for them are discussed.

CONCLUSION

Although several factors have been implicated, genetic or environmental factors underlying differences in gingivitis expression are not fully elucidated. The accompanying studies aim to identify and characterize, among participants in a specifically designed large-scale experimental gingivitis trial, subjects that differ significantly in their gingival inflammatory response to plaque. This is the first step in an effort to determine genetic or environmental factors underlying such differences.

Detection of localized tooth-related factors that predispose to periodontal infections

The primary goal of periodontal therapy is to produce an environment that is conducive to oral health. This is achieved by eliminating the subgingival infection and implementing supragingival plaque control measures designed to prevent the re-colonization of the sulcus. Local etiologic factors, as described above, my prevent the removal of subgingival plaque, and may even contribute to destruction of the periodontal tissues. Thus, it is crucial to be able to recognize and, when possible, eliminate any plaque-retentive factor that could contribute to disease progression. Iatrogenic factors such as subgingival margins, restorative overhangs, overcontoured restorations and unpolished surfaces can be altered. Similarly, cervical enamel projections, enamel pearls and, in certain instances, palatal grooves can be removed or recontoured to enable the patient to access the area for good plaque control. There are some things that we cannot alter. Anatomic anomalies, particularly in posterior teeth, cannot be changed. However, awareness of potential anatomic variations and early detection of them may be able to prevent future attachment loss.

Bilateral buccal radicular groove in maxillary incisors: case report

AIM

To present the rare localization of a radicular groove on the buccal aspect of a tooth and to discuss the pathology and management of the concomitant endo-periodontal defect.

SUMMARY

Bilateral buccal radicular grooves were found on the maxillary central incisors of a 60-year-old female Caucasian. One groove was associated with deep local pocketing resulting in pulp necrosis and the formation of a periodontal-endodontic lesion. After endodontic treatment of the affected tooth, periodontal surgery was performed during which an apicoectomy was carried out on the root-filled tooth. Both the buccal grooves were removed by grinding, the roots were planed with curettes and a guided-tissue regeneration technique applied using amelogenin (Emdogain, Biora, Sweden). Following a period of 2 years, re-examination showed excellent healing with the complete elimination of the periodontal pocket on both incisors and significant radiographic evidence of bone regeneration.

KEY LEARNING POINTS

Deep radicular grooves can predispose to pulp necrosis and the establishment of combined periodontal-endodontic lesions. Evaluation of clinical signs and appropriate diagnostic tests are of paramount importance in order to prevent incorrect diagnosis and treatment. Endodontists must be capable of performing advanced periodontal regeneration techniques during endodontic surgery.

Radiographic alveolar bone loss in untreated Taiwan Chinese subjects with adult periodontitis measured by the digital scanning radiographic image analysis method

OBJECTIVES

To determine differences in radiographic alveolar bone loss (RABL) by age group, gender and tooth type in subjects with adult periodontitis using the digital scanning radiographic image analysis (DSRIA) method.

METHODS

A total of 4262 teeth were examined for RABL in 178 individuals (96 males and 82 females). Mesial and distal sites were determined by the DSRIA method following scanning of periapical radiographs and using the Microstation 95 image software.

RESULTS

Linear assessment of RABL using DSRIA revealed the following results. Mean bone loss of maxillary and mandibular anterior teeth was significantly higher (P<0.001 and P<0.01, respectively) in males compared with females using a two-sample t-test. The highest values of mean RABL occurred most commonly in the maxillary first molars (53.8% and 51.4% for females and males, respectively) and the mandibular central incisors (50.4% and 41.5% for males and females, respectively). Mean RABL was greater in males than in females for both the mandibular and maxillary arches, with the exception of molar sites.

CONCLUSIONS

Maxillary first molars and mandibular incisors are the highest risk sites. Moreover, greater loss occurs at the molar site in females compared with males for untreated periodontitis in Taiwan Chinese people.

The effect of shared genetic and environmental factors on periodontal disease parameters in untreated adult siblings in Guatemala

BACKGROUND

Increasing evidence supports the role of genetic factors in susceptibility to infectious diseases, including chronic periodontitis. The role of genetic factors in phenotypic expression can be estimated from the degree of resemblance between relatives, as compared with that of unrelated members of a population. Heritability is an estimate of the proportion of total phenotypic variation of a quantitative trait, which is attributable to genetic factors, and is based on the variance within versus between family members. The aim of this study was to determine whether there is a familial basis for periodontal disease status in an untreated population in Guatemala using heritability estimates as a measure of familial clustering of disease.

METHODS

One-hundred and thirteen adult subjects (including both siblings and spouse pairs), age range 35 to 60 years, participated in this study. Full-mouth periodontal examinations were performed and heritability estimates were calculated for mean plaque score, mean gingival index (GI), probing depth (PD), and clinical attachment level (CAL). Intraclass correlation coefficients (ICCs) were calculated using the same parameters for spouses to determine whether a common family environment in adulthood plays a role in disease expression.

RESULTS

Only in the case of mean plaque score and mean recession score were heritability estimates significantly above zero at alpha = 0.05. For spouse pairs, mean GI score, mean PD, and percentage of sites of PD > or = 5 mm showed a statistically significant ICC.

CONCLUSIONS

These results lead us to reject the hypothesis that there is substantial heritability for periodontal disease expression in this population. This may be due to an underlying lack of genetic variation within this sample or may indicate that, compared with the role of environmental factors, the genetic contribution to periodontal disease phenotypes is relatively minor.

Periodontal healing after bonding treatment of vertical root fracture

Vertical root fractures lead to advanced periodontal breakdown with deep periodontal pockets and vertical bone defects. The purpose of this study is to evaluate clinically the periodontal healing of root fracture treatment using adhesive resin cement. In 22 patients, 23 teeth with vertical root fractures were treated with 4-META/MMA-TBB resin cement. Eleven fractured roots were bonded through the root canal (group A) and 12 fractured roots were bonded extra-orally and replanted (group B). All teeth were then restored with full cast crowns (n=20) or coping (n=3). Mean probing depth was 6.6 mm at pre-treatment and 4.4 mm 6 months after the treatment in group A, and 7.4 mm and 4.6 mm, respectively, in group B. Bleeding scores were 100% at pre-treatment and 36.4% after 6 months in group A and 91.7% and 8.3%, respectively in group B. Radiographic bone level was 56.8% at pretreatment and 59.1% after 6 months in group A, and 18.8% and 29.2%, respectively, in group B. Two roots of group A and three roots of group B were extracted due to refracture, deterioration of periodontal inflammation, mobility, and luxation. The remaining roots (n=18) presented no discomfort to the patients and there was no deterioration of periodontal conditions over a mean period of 33 months (range 14-74 months) in group A and over a mean period of 22 months (range 6-48 months) in group B. There was no ankylosed teeth nor was any root resorption detected. The results suggested that the treatment of vertical root fracture using 4-META/MMA-TBB resin has good prognostic possibilities.

Successful treatment of pulpal-periodontal combined lesion in a birooted maxillary lateral incisor with concomitant palato-radicular groove. A case report

Palato-radicular groove (PRG) is a common developmental anomaly of maxillary incisors, whereas PRG associated with a birooted maxillary incisor is relatively infrequent. The clinical significance of PRG is related to the incidence of localized periodontitis with or without pulpal pathosis, depending on the depth, extent, and complexity of the groove. Successful treatments of PRG in single-rooted incisors have been reported in the literature. However, treatment of PRG in birooted incisors has often been ineffective. This case report describes a pulpal-periodontal combined lesion occurring on a birooted maxillary left lateral incisor with concomitant PRG in a 13-year-old boy which was successfully treated by conventional endodontic therapy in combination with periodontal treatment including accessory root resection, radiculoplasty and bone grafting. Seven-year follow-up is included in this report. The basis of a successful result is accurate diagnosis and elimination of inflammatory irritants and contributory factors. Awareness of the existence of this abnormality by the clinician is important.

Retention of adhesive cement on the tooth surface after crown cementation

STATEMENT OF PROBLEM

Adhesive cements increase crown retention, but it is unknown if traces of cement remain undetected on the tooth surface after clinical removal of excess cement, which could exacerbate plaque retention.

PURPOSE

This study measured the surface area, volume, mean depth, and maximum depth of a resin composite and a compomer luting cement left adherent on the tooth surface after removal of excess cement, as judged clinically.

METHODS AND MATERIAL

Four groups of specimens (n = 48) were prepared for full coverage crowns: group AC bonding alloy with chamfer finish line, group G gold alloy with chamfer finish line, group PC porcelain with a chamfer finish line, and group PS porcelain with a shoulder finish line. Two profiles of the mesial and distal surfaces of the teeth were carried out: (1) tooth with crown seated but not cemented and (2) tooth with the crown cemented in place. Two cements and 2 methods of cement removal were studied.

RESULTS

A 4-way analysis of variance for cement, crown type, method of removal, and tooth surface morphology showed that significantly greater volumes and mean depth, but not surface areas, of resin composite cement remained adherent than compomer cement (P<.05). Among crown types, significant differences were found for cement volume (group G>AC, G>PC, G>PS), cement surface area (group AC>PC, G>PC, G>PS), and maximum cement depth (group G>AC). There was no significant difference between the 2 methods of cement removal. Significantly larger surface areas and maximum depths of cement were retained on the anatomically grooved mesial surface of the maxillary first premolars than on the ungrooved distal surface.

CONCLUSION

Subclinical cement retention occurred after crown cementation, which was influenced by cement, crown type, and tooth surface morphology but not method of cement removal.

The endodontic-periodontal continuum revisited: new insights into etiology, diagnosis and treatment

For many decades, investigators have conducted studies of the interrelationship between endodontics and periodontics. This review article examines previously held concepts regarding the endodontic-periodontal continuum in light of new research and explores promising advances in understanding etiology and in diagnosis and treatment.

The influence of anatomic and iatrogenic root surface characteristics on bacterial colonization and periodontal destruction: a review

PERIODONTITIS IS A MULTIFACTORIAL infectious disease affecting primarily a subset of subjects and a subset of sites. Recent microbiological data have acknowledged that before disease progression can occur, a susceptible host and site are required, in addition to the presence of pathogenic bacteria. This review discusses factors affecting periodontal disease progression and focuses in particular on the influence of anatomic and iatrogenic root surface characteristics. Retrospective studies clearly suggest a strong association between anatomic aberrations and periodontal attachment loss. Cemental tear seems to have the potential to initiate an aseptic, rapid, site-specific periodontal breakdown in a non-infected environment, illustrating the complexity of the attachment loss process. Recent experimental findings, furthermore, demonstrate a significant influence of root surface instrumentation roughness upon subgingival plaque formation and gingival tissue reactions, as well as a significant and positive relationship between subgingival plaque accumulation and inflammatory cell mobilization. These results indicate that subgingivally located irregularities may form stagnant sites or ecological niches which favor both retention and growth of organisms. Such events in addition to the progressive inflammatory changes may critically influence the subgingival environment by turning a stable site into an unstable or active periodontitis site. Thus, local anatomic and iatrogenic root surface characteristics may have a more profound effect on gingival health than previously assumed, particularly on a site level.

Relationship between molar root fusion and localized periodontitis

We investigated the relationship between molar root fusion and localized periodontitis in this study. A total of 143 individuals (1,109 molars) aged 23 to 68 years were examined for the presence of molar root fusion at diseased and healthy sites. Molar root fusions were diagnosed by periapical radiographs and clinical probing. Periodontal parameters measured included probing depth (PD), clinical attachment loss (CAL), gingival index (GI), and plaque index (PLI) around fused molars. Results indicated that the prevalence of molar root fusions in males and females was 15.2% (93/612) and 32.2% (160/497), respectively. The distribution of molars with root fusions occurs in the following order: maxillary second molars (51.8%), mandibular second molars (32.3%), maxillary first molars (5.7%), and mandibular first molars (0%). Statistically significant differences were observed between molar root fusions at healthy and diseased sites with respect to PLI, GI, PD, and CAL. The highest prevalence of molar root fusion was observed in females.