Does continuous chemical disinfection affect mechanical properties of CAD/CAM PMMA?

PURPOSE

This study was aimed at analyzing the effect of disinfectants on the roughness and mechanical properties of computer-aided design/computer-aided manufacturing (CAD/CAM) polymethylmethacrylate (PMMA) dentures.

MATERIALS AND METHODS

Two groups of denture base resins were tested: heat-polymerized and milled blocks. The specimens were shaped (n=80) for flexural strength (FS), flexural modulus (FM), and (n=240) for the properties of roughness (Ra) and microhardness alterations (KHN). They were categorized into the following groups based on immersion: control (deionized water), H1 (1% sodium hypochlorite), H05 (0.5% sodium hypochlorite), and C2 (2% chlorhexidine) groups. The immersion periods were 0 (T0), 130 (T1), and 260 (T2) cycles. Statistical analyses were performed for flexural properties using the three-way analysis of variance (ANOVA). Microhardness and surface roughness were analyzed using repeatedmeasures ANOVA. A significance level of 5% was set.

RESULTS

CAD/CAM PMMA showed higher FS (P = .001) and FM (P < .001) than conventional PMMA. The KHN value was superior to the conventional PMMA (P < .001). The chemical solution affected the surface roughness of both resins (P = .007). The CAD/CAM PMMA block showed increased Ra values when H1 was used. Cycling separately increased the FS of conventional PMMA (T1 vs. baseline; P < .05). However, the FM of CAD/CAM PMMA was higher (T1 and T2 vs. baseline; P < .05). The time factor increased the microhardness of both resins (T2 vs. baseline; P < .05).

CONCLUSION

The CAD/CAM resin showed higher values compared to conventional PMMA in all tests, regardless of the chemical solution used; however, the values obtained for both resins were clinically acceptable. Int J Prosthodont 2023. doi: 10.11607/ijp.8301.

Mast cells exhibit intracellular microbicidal activity against Aggregatibacter actinomycetemcomitans

BACKGROUND AND OBJECTIVE

Several studies have demonstrated that mast cells are equipped with versatile tools to combat and kill bacteria. Additionally, mast cells produce and secrete a variety of mediators, which either regulate the host's immune system or directly attack bacteria. In this study, the intracellular microbicidal capacity of mast cells against Aggregatibacter actinomycetemcomitans was evaluated.

METHODS

Murine mast cells were challenged in vitro with A actinomycetemcomitans for 3, 5, 10, and 24 hours. Subsequently, the colony-forming units were counted. Additionally, the production and release of nitric oxide and hydrogen peroxide were analyzed by DAF-FM diacetate, the Griess reaction, and the Amplex Red kit, respectively. Cell death was evaluated using FITC Annexin V and propidium iodide staining.

RESULTS

Mast cells are able to efficiently eliminate periodontopathogen, with best results after 10 hours of intracellular challenge. The production/release of nitric oxide-and to a lesser extent of hydrogen peroxide-by mast cells was in agreement with its microbicidal capacity. Ninety percent of the mast cells  maintained their cellular viability even after 24 hours of bacterial challenge.

CONCLUSIONS

This is-to the best of our knowledge-the first report to describe the intracellular microbicidal activity of mast cells against A actinomycetemcomitans, concerning the production and release of potentially bactericidal substances. Further, the low number of cell deaths confirms that the decreased number of colony-forming units was due to the higher antimicrobial activity of mast cells. The results highlight the importance of these cells in the defense mechanisms of biofilm-induced periodontal disease.

Rhizopus-host interplay of disseminated mucormycosis in immunocompetent mice

Aim: To investigate the immune response of disseminated Ryzopus oryzae infection in immunocompetent mice. Methods: C57Bl/6, BALB/c and Swiss wild-type mice were intravenously infected with R. oryzae; the parameters of infection and immune response were determined. Transcriptional signature of Th17 immune response and infection in Il17ra^-/- mice were also evaluated. Results: All mouse strains showed an initial spread of R. oryzae in the target tissues; however, after 30 days, C57Bl/6 and BALB/c mice showed an effective fungal clearance associated with specific production of IL-17 and IL-2. We also observed that 60% of Il17ra^-/- mice succumbed to infection within 16 days. Conclusion: This study has established an immunocompetent model for disseminated mucormycosis and highlighted the role of IL-17 signaling in immunity against R. oryzae.

CD44 and ALDH1 immunoexpression as prognostic indicators of invasion and metastasis in oral squamous cell carcinoma

BACKGROUND

Tumour metastasis has been associated with cancer stem cells, a small population with stem-like cells properties, higher rate of migration and metastatic potential compared to cells from the tumour bulk. Our aim was to evaluate the immunoexpression of the putative cancer stem cell biomarkers ALDH1 and CD44 in primary tumour and corresponding metastatic lymph nodes.

METHODS

Tumour tissue specimens (n = 50) and corresponding metastatic lymph nodes (n = 25) were surgically obtained from 50 patients with oral squamous cell carcinoma and submitted to immunohistochemistry. CD44 and ALDH1 were semi-quantitatively scored according to the proportion and intensity of positive cells within the invasive front and metastatic lymph nodes as a whole. A combined score was obtained by multiplying both parameters and later dichotomized into a final score classified as low (≤2) or high (>2) immunoexpression.

RESULTS

ALDH1 immunoexpression and CD44 immunoexpression were detected in both tumour sites, although the means of ALDH1 (P = .0985) and CD44 (P = .4220) cells were higher in metastasis compared to primary tumours. ALDH1^high was positively associated (P = .0184) with angiolymphatic invasion, while CD44^high was positively associated (P = .0181) with metastasis (N+). At multivariate analysis, CD44 significantly increased the odds of lymph node metastasis, regardless of T stage (OR = 8.24; 1.64-65.64, P = .0088).

CONCLUSIONS

CD44 immunoexpression was a significant predictor of lymph node metastasis, while ALDH1^high immunostaining was associated with angiolymphatic invasion. Altogether, it suggests that immunoexpression of CD44 and ALDH1 links the cancer stem cell phenotype with oral squamous cell carcinoma invasion and metastasis.

TLR2-/- Mice Display Increased Clearance of Dermatophyte Trichophyton mentagrophytes in the Setting of Hyperglycemia

Dermatophytosis is one of the most common human infections affecting both immunocompetent individuals and immunocompromised patients, in whom the disease is more aggressive and can reach deep tissues. Over the last decades, cases of deep dermatophytosis have increased and the dermatophyte-host interplay remains poorly investigated. Pattern recognition molecules, such as Toll-like receptors (TLR), play a crucial role against infectious diseases. However, there has been very little research reported on dermatophytosis. In the present study, we investigated the role of TLR2 during the development of experimental deep dermatophytosis in normal mice and mice with alloxan-induced diabetes mellitus, an experimental model of diabetes that exhibits a delay in the clearance of the dermatophyte, Trichophyton mentagrophytes (Tm). Our results demonstrated that inoculation of Tm into the footpads of normal mice increases the expression of TLR2 in CD115⁺Ly6C^high blood monocytes and, in hypoinsulinemic-hyperglycemic (HH) mice infected with Tm, the increased expression of TLR2 was exacerbated. To understand the role of TLR2 during the development of murine experimental deep dermatophytosis, we employed TLR2 knockout mice. Tm-infected TLR2^-/- and TLR2^+/+ wild-type mice exhibited similar control of deep dermatophytic infection and macrophage activity; however, TLR2^-/- mice showed a noteworthy increase in production of IFN-γ, IL-10, and IL-17, and an increased percentage of splenic CD25⁺Foxp3⁺ Treg cells. Interestingly, TLR2^-/- HH-Tm mice exhibited a lower fungal load and superior organization of tissue inflammatory responses, with high levels of production of hydrogen peroxide by macrophages, alongside low TNF-α and IL-10; high production of IL-10 by spleen cells; and increased expansion of Tregs. In conclusion, we demonstrate that TLR2 diminishes the development of adaptive immune responses during experimental deep dermatophytosis and, in a diabetic scenario, acts to intensify a non-protective inflammatory response.

Effect of denture-coating composite on Candida albicans biofilm and surface degradation after disinfection protocol

INTRODUCTION

Denture stomatitis is the most common pathology affecting denture wearers and its main cause is colonisation of dentures with Candida albicans.

OBJECTIVE

This study investigated the effectiveness of two commercial composite surface sealants (Biscover(®) LV and Surface Coat(®)) to reduce C. albicans biofilm colonisation on denture resin, as well as their surface integrity after disinfection cycles with 1% sodium hypochlorite solution.

METHODS

Heat-cured acrylic resin specimens were manufactured (10 mm × 10 mm × 1 mm). The specimen surfaces were mechanically polished to simulate rough or smooth denture surfaces. Four surface-treatment groups were tested: smooth surfaces [0.3 μm of mean roughness (Ra)]; rough surfaces (3 μm of Ra); rough surfaces treated with Biscover(®) LV; and rough surfaces treated with Surface Coat(®). Specimens of each group were randomly divided to undergo immersion in distilled water or 1% sodium hypochlorite for 30 or 90 cycles each. Specimens of all groups in each immersion solution were tested using a crystal violet (CV) staining assay for biofilm quantification and by scanning electron microscopy for visual analyses of surface integrity and biofilm structure. CV assay data were analysed using one-way analysis of variance (ANOVA) followed by Tukey's multiple comparison test (P < 0.05).

RESULTS

The effectiveness and surface integrity of Biscover(®) LV-treated surfaces were similar to those of smooth surfaces, whereas Surface Coat(®) -treated surfaces presented a similar performance to rough surfaces in all solutions and cycles.

CONCLUSION

These results suggest the possibility of clinical use of Biscover(®) LV for denture coating on surfaces in which mechanical polish is not indicated, such as the fitting surface.

Papillary Cystadenoma of Minor Salivary Glands: Report of 11 Cases and Review of the English Literature

Papillary cystadenoma is a rare, benign salivary gland tumor which is well-circumscribed, containing cystic cavities with intraluminal papillary projections. Only 19 cases arising within minor salivary glands (MnSG) from the oral cavity sites have been reported in the English literature (PubMed 1958-2014). We report 11 new cases of MnSG papillary cystadenomas in conjunction with a review of the literature. Demographic information, clinical and histologic features, treatment and prognosis are compiled and discussed for all 30 cases reported in the English literature.

Mast cells act as phagocytes against the periodontopathogen Aggregatibacter actinomycetemcomitans

BACKGROUND

Evidence to date shows that mast cells play a critical role in immune defenses against infectious agents, but there have been no reports about involvement of these cells in eliminating periodontopathogens. In this study, the phagocytic ability of mast cells against Aggregatibacter actinomycetemcomitans compared with macrophages is evaluated.

METHODS

In vitro phagocytic assays were conducted using murine mast cells and macrophages, incubated with A. actinomycetemcomitans, either opsonized or not, with different bacterial load ratios. After 1 hour, cells were stained with acridine orange and assessed by confocal laser-scanning electron microscopy.

RESULTS

Phagocytic ability of murine mast cells against A. actinomycetemcomitans was confirmed. In addition, the percentage of mast cells with internalized bacteria was higher in the absence of opsonization than in the presence of opsonization. Both cell types showed significant phagocytic activity against A. actinomycetemcomitans. However, the percentage of mast cells with non-opsonized bacteria was higher than that of macrophages with opsonized bacteria in one of the ratios (1:10).

CONCLUSIONS

This is the first report about the participation of murine mast cells as phagocytes against A. actinomycetemcomitans, mainly in the absence of opsonization with human serum. Our results may indicate that mast cells act as professional phagocytes in the pathogenesis of biofilm-associated periodontal disease.

Differences between salivary and blood neutrophils from elderly and young denture wearers

We previously showed that neutrophils from patients with Candida-related denture stomatitis exhibited damaged function, and the advance in age intensified this condition. Because such alterations had been determined in elderly people that were not denture wearers, the purpose of this study was to clarify functional and phenotypic characteristics of neutrophils from elderly denture wearers (EDW) and young denture wearers (YDW) without oral lesion. We enrolled 20 denture wearers (12 EDW and 8 YDW) and determined the positivity of Candida species on maxillary prosthesis and palate. Additionally, blood and salivary neutrophils were evaluated. Furthermore, cytokines and chemokines salivary levels were detected. YDW presented higher positivity of Candida albicans than elderly ones. However, blood neutrophils from EDW expressed less CXCR1, CD62L and CD11b and had lower C. albicans phagocytosis than YDW. Although myeloperoxidase and elastase activity was significantly higher in C. albicans-stimulated blood neutrophils from elderly, they produced high levels of IL-10 and low levels of Granulocyte macrophage-colony stimulating factor (GM-CSF). Despite apoptosis rate of salivary neutrophils was enhanced, these cells were at a high number in YDW. GM-CSF and IL10 were lower in saliva from elderly group. These data confirmed that ageing affects blood and salivary neutrophils and could predispose elderly to persistent oral infections.

Differential expression of chemokines and chemokine receptors in inflammatory periapical diseases

BACKGROUND

Periapical lesions are thought to be the result of a local inflammatory response mediated by inflammatory cell infiltration and production of inflammatory mediators. Although chemokines are strongly implicated in the migration and activation of leukocytes in different inflammatory diseases and experimental models, little is known regarding the expression of chemokines and their receptors in human apical periodontitis.

OBJECTIVE AND METHODS

The objective of this study was to determine the expression of chemokines and their receptors by real-time polymerase chain reaction in samples obtained from healthy gingiva, periapical granulomas, and inflammatory periradicular cysts. The inflammatory infiltrate was characterized by immunohistochemistry.

RESULTS

Comparing cysts and granulomas, an increase in CD4+ and CD8+ cells was observed in granulomas, despite the similar numbers of CD45RO-positive cells detected in both lesions. The analysis of mRNA expression revealed increased levels of CCR1, CCR2, CCR3, CCR5, CXCR1, and CXCR3 in both types of lesion compared with controls. Cysts exhibited a higher expression of CCR3, CCR5, CXCR1, and CXCR3 compared to granulomas. A significantly higher expression of RANTES, IP-10, and MCP-1 was detected in cysts compared with controls or granulomas. The expression of interleukin-8, MIP-1alpha, and MIP-1beta was not different in the three experimental groups.

CONCLUSIONS

The increase in Th1 type (CCR1, CCR5, and CXCR3) and Th2 type (CCR2 and CCR3) receptors in both periapical lesions suggests the concomitant occurrence of Th1 and Th2 responses. Furthermore, the prevalent expression of the receptors CCR3, CCR5, CXCR1, and CXCR3 and of the chemokines RANTES, IP-10, and MCP-1 in cysts may point to a role in the progression of granulomas to cysts.

Quantification of mast cells in different stages of human periodontal disease

OBJECTIVE AND METHODS

Among the cells involved in immune and inflammatory responses in periodontal disease, mast cells have been shown to be capable of generating a large number of biologically active substances. The present study was undertaken to identify and quantify the presence of mast cells in different stages of human periodontal disease using histochemical (toluidine blue) and immunohistochemical (tryptase-positive mast cells) techniques.

RESULTS

Mast cell densities (cells per mm(2)) were significantly increased in chronic periodontitis/gingivitis lesions compared with clinically healthy gingival tissues (Health) uniquely by immunohistochemical technique. Interestingly, mast cells were distributed specially in close apposition to mononuclear cells.

CONCLUSIONS

In human periodontal disease there is an increase in the number of mast cells that may be participating either in the destructive events or in the defense mechanism of periodontal disease via secretion of cytokines, including perpetuation of the Th2 response, and cellular migration and healing processes.

Macrophages and mast cells control the neutrophil migration induced by dentin proteins

Dentin sialoprotein (DSP) and dentin phosphoprotein (DPP), the major dentin proteins, have been shown to induce neutrophil migration through release of IL-1beta, TNF-alpha, MIP-2, and KC. However, the sources of these mediators were not determined. Here, the roles of macrophages and mast cells (MC) in dentin-induced neutrophil accumulation were investigated. Peritoneal MC depletion or the enhancement of macrophage population increased DSP- and DPP-induced neutrophil extravasation. Moreover, supernatants from DSP- and DPP-stimulated macrophages caused neutrophil migration. The release of neutrophil chemotactic factor by macrophages was inhibited by dexamethasone or the supernatant of DSP-treated MC. Consistently, dexamethasone and the MC supernatant inhibited the production of IL-1beta, TNF-alpha, and MIP-2 by macrophages. This inhibitory activity of the DSP-stimulated MC was neutralized by anti-IL-4 and anti-IL-10 antibodies. These results indicate that dentin induces the release of the neutrophil chemotactic substance(s) by macrophages, which are down-modulated by MC-derived IL-4 and IL-10.

Comparative morphological analysis of the root developmental groove with the palato-gingival groove

The palato-gingival groove is an anomaly of shape that modifies dental tissues organization while the developmental root groove is described within normal root anatomy. The morphology of dental tissues in relation to the presence of the developmental root groove has not been properly described. This study analyzed microscopically the morphology of dental tissues related to the root developmental groove comparing it with that presented on teeth affected by palato-gingival groove. Many similarities were observed such as the increased cementum thickness, decreased dentin thickness, pulp compartment surface alteration, irregularity of the dentin-cementum junction and of the cementum surface. These results suggest a common determining factor to this structure organization pattern. It is possible that the palato-gingival groove could be the result of an alteration of genetic mechanisms, rather than a dental germ folding, determined by privation of space, as previously hypothesized.

Cytokine and chemokine response of bone cells after dentin challenge in vitro

OBJECTIVE

The aim of this study was to characterize the effects of dentin extracts on cytokine, chemokine and nitric oxide (NO) production by primary rat bone cells.

STUDY DESIGN

Osteoblastic bone marrow cultures were exposed to particulate (D-part), non-particulate (D-n-part) and demineralized dentin extracts and evaluated for proliferative activity, cell morphology, alkaline phosphatase activity and bone-like nodule formation. Cytokine production was assessed by enzyme-linked immunosorbent assay and NO release by the Griess method.

RESULTS

The dentin extracts did not affect osteoblast numbering. Conversely, they up regulated in a dose-dependent manner the production by the osteoblasts of the pro-inflammatory interleukin-1beta (IL-1beta), tumor necrosis factor-alpha, IL-6, cytokine-induced neutrophil chemoattractant-1, and of the anti-inflammatory cytokine, IL-10. The NO production was stimulated only by D-n-part.

CONCLUSION

These results demonstrate that dentin induces the production of inflammatory cytokines by osteoblasts and suggest that pro-resorptive pathways might be stimulated when dentin molecules come into contact with bone cells during pathological processes associated with dentin and bone matrix dissolution.

Dentin sialoprotein and phosphoprotein induce neutrophil recruitment: a mechanism dependent on IL-1beta, TNF-beta, and CXC chemokines

Dentin is a reservoir of several potentially active molecules, and dentin sialoprotein (DSP) and dentin phosphoprotein (DPP) are the two major non-collagenous proteins. It has been established that dentin molecules are released as a consequence of osteoclast action during the resorption process. Along with osteoclasts, inflammatory cells seem to play an important role at sites of root resorption. Although the role of dentin molecules in dentinogenesis is well known, their role in pathological processes associated with dentin matrix dissolution is unclear. Recent studies have suggested that dentin components may function as chemotactic and activator signals for inflammatory cells at these sites. Herein we present evidence that demineralized dentin crude extract, DSP, and DPP induced doseand time-dependent neutrophil migration into the peritoneal cavity of mice and that this activity was inhibited by dexamethasone, but not by indomethacin or MK886. The blockade of tumor necrosis factor-alpha (TNF-alpha) and interleukin-1 (IL-1) receptors inhibited neutrophil accumulation. The neutrophil migration was also diminished in the absence of the chemokines cytokine-induced neutrophil chemoattractant (KC) and macrophage inflammatory protein-2 (MIP-2), but not in the absence of macrophage inflammatory protein-1alpha (MIP-1alpha). These results demonstrate that dentin induces neutrophil migration via the synthesis of IL-1beta, TNF-alpha, and chemokines and they suggest that dentin matrix proteins may have an active role in inflammatory cell recruitment during pathological processes associated with dentin and bone matrix dissolution.

Dentin matrix proteins and soluble factors: intrinsic regulatory signals for healing and resorption of dental and periodontal tissues?

Dentin contains numerous polypeptides and signaling molecules sequestered in a mineralized matrix. The exposure and release of these molecules occur as a consequence of injury to the pulp and periodontal ligament, which may result from luxation, orthodontic movement or infections of tooth and periodontal structures. When released at these sites, dentin constituents have the potential to act on different surrounding cells, including periodontal cells, osteoblasts, osteoclasts and inflammatory cells, and to affect the course of dental disease. Experimental studies have highlighted the interactions between dentin and cells from tooth and periodontal tissues and reveal dentin to be a cell adhesive, signaling and migratory stimulus for various mesenchymal and inflammatory cells. These results support the hypothesis that dentin molecules might function as regulatory signals for the healing and resorption of dental and periodontal tissues. Data from recent and classical investigations are summarized, many open questions are discussed, and current hypotheses concerning the mechanisms of tooth resorption and periodontal healing are outlined. Many questions regarding the importance of dentin as a source of multifunctional molecules remain unanswered and provide important directions for future studies.

Dentin-induced in vivo inflammatory response and in vitro activation of murine macrophages

The activation of inflammatory cells and consequent release of mediators play an important role in the resorption of mineralized tissues. In the present study, we examined the ability of dentin extracts to induce inflammatory cell recruitment and activation. We showed here that dentin extracts triggered an intense cell migration and progressive cell maturation, in a time- and dose-dependent manner. Expression of interleukin-1 beta (IL-1 beta), tumor necrosis factor-alpha (TNF-alpha), nitric oxide (NO), and hydrogen peroxide (H(2)O(2)) was also up-regulated by dentin extracts. These results show that inflammatory events can be elicited in response to dentin, which may suggest a possible involvement of dentin molecules in the inflammatory events, coupled with their release at the root resorption sites.

Nitric oxide synthesis and severity of human periodontal disease

The expression of the inducible nitric oxide synthase enzyme (iNOS) is a response to an inflammatory stimulus and produces a large amount of nitric oxide (NO), which may act as a cytotoxic molecule against the invading microorganism and may be related to both harmful and beneficial effects to tissues.

OBJECTIVE AND MATERIAL AND METHODS

In order to further characterize the presence of NO in human periodontal disease, we undertook a quantitative study of iNOS positive cells in samples of clinically healthy gingival tissues, plaque-induced gingivitis and localized chronic periodontitis using immunohistochemistry.

RESULTS

A significant increase in the number of iNOS+ cells mm-2 was found in the samples of the gingivitis and periodontitis compared with those of the control. In all groups most of the polymorphonuclear cells showed intense immunoreactivity for iNOS independent of the disease stage, and the percentage of iNOS+ polymorphonuclear cells increased significantly in periodontal disease when compared with the control.

CONCLUSION

Our results indicate that iNOS increases in the presence of periodontal disease. In addition, our findings suggest that polymorphonuclear cells present an additional activation pathway in periodontal disease, expressing significant iNOS and probably representing an important source of NO in human periodontal disease that has not been previously reported.

Study of the expression of CD68+ macrophages and CD8+ T cells in human granulomas and periapical cysts

In the periapex, the interaction among inflammatory cells and microorganisms and their products results both in specific and nonspecific immune responses. Many studies have reported quantitative analysis of the immunocompetent cells in periapical lesions, but the exact ratio of these cells in cysts and granulomas remains unknown. In the present study, we undertook a quantitative analysis of CD68+ cells and CD8+ T cells in human periapical granulomas and cysts. Immunoperoxidase staining revealed that CD68+ cells were present in both lesions, with no statistically significant difference, mainly distributed in the inner portion of the lesion, where the inflammation site is more active. On the other hand, CD8+ lymphocytes were more numerous in cysts. Thus, it appears that CD8+ T cells may play a more important role in a later phase of periapical lesion progression, probably exerting regulatory or cytotoxic functions in cellular immune response, which may lead to the stabilization of these lesions.

Macroscopic and microscopic analysis of the palato-gingival groove

With the objective of correlating the anatomical aspects of the palato-gingival groove with its etiology, diagnosis, and alternative treatments, 13 permanent maxillary incisors with palato-gingival grooves were selected from a large sample and subjected to macroscopic and microscopic analysis of groove morphology. The palato-gingival groove occurred most frequently on the lingual aspect of the lateral incisor (11 of 13), and its coronal and radicular extensions were on the disto-lingual surface of the incisors (7 of 13 and 6 of 13, respectively). Deformation of the contour of the pulp cavity was noted subjacent to the groove (9 of 13), along with diminished enamel and dentin thickness (11 of 13 and 13 of 13, respectively) and an increase in cement (12 of 13). The groove was observed extending to the apical third in nine specimens, and a direct communication between the pulp and periodontium was observed in only one case. From these examinations it is concluded that the palato-gingival groove can be clinically diagnosed, preventing subsequent problems; however microscopic analysis of the affected tooth is necessary to allow precise evaluation of the groove's extension and damage to the dental structure.

The palato-gingival groove. A cause of failure in root canal treatment

The authors describe a clinical case of a palato-gingival groove on a maxillary central incisor with associated localized periodontal disease and pulp necrosis. The general clinician's initial diagnosis was incorrect; this led to incomplete treatment and subsequent loss of the tooth. Recognition of the palato-gingival groove is critical, especially because of its diagnostic complexity and the problems that may arise if it is not properly interpreted and treated.