Interdisciplinary management of a maxillary central incisor with a palato‐radicular groove: A case report with 27 years follow‐up

Abstract

Objective: The palato-radicular groove (PRG) is caused by a developmental anomaly, genetically determined, whereby an in-folding of the enamel organ and Hertwig's epithelial root sheath occurs. The depth and length of the groove determine the prognosis for the tooth. The interdisciplinary team formulated a treatment plan to save this tooth for this 8-year-old patient. The goal was to prolong the life of the tooth until his growth was completed and a more permanent tooth replacement could be considered if the tooth failed.Clinical considerations: This patient had #8 with a very deep palatal groove extending from the CEJ to the apex of the tooth, causing a 12 mm periodontal pocket with suppuration. Endodontic treatment, periodontal regeneration, and orthodontics were done to prolong the life of the tooth and preserve the bone for future tooth replacement if the tooth failed and needed to be extracted. The tooth survived for 11 years before the pocketing recurred due to the deep groove. The tooth was extracted and replaced with an implant. Conclusion:Teeth with a PRG present multiple challenges depending on the depth and length of the groove. An accurate diagnosis of the endodontic and periodontal status of the tooth is critical. Teeth with very long and deep grooves make the case more difficult to treat endodontically and periodontally. The tooth had a very poor prognosis; however, it was saved for an extended period of time with a well thought out interdisciplinary treatment plan. The advantages of maintaining this tooth, in lieu of extraction at age 8, will be elucidated. Clinical significance: Retaining guarded teeth in the maxillary esthetic zone for an 8-year-old patient, has many advantages. It can simplify and enhance future treatment results. The patient retained this central incisor through the formative years. It simplified the orthodontic treatment and implant treatment. The importance of keeping "roots in the bone" to preserve the alveolar bone has many advantages for future treatment options.

Non-surgical management of dens invaginatus type IIIB in maxillary lateral incisor with three root canals and 6-year follow-up: A case report and review of literature

“…The prognosis of DI cases has not been sufficiently studied and most data regarding the condition are available in case reports[ 4 , 5 , 18 , 19 , 23 - 27 , 29 , 30 ]. The follow-up period of successfully managed DI cases varies from 6 mo[ 4 ] to 27 years[ 5 ], indicating a good prognosis; although, a well-designed systematic review and meta-analysis or a large-sample original research study is needed to draw definite conclusions on prognosis. CBCT was not performed during diagnosis, which can be considered a limitation of the present case report, but the underlying radiation dose concerns for patient age justify our caution.…”

“…Success of endodontic treatment relies on myriad features of the clinical process, including accurate diagnosis, proper access cavity preparation, biomechanical preparation, obturation and post-endodontic restoration, as well as the physician’s knowledge of root canal anatomy. The majority of maxillary lateral incisors are one-rooted with single canal[ 1 ], but anatomical variations such as the presence of multiple canals[ 2 - 4 ], radicular palatal grooves[ 5 ], dens invaginatus (DI)[ 6 ], talon cusps with DI[ 7 ], enamel projections at cemento-enamel junction, etc [ 8 ] can complicate their endodontic management.…”

“…The exact cause of DI formation is unknown, although trauma, genetics, infection of the tooth bud during development, and pressure from adjacent developing tooth germ have been suggested as causes. The clinical appearance of DI varies from normal morphology to conical-, peg- or barrel-shaped, large bucco-lingual dimensions, or association with talon cusp[ 3 , 5 , 7 ]. Based on Oehlers’s classification[ 14 ], according to depth of penetration and communication with the periodontal ligament or periapical tissue (determined radiographically), it is classified into the following three types/four subtypes: type I, an enamel-lined minor invagination that does not extend beyond the cementoenamel junction; type II, an invagination extending apically beyond the cementoenamel junction as a blind sac and which may or may not communicate with the dental pulp but has no communication with the periodontal ligament; type IIIA, an invagination penetrating through the root and laterally communicating with the periodontal space by a pseudo foramen without any direct communication with the pulp; and type IIIB, an invagination penetrating the root to communicate with the periodontal ligament at the apical foramen without any direct communication with the pulp.…”

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

“…In the past, teeth with PGGs were typically extracted due to endodontic-periodontal complications and hopeless prognosis [20]. Over the years, numerous treatment options for PGGs have emerged, namely curettage of the affected tissues, elimination of the groove (saucerization), sealing the groove up to the cementoenamel junction, exclusive endodontic and periodontal interventions, combined endodonticperiodontal procedures, and surgical approaches such as guided tissue regeneration and intentional replantation [22].…”