Year : 2010 | Volume
: 21 | Issue : 2 | Page : 306--308
Management of lateral incisor with palatal radicular groove
Manoj Kumar Hans, Ramachandra S Srinivas, Shashit B Shetty
Department of Conservative Dentistry and Endodontia, Kanti Devi Dental College and Hospital, Delhi-Agra National Highway # 2, P.0. Chhatikara, Mathura - 281 006, Uttar Pradesh, India
Manoj Kumar Hans
Department of Conservative Dentistry and Endodontia, Kanti Devi Dental College and Hospital, Delhi-Agra National Highway # 2, P.0. Chhatikara, Mathura - 281 006, Uttar Pradesh
Palatal radicular grooves are developmental anomalies of maxillary incisors, which contribute to localized periodontitis resulting in loss of anterior teeth. Palatal radicular grooves, when present, act as a site for plaque accumulation and periodontal infection. They are easily overlooked as etiologic factors, as these grooves are covered by periodontal tissues. The clinician has to be alert and check for variations in the anatomy of the tooth as a cause of pulp necrosis in the anterior segment of the tooth, when other causes are ruled out. Recognition of palatal radicular grooves is critical, especially because of its diagnostic complexity and the problems that may arise if it is not properly interpreted and treated. This case report describes the diagnosis and management of a maxillary lateral incisor with necrotic pulp and localized periodontal destruction, associated with a palatal radicular groove.
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Hans MK, Srinivas RS, Shetty SB. Management of lateral incisor with palatal radicular groove.Indian J Dent Res 2010;21:306-308
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Hans MK, Srinivas RS, Shetty SB. Management of lateral incisor with palatal radicular groove. Indian J Dent Res [serial online] 2010 [cited 2021 May 13 ];21:306-308
Available from: https://www.ijdr.in/text.asp?2010/21/2/306/66627
Maxillary incisor anomalies are common. In cases of tooth malformation, bacterial invasion and infection are often the cause of pulpal inflammation and tooth loss.  Maxillary incisors can present with a number of major and minor embryonic malformations. Why different malformations occur is not known, although there is evidence that most anomalous tooth developments are genetically determined.  Palatal radicular grooves, which have also been termed radicular lingual grooves, distolingual grooves, palatal gingival grooves, and radicular palatal grooves, are developmental anomalies that represent an infolding of the enamel organ and the epithelial sheath of Hertwig.  Usually, these grooves start coronal to the cingulum and continue for varying distances and directions along the root. The groove is a locus for plaque accumulation, which destroys the sulcular epithelium and later deeper parts of the periodontium, finally resulting in the formation of a severe localized periodontal defect.  Proper cleaning of the defect is difficult, if not impossible for the patient.  Palatal radicular grooves can vary in depth and complexity. Mild grooves terminate at the cementoenamel junction, whereas, moderate grooves continue apically along the root surface.  We report a case of a maxillary lateral incisor with a palatal radicular groove, associated with pulpal necrosis and localized periodontitis. The clinical features and treatment of the problem are reported.
A 28-year-old female patient reported to the Department of Endodontics, Kanti Devi Dental College and Hospital, Mathura, India, with a chief complaint of pus discharge in the upper front tooth for the last seven days. On examination, an intra-oral sinus on the labial aspect of the maxillary right lateral incisor was found [Figure 1]. There was no history of trauma and / or discoloration of the tooth. The maxillary right lateral incisor did not respond to electric and thermal pulp testing. Testing of the adjacent and contralateral teeth elicited normal responses to these tests. A periapical radiograph showed a diffuse radiolucency at the apex and a radiolucent line running adjacent to the root canal on the distal aspect [Figure 2]. On further clinical examination, a groove running from the cingulum toward the root was found on the palatal aspect. The probing pocket depth on the distopalatal line angle of the maxillary lateral incisor was 7 mm. Based on the clinical and radiographic findings a diagnosis of an endo-perio lesion was made. A decision to endodontically treat the tooth followed by periodontal surgery was taken, explained to the patient, and an informed consent was obtained from the patient.
The tooth was isolated with a rubber dam prior to access preparation and determining the working length. Cleaning and shaping of the canal was done with K-files using a step back technique and the canal was obturated by the lateral condensation of the gutta percha and zinc oxide eugenol containing sealer (Tubliseal) [Figure 3]. The mucoperiosteal flaps were elevated on both the labial and palatal aspects, to allow degranulation of the lesion. A palatal radicular groove running up to the middle of the root was noted [Figure 4]. Radiculoplasty was undertaken using a round bur after which the groove was conditioned with polyacrylic acid and sealed with glass ionomer cement (Fuji II; GC Corporation, Tokyo, Japan) [Figure 5] and [Figure 6]. A shallow bony defect was noted on the labial aspect after degranulation. As the defect was shallow, a bone graft was not placed. The flaps were replaced and sutured. A non-steroidal anti-inflammatory drug, Ibuprofen 400 mg (twice daily for three days) was given postoperatively for its analgesic and anti-inflammatory properties. Healing was uneventful and the sutures were removed after one week.
At the three-month recall, the probing depth was 2 mm, which was a reduction of 5 mm in probing depth. Periapical radiographs at three months showed a reduction in apical radiolucency. At the six-month recall, the periodontal health of the lateral incisor was stable and bleeding on probing was not observed [Figure 7]. Progression of hard tissue healing was noticed in the periapical radiograph taken at six months [Figure 8].
Presence of palatal radicular grooves was considered to be an important contributing factor to the development of localized periodontitis, as it favored the accumulation and proliferation of bacterial plaque deep into the periodontium.  Albaricci et al. studied the prevalence and different morphological conditions of the palatal radicular grooves in 376 maxillary lateral and central incisors.  Prevalence in the lateral incisors was 11.1%, with higher prevalence in the proximal localization (62.8%), origination was from the central fossa (57.1%) and predominance was in the oblique trajectory (62.8%). Of all these teeth, only 8.6% of the palatal radicular grooves reached the root apex, while 97.1% were considered to be flat (< 1 mm).  These grooves usually began in the central fossa, crossed the cingulum and extended to various distances, depths, and directions along the root. The fold usually extended as a twisting defect into the surface of the root to a depth of 2 - 3 mm, and could present radiographically as a radiolucent parapulpal line.  Accessory canals connecting to the pulp in the depth of grooves could lead to bacterial ingress to the pulp space.  Pulp involvement could result due to the introduction of bacterial toxins via channels that existed between the root canal system and the groove. 
In the present case, a periapical radiograph, after obturation [Figure 3], shows a radiolucent line mimicking a lateral canal, communicating from the root canal to the periodontal lesion. This radiolucent line is the parapulpal line representing the palatal radicular groove. As there is no history of trauma or caries, the existence of a lateral canal may be the most probable cause of bacterial passage from the palatal radicular groove into the root canal. Once the pulp becomes necrotic, endodontic therapy is indicated. However, conventional endodontic treatment alone will not be effective, because the bacterial etiology is residing extra radicularly, as a self-sustaining lesion. 
Successful treatment of the palatal radicular groove depends on the ability to eradicate inflammatory irritants, by eliminating the groove.  Radiculoplasty is recommended to eliminate the groove, which often harbors bacteria and debris leading to a local inflammatory reaction.  Conditioning of the groove has been done as it removes the surface debris, increases the wettability, and increases the bond strength of the glass ionomer cement.  Glass ionomer cement has been used as it has an antibacterial effect, chemical adhesion to the tooth structure, and good sealing ability.  Clinical and histological studies have shown that there is an epithelial and connective tissue adherence to the glass ionomer cement during the healing process.  In the present case, healing has been slower in the periodontal lesion as the defect was of a horizontal type and reduction in the pocket depth may be due to healing by formation of a long junctional epithelium. 
Effective recognition of the palatal radicular grooves is critical, especially because of their diagnostic complexity and the problems that may arise if they are not properly interpreted and treated.
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