Skip to main content
Download PDF

Palatal groove associated with periodontal lesions: a systematic review illustrated by a decisional tree for management

BMC Oral Health volume 24, Article number: 1037 (2024) Cite this article

Abstract

Background

Palatal groove represents a relatively uncommon developmental root anomaly, usually found on the palatal aspect of maxillary incisors. While its origin is controversial, its presence predisposes to severe periodontal defects.

Aim

This study aimed to provide a systematic review of the literature focusing on the varied diagnostic techniques and treatment modalities for periodontal lesions arising from the presence of palatal groove. Based on the existing evidence and knowledge, the study also provides a comprehensive decisional tree, guiding clinicians in the challenging decision-making process face to a palatal groove.

Methods

The literature search was conducted on Medline and Cochrane databases by two independent reviewers, who also performed the screening and selection process, looking for English written articles reporting on diagnosis and management (all treatment approaches) of periodontal lesion(s) associated with a palatal groove. Based on this literature, a comprehensive decisional tree, including a standardized palatal groove evaluation and tailored treatment approaches, is proposed. Moreover, a clinical case is described to demonstrate the practical application of the developed decisional tree.

Results

Over a total of 451 articles initially identified, 34 were selected, describing 40 patients with 40 periodontal lesions associated with palatal grooves. The case report illustrates a deep, large, circumferential intra-bony defect on the palatal side of the tooth #22 associated with a shallow, moderately long palatal groove in an 18-year-old male patient. Following reevaluation, a single flap surgery was deemed necessary, combined with a regenerative procedure. At 2 years post-treatment, the tooth #22 is healthy, in a functional and esthetic position. The decision-making process, based on local and systemic patient’s conditions, should allow an early and precise diagnosis to prevent further complications and undertake an adequate treatment.

Conclusion

Palatal grooves are relatively rare; however, they are frequently associated with severe periodontal defects. The identification, diagnosis, prompt, and tailored management of the associated lesion is essential to mitigate potential periodontal and endodontic complications related to the presence of palatal groove.

Systematic Review Registration

[https://www.crd.york.ac.uk/prospero/], identifier [C CRD42022363194].

Peer Review reports

Introduction

Palatal groove (PG) is defined as an anatomic anomaly characterized by the presence of a developmental groove on a dental root that, when present, is usually found on the palatal aspect of maxillary incisors [1]. Over the years, several terms have been used to describe this anomaly, including palatal or palate-gingival groove [2, 3], developmental radicular anomaly [4], distolingual groove [5], radicular lingual groove [6, 7], palatoradicular groove [8, 9], radicular groove [10], and cinguloradicular groove [11].

The origin of the PG is controversial, but it is assumed to be related to the infolding of the enamel organ or Hertwig epithelial root sheath during the tooth development [12]. Additional hypogenetic root formation [13, 14] as well as an altered genetic mechanism [15] have also been suggested.

PG is relatively rare. Everett et al. [5] reported a prevalence of PG on 2.8% of lateral incisors whereas Withers et al. [16] observed a PG on 2.3% of maxillary incisors (4.4% of maxillary laterals and 0.28% of maxillary centrals). Kogon et al. [8] examined 3168 extracted maxillary central and lateral incisors and found PG on 4.6% of them (3.4% of maxillary centrals and 5.6% of maxillary lateral incisors), with over half of the PG extending more than 5 mm apical to the cementoenamel junction leading to a localized periodontal lesion. The most recent study by Mazzi-Chevez et al. [17] observed 150 maxillary central incisors, lateral incisors, and canines with a micro-CT and found that PG affected 2% of central incisors and 4% of lateral incisors. In 100% of cases, the PG originated in the enamel.

As the term implies, PG is formed around the cingulum of the tooth and continues apically down from the cementoenamel junction, terminating at various depths and length along the root [18]. In contrast to maxillary bicuspids, incisors generally display a U-shaped groove.

This anatomic anomaly is frequently associated with a breakdown of the periodontal attachment involving the groove; a self-sustaining localized periodontal pocket can develop [4], where the PG itself provides a site for bacterial accumulation. The subsequent progressive inflammation along the PG and its apical portion may lead to periodontal and endodontic pathologic conditions [19]. Furthermore, there may be communication between the pulp canal system and the periodontium through the pulp cavity and/or accessory canals, which may also lead to combined endodontic-periodontal lesions [20]. According to the 2017 classification of periodontal and peri-implant diseases and conditions [21], PG can be classified as a localized tooth-related factor that modifies or predisposes to plaque-induced gingival diseases/periodontitis [22], and can be associated with periodontal abscess in non-periodontitis patients.

The prognosis for teeth with PG extending apically is often poor [12], highlighting the critical need for prompt and accurate diagnosis to avert further periodontal and endodontic complications, ultimately preventing tooth extraction. This study is fundamentally motivated by the scarcity of consolidated guidelines for managing such complex dental conditions. Hence, the objective of this study was to conduct a systematic review of the existing literature, focusing on the diagnosis and management of periodontal lesions linked to PG. Based on this review, the goal was to develop a comprehensive decisional tree, thereby proposing a standardized treatment protocol to aid in the clinical decision-making. This study also includes a clinical case report to demonstrate the practical application of the developed decisional tree, reinforcing its clinical relevance and utility.

Material and methods

Development of the systematic review protocol

A protocol covering all aspects of the systematic review methodology was developed before starting the review. The protocol included the definition of: a focused question; the literature search strategy; the study selection criteria; the outcome measures; the screening methods; the data extraction; and the data synthesis. The protocol was registered in PROSPERO (CRD42022363194).

Defining the focused question

The research question was formulated according to the PICOS (Population, Intervention, Comparison, Outcome, Study) strategy, which identify the search and selection criteria as follows:

  • P: Patients with periodontal lesion(s) associated with a PG

  • I: PG identification (diagnosis) and management. All treatment approaches (non-surgical, surgical, with or without the adjunctive use of potentially regenerative materials, i.e. barrier membranes, grafting materials, growth factors/proteins and combinations thereof) were considered.

  • C: alternative treatment approach or no comparison.

  • O: periodontal parameters, including clinical attachment level (CAL, measure in mm), probing pocket depth (PPD, measured in mm), recession (REC, measured in mm), plaque index (PI, any validated clinical score), bleeding on probing (BOP) or other inflammatory indexes, radiographic bone loss.

  • S: Any type of human studies including case reports, with a minimum of 6 weeks follow-up after treatment. Only studies published in English were considered. Studies written in languages other than English, review articles, cell and/or animal studies, letters, editorials, conference summaries, commentaries, and studies considering PG with only an endodontic involvement or that used self-report assessment of treatment outcomes were not considered.

So, the focused question was formulated as follows: what is the efficacy of treatments for periodontal lesions associated with PG?

Search strategy

The literature was searched for articles published up to June 2022 on MEDLINE and Cochrane databases. Multiple combinations of pertinent search terms were employed (Supplemental Table 1). The reference lists of the included studies were also evaluated in order to identify additional articles. To ensure its reproducibility, the PRISMA guidelines were followed [23], and the PRISMA flowchart was filled [24] (Fig. 1).

Fig. 1
figure 1

PRISMA flow diagram on the selection process of the studies included in the systematic review

Full size image

Literature screening and data extraction

The titles and abstracts of the initially identified studies were screened by two independent reviewers (Y.G. and V.G.). Then, the pre-selected studies underwent a full text evaluation to assess the final inclusion or not. All records for which inclusion was obtained “uncertain” for on reviewer, disagreement was solved by discussion between authors. Whenever needed, the authors of the selected studies were contacted to provide missing data.

Study screening and selection was carried out by using the Rayyan online software [25], which assisted the reviewers in the different step of the literature review process. Duplicate references were removed automatically using Mendeley software. Data extraction was carried out on a dedicated excel spreadsheet. The risk of bias assessment was carried out by using the Joanna Briggs Institute (JBI) scale [26, 27].

Results

The literature search resulted in 451 potentially relevant publications (Fig. 1). After the first selection step, based upon the title and abstract, 88 articles were pre-selected. After full-text evaluation, 34 articles were included and analyzed. All of them were case series and case reports. A total of 40 patients were described, of which 23 women (57.5%). The characteristics of the selected studies are presented in Table 1. Their quality assessment is reported in Table 2.

Table 1 Studies identifying palatal groove with associated periodontal lesion(s) and their management
Full size table
Table 2 Risk of bias assessment of the included studies according to the Joanna Briggs Institute (JBI) [45, 46]
Full size table

Qualitative synthesis of the literature

Among those 40 clinical cases, 12 cases report failed to provide a clinical description of the PG. Four studies described the PG depth alone, 17 studies described the PG length alone, and 7 studies provided a combined description of depth and length of the PG. From a periodontal point of view, the periodontal lesion morphology was correctly described (depth and width) in only 4 cases, 2 of which also reported the number of bony walls. Among the 22 cases reporting a diagnosis, 17 (77.3%) described combined endo-periodontal lesions, whereas 5 were purely periodontal lesions.

Endodontic involvement was present in 29 cases: 22 cases presented with a pulp necrosis, and 7 cases with an endodontic treatment. Pulp vitality was present in 10 cases and 1 case failed to report the endodontic status.

The endodontic treatment consisted in either a temporary filling (calcium hydroxide) later replaced by a definitive filling (gutta percha), or directly with a definitive filling (gutta percha) when indicated. Among those 29 endodontically treated teeth, 9 underwent an apicoectomy (using mineral trioxyde aggregate) at the surgical phase.

PG sealing was performed in 16 cases using mainly glass-ionomer cement but also mineral trioxide aggregate (MTA), tricalcium silicate cement, composite flow and amalgam. In 5 cases, an extra-oral filling of the groove was performed before the tooth reimplantation. In all cases, radiculoplasty was performed either for groove removal when it was shallow or by saucerization to allow a proper filling when grooves were deep.

To treat the PG associated periodontal defect, several different intervention types were described, using: allogenic bone, xenogeneic bone, alloplastic materials, barriers, growth factors and biological factors (and combinations thereof). These surgical regenerative procedures were reported in 25 cases. Only 2 cases [3, 40], justified the use of biomaterials and flap designs in relation to the analysis of the associated periodontal lesion after PG management.

All cases reported clinical healing except for 2 cases of failures following tooth reimplantation due to external root resorption leading to tooth removal after 36 months [33] and 2 failures after 6 months following a surgery without regeneration or root filling [29]. The case with the longest follow-up (324 months) indicated that following an endodontic treatment with a periodontal regeneration and an orthodontic treatment, a recurrent periodontal breakdown occurred 11 years, leading to tooth extraction and implant placement [35].

Case-report

We describe the case of an 18-year-old male patient referred to the periodontics department of the Rothschild Hospital (AP-HP) in Paris. Written informed consent was obtained for the publication of clinical data and images included in this article. The patient was experiencing pain due to the inflammation on the palatal side of tooth #22 with intermittent suppuration. The clinical examination revealed a central, shallow, and of moderate length (up to 70% of the root length) PG on the tooth #22, with a probing pocket depth of 12 mm on the palatal side associated with a tooth mobility 3 (Mühlemann 1951). The tooth responded positively to electrical test. At the radiographic evaluation, bone loss could be noted mesially and distally of #22 (Fig. 2).

Fig. 2
figure 2

Case report. Clinical and radiographical initial situation of the tooth #22 presenting with a palatal groove. The periodontal charting showed deep periodontal pockets on the palatal probing sites associated with bleeding and plaque accumulation

Full size image

A slight bony bridge could be distinguished between #21 and #22 in the coronal portion. Thus, a localized periodontal defect due to the presence of subgingival PG was diagnosed.

The periodontal treatment first consisted in a non-surgical debridement performed in one session. Tooth splinting was performed from #21 to #23 to minimize mobility (Fig. 3).

Fig. 3
figure 3

Root planning and flattening of PG on tooth #22: initial occlusal view of #22 (a); Manual scaling 22 (b); flattening of PG 22 in the coronal part (c)

Full size image

At the re-evaluation 8 weeks later, the tooth presented no superficial inflammation, but a persistent periodontal pocket of 12 mm deep on the palatal side. Surgery was indicated due to the presence of a large, deep, 3-wall intra-bony defect around tooth #22 (Fig. 4).

Fig. 4
figure 4

Regenerative therapy: view at the periodontal re-evaluation, 2-months after the initial treatment (a); large and deep 3-walls intra-bony defect (b); application of EMD (c); application of DBBM (soft tissue support, osteoconductive) (d); sutures (e); radiographic image at the 2-month follow-up (f)

Full size image

A SFA (Single Flap Approach) was designed with a surgical access limited on the palatal side for esthetic reason and optimal visualization. A full periosteal flap was raised, and the granulation tissue was removed. The aberrant local anatomy was corrected up to the most apical part and a regenerative procedure combining enamel matrix derivates with a bone substitute was applied to avoid soft tissue shrinkage and collapse. Sutures with a non-resorbable monofilament 6/0 were made using U-crossed and single points. A postoperative radiograph was taken (Fig. 4f). An antibiotic therapy with amoxicillin (1 g twice a day for 7 days) was administered. Paracetamol was prescribed as a painkiller and a mouthwash containing 0.12% chlorhexidine gluconate were prescribed for 2 weeks postoperatively. Healing was uneventful and sutures were removed 10 days postoperatively.

At the 6 months reevaluation, the periodontal pocket was no deeper than 4 mm on the palatal side with no bleeding on probing. A recession of 1 mm was observed. Radiographically, a mineralized tissue could be observed up to both bony peaks mesially and distally to #22 (Fig. 5).

Fig. 5
figure 5

Re-evaluation at 6 months (a); 18 months (b) and 30 months (c)

Full size image

At the 1-year follow-up, periodontal health was maintained and an orthodontic treatment was undertaken. After 2 years of treatment, tooth #22 is still healthy with a CAL gain of 7 mm, a functional and esthetic position resulting in the patient’s satisfaction. These results support that periodontal regeneration can be effectively carried out also for deep intra-bony defect associated with PG, once the local risk factor has been adequately managed.

Discussion

The results of the present systematic review indicate that PG are relatively uncommon root anomaly, but they are frequently associated with periodontal lesion that require treatment. The selected studies showed that PG can be managed concomitantly with periodontal regeneration, with or without associated endodontic treatment. It must be noted that the presence of a PG may play a significant role in exacerbating periodontal lesions. This could be explained, at least partly, by the mediation role of inflammatory factors like the TGF-B1, which is involved in the regulation of the inflammatory response and in the remodeling of periodontal tissues, as highlighted by recent studies [58, 59]. These findings necessitate a nuanced and well-defined diagnostic and therapeutic approach, which should consider not only on the anatomical challenges linked to the presence of a PG but also on the underlying inflammatory mechanisms, in order to ensure an effective treatment and prevent potential endodontic complications.

A variety of treatments approaches has been described in case reports and case series and summarized in the present review. The appreciation of the morphology and origin of PG on maxillary incisors may be challenging and thus delay the diagnosis and treatment planning. Therefore, developing a standardized approach based on the available literature is advisable.

A PG can be classified according to its location, length along the root, and depth of the groove towards the pulp cavity [60]. The analysis of the associated periodontal lesion is also a key parameter to consider. Based on the work of Kim et al. [60], a simplified version including the groove description and the periodontal parameters has been suggested. Such a classification (Table 3) would provide the clinician with precise criteria to justify the therapeutic approach.

Table 3 Classifications of palatogingival groove and intra-bony defect associated
Full size table

Groove location was disregarded in most cases, only one case [40] reported a distal location of the PG. It can be explained by the fact that this parameter will not affect the prognosis or the treatment sequence. In the latest study done on extracted teeth, PG appeared to originate in the distal area of the cingulum margin in most cases (65%), followed by the central fossa (25%), and the mesial area of the cingulum margin (10%) [61].

In terms of depth, only 7 cases reported a shallow PG (50%) and 7 cases reported a deep PG (50%) and no closed tube has been described. This finding is in accordance with Kogon’s study [8] where 44% percent of the PG were described as shallow depressions, 42% as deep depressions, and 4% as closed tubes.

Considering the groove length, 4 cases reported an extension in the cervical third of the groove (17%), 6 in the middle third (25%) and 14 cases in the apical third (58%). According to Pinheiro’s study [61], those grooves extended rarely only to the cervical third (5%), followed by the middle thirds (45%) and the apical thirds of the root in most cases (50%). It is of paramount importance for clinicians to understand the combination of both variations of groove depth along with their length to adapt an adequate treatment considering the fact that PG with deeper grooves and greater degree of extension are the determinants and predictors of poor prognosis periodontally and endodontically wise [5, 31, 42].

Considering the groove description in the selected studies, most of them failed to adequately report it. Only 7 of the 40 cases described the depth and length of the PG. This lack of analysis might result in an inadequate treatment highlighting the need for a classification.

Considering the periodontal approach of the associated intra-bony defect, the selection of the regenerative biologic principle (or material) to use with the soft tissue surgical approach dependeds on the morphology of the intra- bony defect (width, depth, and number of residual bony walls) and on the amount (and quality) of the soft tissues available to cover it [62]. As a general rule, deep and wide defects with only one residual bony wall require a mechanical stabilizer of the blood coagulum (membrane and/or bone filler), whereas in defects with lower defect angles and a greater number of bony walls, biologic mediators of the healing process (e.g. enamel matrix derivates) are indicated [62]. In the present study, only 2 cases [3, 40] succeeded in justifying the use of their regenerative procedure based on the description and analysis of the associated intra-bony lesion. As for PG anatomy, this lack of description of the associated periodontal lesion morphology could mislead the diagnosis and result in a non-optimal treatment. The PG issue had mostly been a concern for endodontist based on those case reports coming from endodontic journals, which might explain the few periodontal parameters reported and the lack of a clear description of the intra-bony defect associated to justify the different management of the periodontal defect. Moreover, the selected case reports do not cover all potentially applicable regenerative techniques, which continue to evolve [63,64,65] and should be further investigated in the particular context, from the microbiological and inflammatory perspectives, of PG-associate lesions.

Based on the presented literature review and in order to guide clinicians towards a comprehensive and complete evaluation of PG associated lesion, we suggested a decisional tree (Fig. 6) that introduces the periodontal parameter in the PG assessment, after evaluating the endodontic status. Indeed, the successful management of a tooth with a PG is firstly dependent on endodontic status, which should be systematically assessed. In cases of negative pulp response and periapical lesions, an endodontic treatment has to be undertaken in the first place [66]. But, the periodontal evaluation is also cardinal to obtain a successful and long-lasting management of PG.

Fig. 6
figure 6

Decisional tree. This graph proposes a decision-making process for the management of PG-associated lesions that takes into account the endodontic status, the characteristics of the palatal groove, and the presence of intra-bony defect

Full size image

The recognition and management of PG for tooth survival has been reported in details in a study done by Kim et al. [60] in 2017. In the rest of the considered literature, half of the treatments described were made without a clear initial diagnosis or proper description of the associated lesions to justify the type of regenerative strategy and flap design approached. Another interesting observation made in this review is that in the case of intentional replantation, among the 5 reported cases, 2 resulted in a failure necessitating the tooth removal [33]. This suggests that replantation strategy should be used as a the latest resort for complex cases involving a PG to the apex with a deep groove.

It must be acknowledged that the available literature and thus the present systematic review present several limitations. Firstly, as mentioned above, there is a lack of standardization in the diagnostic and treatment processes, with a high heterogeneity among the selected articles, most of the times case reports or case series. Secondly, the follow-up time was mostly set between 6 and 24 months, which may be too short to assess treatment outcomes or observed complications and relapse. Indeed, after a 36 months follow-up, failures have been reported [33] and after 10 years, a periodontal breakdown occurred on a treated tooth [35] and both resulted in the tooth removal. No re-entry surgery and/or histologic evaluations were described and no prospective longitudinal studies evaluating the stability of the clinical and radiographic parameters and the absence of the recurrence of disease were found. Thus, any conclusion about the success achieved with the treatments described in the present review should be drawn with caution as the long-term prognosis of the treatment of PG-associated lesions of teeth remains to be determined. Updates of case series and case reports that could describe results after 5, 10 and 15 years from the initial PG diagnosis are advocated. Finally, the level of the body of evidence on PG is considered as low. Although the nature of PG as rare condition may explain why mainly case reports or case series are published, future clinical and comparative studies should be designed to investigate PG management and treatment success at long term. Nonetheless, based on the currently available literature, a decisional tree (Fig. 6) has been proposed to guide clinicians and create a reference for PG management to respond to a patient’s health condition. This should be periodontally updated as new evidence emerges but in the meantime, it can be useful to provide a clinical guidance as well as a model for the standardization of the diagnostic and treatment processes in clinical cases dealing with PG management.

Conclusion

Teeth with PG represent a challenge for clinicians. Despite their rarity (2% of maxillary lateral incisors), the complexities associated with PG, such as diverse anatomical features and clinical scenarios, underscore the necessity for accurate diagnosis and tailored treatment approaches. This study provides a systematic review of pertinent literature, consisting mainly in case reports, and culminates in the proposal of a decision tree, which aims to assist clinicians in the decision-making process through a structured evaluation of the PG characteristics guiding the treatment approach. The ultimate goal is to mitigate potential periodontal and endodontic complications of PG while providing a successful management. In parallel, the present study highlights the need of future research on this topic, particularly with clinical studies with a sufficiently long follow-up to monitor the treatment outcomes and their stability over time. Indeed, further evidence is needed to develop standardized diagnostic and treatment protocols for PG.

Availability of data and materials

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.

References

  1. Glossary of Endodontic Terms. American Association of Endodontics. 10th ed. 2020.

    Google Scholar 

  2. Bacic M, Karakas Z, Kaiét Z, Sutalot J. The association between palatal grooves in upper incisors and periodontal complications. J Periodontol. 1990;2:197–9.

    Article  Google Scholar 

  3. Schwartz SA, Koch MA, Deas DE, Powell CA. Combined endodontic-periodontic treatment of a palatal Groove : a case report. J Endod. 2006;32(6):573–8.

    Article  PubMed  Google Scholar 

  4. Simon J. Predictable endodontic and periodontic failures as a result of radicular anomalies. J Oral Maxillofac Surger Oral Surg. 1971;42:823–6.

    Google Scholar 

  5. Everett FG. The Disto-lingual Groove in the Maxillary Lateral Incisor; a periodontal hazard. A Periodontal Hazard J Periodontol. 1972;43(6):352–61.

    CAS  PubMed  Google Scholar 

  6. August D. The radicular lingual groove: an overlooked differential diagnosis. J Am Dent Assoc. 1978;96:1037–9.

    Article  CAS  PubMed  Google Scholar 

  7. Meister F. Successful treatment of a radicular lingual groove: case report. J Endod. 1983;9:561–4.

    Article  PubMed  Google Scholar 

  8. Kogon S. The prevalence, location and conformation of palato- radicular Grooves in Maxillary Incisors*. J Periodontol. 1985;57:231–4.

    Article  Google Scholar 

  9. Hou GL. Relationship between palato-radicular grooves and localized periodontitis. J Clin Periodontol. 1993;20:678–82.

    Article  CAS  PubMed  Google Scholar 

  10. Pécora J. Study of the incidence of radicular grooves in maxillary incisors. Braz Dent J. 1992;3:11–6.

    PubMed  Google Scholar 

  11. Assaf M. The cingulo-radicular groove: its significance and management: two case reports. Compendium. 1992;13:94–8.

    CAS  PubMed  Google Scholar 

  12. Gound TG MGI. Treatment options for the radicular lingual groove: a review and discussion. Pract Periodontics Aesthet Dent. 1998;10:369–75.

    Google Scholar 

  13. Ennes JP, Lara VS. Comparative morphological analysis of the root developmental groove with the palato-gingival groove. Oral Dis. 2004;10:378–82.

    Article  CAS  PubMed  Google Scholar 

  14. Goon WWY, Carpenter WM, Brace NM, Ahlfeld RJ. Complex facial radicular Groove in a maxillary lateral incisor. J Endod. 1991;17(5):244–8.

    Article  CAS  PubMed  Google Scholar 

  15. Mittal M, Vashisth P, Arora R, Dwivedi S. Combined endodontic therapy and periapical surgery with MTA and bone graft in treating palatogingival groove. BMJ Case Rep. 2013:1–4.

  16. Withers JA, Brunsvold MA, William J, Rahe AJ. The relationship of palato-gingival grooves localized periodontal disease. J Periodontol. 1981;52(1):41–4.

    Article  CAS  PubMed  Google Scholar 

  17. Mazzi-chaves JF. Influence of anatomical features in the endodontic treatment planning of maxillary anterior teeth. Braz Dent J. 2022;36:1–15.

    Google Scholar 

  18. Lee KW. Palato-gingival grooves in maxillary incisors. A possible predisposing factor to localised periodontal disease. Br Dent J. 1968;124:14–8.

    CAS  PubMed  Google Scholar 

  19. Sharma S. Palatogingival groove : recognizing and managing the hidden tract in a maxillary incisor : A case report. J Int Oral Health. 2015;7(6):110–4.

    PubMed  PubMed Central  Google Scholar 

  20. Gao Z, Shi J, Wang Y, Gu F. Scanning electron microscopic investigation of maxillary lateral incisors with a radicular lingual groove. Oral Surg Oral Med Oral Pathol. 1989;68:462–6.

    Article  CAS  PubMed  Google Scholar 

  21. Herrera D, Alonso B, Feres M. Acute periodontal lesions ( periodontal abscesses and necrotizing periodontal diseases ) and endo-periodontal lesions. J Periodontol. 2017;89(1):85–102.

    Google Scholar 

  22. Jepsen S, Caton JG, Albandar JM, Bissada NF, Bouchard P, Cortellini P, et al. Periodontal manifestations of systemic diseases and developmental and acquired conditions: consensus report of workgroup 3 of the 2017 world workshop on the classification of periodontal and peri-implant diseases and conditions. J Periodontol. 2018;89(1):S237–48.

    PubMed  Google Scholar 

  23. Page MJ, Mckenzie JE, Bossuyt PM, Boutron I, Hoffmann C, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews systematic reviews and meta-analyses. BMJ. 2021;372(71):1–9.

    Google Scholar 

  24. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. 2015. p. 1–9.

  25. Ouzzani M. Rayyan — a web and mobile app for systematic reviews. Syst Rev. 2017;5:1–10.

    Google Scholar 

  26. Munn A, et al. introduction to the JBI critical appraisal tool. JBI Evid Synth. 2020;18(10):2127–33.

    PubMed  Google Scholar 

  27. Peters MDJ, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Implement. 2021;19:3–10.

    Article  PubMed  Google Scholar 

  28. Hungund S, Kumar M. Palato-radicular groove and localized periodontitis : a series of case reports. J Contemp Dent Pract. 2010;11(5):1–8.

    Article  Google Scholar 

  29. Mayne JR, Martini IG. The palatal radicular groove. Two case reports. Aust Dent J. 1990;35(3):277–81.

    Article  CAS  PubMed  Google Scholar 

  30. Corbella S, Alberti A, Zotti B, Francetti L. Case report periodontal regenerative treatment of intrabony defects associated with palatal grooves : a report of two cases. Case Rep Dent. 2019;2019:1–7.

    Google Scholar 

  31. Cho YD, Lee JE, Chung Y, Lee WC, Seol YJ, Lee YM. Collaborative management of combined periodontal-endodontic lesions with a palatogingival groove: a case series. J Endod. 2017;43(2):332–7.

    Article  PubMed  Google Scholar 

  32. Karunakaran JV, Fenn SM, Jayaprakash N, Ragavendran N. Successful surgical management of palatogingival groove using platelet-rich fibrin and guided tissue regeneration: a novel approach. J Pharm Bioall Sci. 2017;9:268–73.

    Article  Google Scholar 

  33. Han B, Liu YY, Liu KN, Gao M, Wang ZH, Wang XY. Is intentional replantation appropriate for treatment of extensive endodontic-periodontal lesions related to palatogingival groove? Chin J Dent Res. 2020;23(3):205–14.

    PubMed  Google Scholar 

  34. Hans M. Management of lateral incisor with palatal radicular groove. Indian J Dent Res. 2010;21(2):306–8.

    Article  PubMed  Google Scholar 

  35. Mathews D. Interdisciplinary management of a maxillary central incisor with a palato-radicular groove: a case report with 27 years follow-up. J Esthet Restor Dent. 2021;33:1077–83.

    Article  PubMed  Google Scholar 

  36. Kishan KV. Management of palato radicular groove in a. J Nat Sci. 2014;5(1):178–81.

    CAS  Google Scholar 

  37. Friedman S. The radicular palatal groove - a therapeutic modality. Endod Dent Traumatol. 1988;4:282–6.

    Article  CAS  PubMed  Google Scholar 

  38. Sooratgar A, Tabrizizade M, Nourelahi M, Asadi Y, Sooratgar H. Management of an endodontic-periodontal lesion in a maxillary lateral incisor with palatal radicular groove: a case report. Iran Endod J. 2016;11(2):142–5.

    PubMed  PubMed Central  Google Scholar 

  39. Schäfer E. Malformations in maxillary incisors : case report of radicular palatal groove. Endod Dent Traumatol. 2000;16:132–7.

    Article  PubMed  Google Scholar 

  40. Zucchelli G, Mele M, Checchi L. The Papilla Amplification Flap for the treatment of a localized periodontal defect associated with a palatal groove. J Periodontol. 2006;77(10):1788–96.

    Article  PubMed  Google Scholar 

  41. Rankow HJ, Krasner PR. Endodontic applications of guided tissue regeneration in endodontic surgery. J Endod. 1996;22(1):34–43.

    Article  CAS  PubMed  Google Scholar 

  42. Castelo-Baz P, Ramos-Barbosa I, Bel A. Combined endodontic-periodontal treatment of a palatogingival groove. J Endod. 2015;41(11):1918–22.

    Article  PubMed  Google Scholar 

  43. Hasan A, Ali J. Combined endodontic and surgical management of twin rooted maxillary lateral incisor with a palatogingival groove. Iran Endod J. 2018;13(3):413–9.

    PubMed  PubMed Central  Google Scholar 

  44. Garrido I. Combined endodontic therapy and intentional replantation for the treatment of palatogingival groove. J Endod. 2016;42(2):324–8.

    Article  PubMed  Google Scholar 

  45. Sucheta A. Treatment of an intrabony osseous lesion associated with a palatoradicular groove. Contemp Clin Dent. 2012;3:260–3.

    Article  Google Scholar 

  46. Ferreira ZA, Pilatti ML. Treatment of a palatal groove-related periodontal bone defect. Quintessence Int. 2000;31(5):342–5.

    CAS  PubMed  Google Scholar 

  47. Andreana S. A combined approach for treatment of developmental groove associated periodontal defect. A Case Report*. J Periodontol. 1998;69:601–7.

    Article  CAS  PubMed  Google Scholar 

  48. Al-hezaimi K, Frcd C, Naghshbandi J. Successful treatment of a radicular groove by intentional replantation and Emdogain therapy : four years follow-up. YMOE. 2009;107(3):e82–5.

    Google Scholar 

  49. Forero-López J, Gamboa-Martínez L, Pico-Porras L, Niño-Barrera JL. Surgical management with intentional replantation on a tooth with palato-radicular groove. Restor Dent Endod. 2015;7658:166–71.

    Article  Google Scholar 

  50. Guruprasad CN, Pradeep AR, Agarwal E. 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. Clin Adv Periodontics. 2012;2(1):28–33.

    Article  CAS  PubMed  Google Scholar 

  51. Jeng JH, Lu HKJ. Treatment of an osseous lesion associated with a severe palato- radicular groove : a case report. J Periodontol. 1992;63:708–12.

    Article  CAS  PubMed  Google Scholar 

  52. Kerezoudis NP, Siskos GJ, Tsatsas V. Bilateral buccal radicular groove in maxillary incisors: case report. Int Endod J. 2003;36:898–906.

    Article  CAS  PubMed  Google Scholar 

  53. Kozlovsky A. Facial radicular groove in maxillary central incisor: a case report. J Periodontol. 1988;46:615–22.

    Article  Google Scholar 

  54. Ling DH, Shi WP, Wang YH, Lai DP, Zhang YZ. Management of the palato-radicular groove with a periodontal regenerative procedure and prosthodontic treatment: a case report. World J Clin Cases. 2022;10(17):5732–41.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Narmatha V. The complex radicular groove: interdisciplinary management with mineral trioxide aggregate and bone substitute. J Contemp Dent Pract. 2014;15(6):792–6.

    Article  CAS  PubMed  Google Scholar 

  56. Wei PC, Geivelis M, Chan CP, Ju YR. Successful treatment of pulpal-periodontal combined lesion in a birooted maxillary lateral incisor with concomitant palato-radicular groove. J Periodontol. 1999;70(12):1540–6.

    Article  CAS  PubMed  Google Scholar 

  57. Gandhi A. Endodontic-periodontal management of a maxillary lateral incisor with an associated radicular lingual groove and severe periapical osseous destruction - a case report. J Ir Dent Assoc. 2012;58(2):95–100.

    PubMed  Google Scholar 

  58. Ramadan DE, Hariyani N, Indrawati R, Ridwan RD, Diyatri I. Cytokines and chemokines in periodontitis. Eur J Dent. 2020;14(3):483–95.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Xu Y, Qiu J, Sun Q, Yan S, Wang W, Yang P, et al. One-year results evaluating the effects of concentrated growth factors on the healing of intrabony defects treated with or without bone substitute in chronic periodontitis. Med Sci Monit. 2019;12(25):4384–9.

    Article  Google Scholar 

  60. Kim HJ, Choi Y, Yu K, Lee W, Min KS. Recognition and management of palatogingival groove for tooth survival: a literature review. Restor Dent Endod. 2017;42(2):77–86.

  61. Pinheiro TN, Consolaro A, Cintra LTA, Azuma MM, Benetti F, Silva CC. Palatogingival groove and root canal instrumentation. Int Endod J. 2020;53:660–70.

    Article  CAS  PubMed  Google Scholar 

  62. Cortellini P. Clinical concepts for regenerative therapy in intrabony defects. Periodontol. 2000;2015(68):282–307.

    Google Scholar 

  63. Bhati A, Fageeh H, Ibraheem W, Fageeh H, Chopra H, Panda S. Role of hyaluronic acid in periodontal therapy (Review). Biomed Rep. 2022;17(5):91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Wulandari P, Amalia M, Budi, Simanjuntak R, Satria D. Hyaluronic acid and its role in periodontal healing: Asam Hialuronat dan Peranannya Dalam Penyembuhan Periodontal. Dentika Dental J. 2022;25(1):22–7.

    Article  Google Scholar 

  65. El-Bana AM, El-Shinnawi UM, Attia IM. The effect of hyaluronic acid in combination With β- tri-calcium phosphate in regeneration of periodontal vertical bone defect in periodontitis patients. Mansoura J Dent. 2020;7(27):80–7.

    Article  Google Scholar 

  66. Attam K, Tiwary R, Talwar S, Lamba AK. Palatogingival groove : endodontic-periodontal. J Endod. 2010;36(10):1717–20.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

None.

Funding

None.

Author information

Authors and Affiliations

  1. Service of Odontology, Rothschild Hospital (AP-HP), 5 Rue Santerre, Paris, 75012, France

    Yvan Gaudex, Vianney Gandillot, Philippe Bouchard, Stephane Kerner & Maria Clotilde Carra

  2. Department of Periodontology, UFR of Odontology, Université Paris Cité, 5 Rue Garanciere, Paris, 75006, France

    Yvan Gaudex, Vianney Gandillot, Philippe Bouchard, Stephane Kerner & Maria Clotilde Carra

  3. Service of Odontology, CH Eure Seine Hospital, Evreux, France

    Isabelle Fontanille

  4. Cordeliers Research Centre, Laboratory of Molecular Oral Physiopathology, Paris, France

    Stephane Kerner

  5. Department of Periodontology, Loma Linda University School of Dentistry, Loma Linda, CA, USA

    Stephane Kerner

  6. INSERM- Sorbonne Paris Cité Epidemiology and Statistics Research Centre, Paris, France

    Maria Clotilde Carra

  7. Institution Nationale Des Invalides, Paris, France

    Vianney Gandillot

Authors
  1. Yvan Gaudex
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vianney Gandillot
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Isabelle Fontanille
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Philippe Bouchard
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stephane Kerner
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maria Clotilde Carra
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Y.G. and V.G. drafted the manuscript text, and were involved in the literature review, data acquisition, analysis, and interpretation. Y.G. and V.G. prepared Tables 1 and 2. Y.G., P.B. and I.F. Contributed the case report and Figs. 2, 3, 4 and 5 M.C.C and S.K. prepared Table 3 and Fig. 6. M.C.C., P.B. and S.K revised the draft of the manuscript and contributed to the general criticism. All authors reviewed and approved the manuscript.

Authors’ information

None.

Corresponding author

Correspondence to Maria Clotilde Carra.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Yes.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gaudex, Y., Gandillot, V., Fontanille, I. et al. Palatal groove associated with periodontal lesions: a systematic review illustrated by a decisional tree for management. BMC Oral Health 24, 1037 (2024). https://doi.org/10.1186/s12903-024-04771-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12903-024-04771-z

Keywords

BMC Oral Health

ISSN: 1472-6831

Contact us