Successful surgical management of palatogingival groove using platelet-rich fibrin and guided tissue regeneration: A novel approach

Abstract

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.

The Periodontal-Endodontic Relationship, What Do We Know?

“…The use of regenerative approaches to manage perio-endo lesions has advantages especially in terms of enhanced attachment gain and better long-term outcome of treated teeth. Various other treatment modalities for managing the periodontal component of perio-endo lesions, such as the application of enamel matrix derivatives [92] or platelet-rich fibrins [93] may offer good results. However, more research is warranted in this field with hope that retention of perio-endo involved teeth may become more predictable in the near future.…”

Regenerative treatment of intraosseous defect in endodontic-periodontal lesion: Clinical case

“…When the groove is superficial and located only in the coronal structure, an odontoplasty and periodontal therapy are performed, however, if there is deep and pulp involvement, the treatment becomes complex [5] . They are the most common clinical/radiographic characteristics of endoperiodontal lesions.…”

“…Intra-surgical evaluation includes the morphology of the periodontal defect, the type of defect, the material of choice to fill the defect and enhance healing, control of the patient's oral hygiene, and wound stabilization [6] . Surgical procedures involving the removal of granulation tissue, odontoplasty, scaling and root planning of the area with the groove, and endodontic therapy for the involved tooth have resulted in adequate periapical healing and effectively reduced gingival probing depth [5] .…”

“…Because PRF is autologous, the risk of rejection or disease transmission is avoided, and it is inexpensive, its release continues for at least 7 days [5] . The management of endoneurium lesions without regenerative therapy has a success rate of 27-37%, while the use of regenerative therapies has a rate of 77.5% [8] .…”

Study of the intentional replantation procedure used to treat a tooth with a palatogingival groove: A case report

“…Multiple case reports have described various treatment methods that have been used to treat palatogingival groove ranging from periodontal regeneration to apexectomy, depending on the extent of the infection ( 3 ). The treatment goals of the palatogingival groove tooth include complete eradication of microorganisms, total and permanent sealing of the root groove that communicates between the root canal and the periodontium, and complete healing of the periodontium ( 4 ).…”