Successful Multidisciplinary Management of an Endodontic‐Periodontal Lesion Associated With a Palato‐Radicular Groove: A Case Report

Management of the palato-radicular groove with a periodontal regenerative procedure and prosthodontic treatment: A case report

BACKGROUND

Palato-radicular groove (PRG) is defined as an anomalous formation of teeth. The etiology of PRG remains unclear. The prognosis of a tooth with a PRG is unfavorable. The treatment of combined periodontal-endodontic lesions requires multidisciplinary management to control the progression of bone defects. Some researchers reported cases that had short-term observations. The management of teeth with PRGs is of great clinical significance. However, to date, no case reports have been documented on the use of bone regeneration and prosthodontic treatment for PRGs.

CASE SUMMARY

This case reported the management of a 40-year-old male patient with the chief complaint of slight mobility and abscess in the upper right anterior tooth for 15 d and was diagnosed with type II PRG of tooth 12 with combined endodontic-periodontal lesions. The accumulation of plaque and calculus caused primary periodontitis and a secondary endodontic infection. A multidisciplinary management approach was designed that included root canal therapy, groove sealing, a periodontal regenerative procedure, and prosthodontic treatment. During a 2-year follow-up period, a good prognosis was observed.

CONCLUSION

This report indicates that bone regeneration and prosthodontic treatment may contribute to the long-term favorable prognosis of teeth with PRGs.

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

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.

Treatment of an Endo-Perio Lesion with Ozone Gas in a Patient with Aggressive Periodontitis: A Clinical Case Report and Literature Review

The pulp and periodontium have obvious relationships that have been described in many studies. Pulp infections may affect periodontal tissues and vice versa. Teeth with endo-perio lesions have a worse prognosis than isolated endodontic or periodontal lesions. Elimination of endodontic and periodontal infections is essential for successful treatment, so co-operation between endodontists and periodontists is necessary. In this clinical case, a 44-year-old male presented with primary periodontal disease with secondary endodontic involvement in his lower right canine because of aggressive periodontitis. There was 10 mm of clinical attachment loss and 8 mm periodontal pocket mesial from the tooth and bone radiolucency periapical and lateral from the root. Periodontal therapy was followed by endodontic treatment. Periodontal therapy included root scaling and planing, treatment of the periodontal pocket with ozone gas, systemic antibiotics, oral hygiene instructions, and chlorhexidine rinsing. Endodontic therapy included root canal instrumentation with rotary endodontic files, irrigation, root canal treatment with ozone gas, and obturation with lateral compaction. Radiographs at a 6-month follow-up appointment showed complete healing of the periapical lesion and alveolar bone lateral to the root. Using an interdisciplinary approach to treat endo-perio lesions provides favorable clinical outcomes. Ozone therapy is beneficial for the successful treatment of endo-perio lesions with narrow periodontal pockets in patients with aggressive periodontitis and poor prognosis.

Effect of endodontic treatment on periodontal healing of grade 3 endo-periodontal lesions without root damage in periodontally compromised patients-a retrospective pilot study

OBJECTIVES

There is little evidence about the effect of different treatment protocols for grade 3 endo-periodontal lesions without root damage in patients with periodontitis according to the new classification of periodontal disease. The aim of this study is to evaluate the impact of endodontic treatment on the achievement of periodontal healing.

MATERIALS AND METHODS

Teeth with the initial diagnosis endo-periodontal lesion without root damage grade 3, treated with a standardized endodontic treatment protocol, were included in this study. A retrospective analysis was performed to assess the impact on periodontal healing by evaluating probing pocket depth (PPD), clinical attachment gain (CAL), and periapical index score (PAI).

RESULTS

Nineteen teeth and 13 patients were included. A mean reduction of 3.19 ± 3.41 mm in PPD was recorded. The mean CAL gain was 2.33± 3.75 mm. Five teeth (45.4%) showed an improvement of PAI and were classified as treatment success.

CONCLUSIONS

The results failed to show a highly predictable treatment outcome for endo-periodontal lesion grade 3 without root damage in patients with periodontitis. However, endodontic therapy alone resulted in treatment success for some of the teeth, which would otherwise have had a poor prognosis.

CLINICAL RELEVANCE

Endo-periodontal lesions can often be challenging for dentists in daily clinical practice. To date, there is not much evidence for practitioners to rely on. Therefore, this study aims to strengthen the evidence for the management and treatment of endo-periodontal lesions. Although the outcome is not highly predictable yet, teeth with the initial diagnosis endo-periodontal lesion without root damage grade 3 can benefit from an endodontic treatment.