Journal of

Periodontology
&
Implant Dentistry
 
Case Report

Management of a Palatal Gingival Groove in a Maxillary

Lateral Incisor: A Case Report
Ashkan Salari1 • Maosumeh Faramarzi2* • Seyedeh Fereshteh Naser alavi3
1
Post-graduate Student, Department of Periodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
2
Associate Professor, Department of Periodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
3
Post-graduate Student, Department of Operative Dentistry, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
*Corresponding Author; E-mail: faramarzie@hotmail.com

Received: 12 September 2015; Accepted: 20 December 2015

J Periodontol Implant Dent 2015;7(2):66–69 doi: 10.15171/jpid.2015.013
This article is available from: http://dentistry.tbzmed.ac.ir/jpid

© 2015 The Authors; Tabriz University of Medical Sciences

This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original
work is properly cited.

Abstract
The palate-gingival grooves are an anatomical anomaly in maxillary incisors, which might result in local periodontal
pocket formation, bone loss and sometimes pulpal necrosis. In the present case, there was a groove on the palatal side of a
maxillary lateral incisor with vital pulp. The periodontal problem of the tooth was treated and the 6-month postoperative
follow-up showed attachment gain and decreased pocket depth.
Key words: Anatomical anomaly, bone graft, palate-gingival groove.

tempt to form an additional root or it can be the re-

Introduction
sult of a change in genetic mechanisms.4,5 Clinically
natomic variations are often seen in the human this groove causes accumulation of bacterial plaque
A dentition. Many embryonic malformations such
as cleft palate, globulomaxillary cyst, and missing
and inflammation. The teeth with this anomaly are
often associated with periodontal pockets, bone loss
and peg-shaped teeth happen in the area of maxillary and sometimes pulpal necrosis, the latter indicating
lateral incisors. Another dental anomaly in this area the presence of a combined endodontic-periodontal
is a palate-gingival groove in the palatal aspect of lesion.6,7 The prognosis of teeth with this develop-
teeth.1 This groove is described with other terms like mental defect depends on the depth and width of the
radicular groove, vertical developmental groove and groove. Shallow grooves are treated by odontoplasty
cingulo-radicular distolingual groove.2 It is found in with periodontal therapy whereas deeper grooves are
the enamel or cementum on the palatal aspect of complicated cases with poor prognosis.6 This article
maxillary incisors and usually starts from the cin- presents management of a case of a palate-gingival
gulum surface and continues along the root. The ma- groove in a maxillary lateral incisor.
jority of these grooves are found in the maxillary
lateral incisors and may result from an invagination Case report
of the enamel organ and the epithelial sheath of
In a routine dental examination of a 45-year-old man
Hertwig during odontogenesis.3 Some studies have
in the Post-graduate Division of Department of Pe-
suggested that groove formation is an endless at-
riodontology, Tabriz Faculty of Dentistry, a notch in
 Palatal Gingival Groove in a Maxillary Lateral Incisor 67

the area of cingulum of tooth #12 toward the gingi-

val margin was detected; the pocket depth in that
area was 11 mm and bled during probing while other
areas of the mentioned tooth were normal. There was
also grade I mobility (Figures 1 & 2).
In radiographic examinations, an advanced bony de-
fect was seen on the distal aspect of tooth #12 that
extended toward the apical third of the root (Figure
3).
As the occurrence of palate-gingival groove may
be bilateral, the tooth #22 was also examined in the
clinic and radiographically but there was no evidence
of a groove. The reaction of tooth #12 to thermal and
electrical test was normal and thus no endodontic
treatment was necessary. It seemed the problem was
only periodontal in this case.
The treatment started under local anesthesia with
2%, lidocaine with epinephrine at a concentration of
1:100000. A sulcular incision was made on the pala-
tal side of the maxilla and then a full-thickness mu-
coperiosteal flap was reflected. Granulation tissue Figure 3. Preoperative radiographic view.
was curretaged from the defect. Odontoplasty and
radiculoplasty were conducted with a polishing dia- water cooling. The bony defect was filled with a
mond round bur (Diamant Gmbh, D&Z, Berlin, bone graft and the surface of cingulum was restored
Germany) in a high-speed handpiece under air and with composite resin (Filtek Z250, 3M ESPE, St.
Paul, USA). Then, the palatal flap was returned and
fixed by sling suture technique with 3-0 silk suture
and the area was covered with periodontal dressing
(Coe-pak) (Figure 4).
Postsurgical instructions were given to the patient
and these medications were prescribed: Amoxicillin
500 mg tid for 1week, Ibuprofen 400 mg qid for 3
days and 0.12% CHX mouthwash twice daily for 2
weeks.
Ten days after surgery, sutures and periodontal
dressing were removed. A periodic recall program
was scheduled at 1, 3 and 6 months after surgery. At
the end of this program, the patient had no com-
plaints and the tooth mobility returned to normal.
Figure 1. Preoperative photograph. 
 
There was no bleeding on probing and the probing

Figure 2. Probing of the pocket before surgery. Figure 4. Flap reflection during surgery.
68 Salari et al. 

depth decreased to about 4 mm. The bony defect was makes proper cleaning difficult for both the patient
radiographically filled (Figure 5 & 6). and dentist.7 Patients with this groove may be asso-
ciated with symptoms of periodontal abscess or true
Discussion periodontal disease or true endodontic problem.
The palate-gingival groove is a developmental Also, it may have no symptoms.10
anomaly that extends from the cingulum along the This groove may be seen on radiographs as a dark
root of maxillary incisors and might involve the line extending along the root that resembles a verti-
pulp.7 The prevalence of this groove has been re- cal root fracture. Detection of the groove is not al-
ported to be 2.8‒8.5%.8 Kogan reported a prevalence ways easy because it may be below the gingival
rate of 43% for the palatal groove on the root surface margin or it may be hidden completely by bacterial
of maxillary lateral incisors that measured less than 5 plaque. For detecting these cases, periodontal prob-
mm and in 47% of cases they measured 6‒10 mm.9 ing is recommended because isolated periodontal
The shape of this developmental defect is generally pockets are associated with this anomaly. The depth
funnel-like that creates a niche, causing bacterial and the extent of groove is an important factor in the
plaque accumulation and calculus formation; it prognosis of affected teeth. The shallow and narrow
grooves are often successfully treated whereas deep
grooves are associated with combined endodontic-
periodontal problems and poor prognosis.7
In our case, the tooth #12 had a periodontal prob-
lem without pulpal involvement and therefore, it
needed no root canal therapy. A successful treatment
of this case depends on the ability to eliminate the
groove because the groove favors plaque retention,
giving rise to inflammation, periodontal pocket for-
mation and bone loss. Through odontoplasty and
curettage of granulation tissue the prognosis of teeth
with shallow grooves can be improved. In our case,
after eliminating the groove and curettage of granu-
lation tissue, a bone graft was placed in the bony de-
fect and the cingulum of tooth was restored. After 6
Figure 5. Postoperative pocket depth.  months of follow-up, the patient was asymptomatic
  and the tooth had about 4 mm of probing depth
without bleeding on probing at the palatal side.

Conclusion
The presence of a palate-gingival groove on the pala-
tal aspect of maxillary lateral incisors is not uncom-
mon and lack of awareness of its existence can lead
to inappropriate treatment and eventual tooth loss.
Thus, during oral and dental examinations, the clini-
cian should pay attention to the presence of this
groove.

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