Intentional replantation for the treatment of a double-rooted maxillary lateral incisor with periodontal-endodontic lesions: a case report and literature review / 口腔疾病防治

Objective@#To investigate the clinical characteristics, diagnosis and treatment of severe combined periodontal-endodontic lesions in a double-rooted maxillary lateral incisor with a palatal radicular groove and to provide a reference for clinical diagnosis and treatment.@*Methods@#A patient with a double-rooted left maxillary lateral incisor with a palatal radicular groove and severe combined periodontal-endodontic lesions underwent complete root canal therapy and intentional replantation, and a retrospective analysis of the management of this type of patient was performed based on the literature.@*Results@#The 3-year follow-up examination revealed no discomfort, good healing of the upper left lateral incisor, no pathological loosening, and a palatal gingival sulcus was found at a depth of approximately 1 mm. Review of the literature showed that the prognosis of the affected tooth and the choice of treatment plan were correlated with the length and depth of extension of the lingual groove toward the root, the periodontal condition and the pulpal status of the affected tooth. For minor PRGs or for affected teeth with no loss of pulpal viability, flap surgery and odontoplasty can be used to avoid endodontic treatment or retreatment. For deep or long lingual grooves that result in significant loss of periodontal tissue, endodontic treatment, odontoplasty, or closure of the grooves and guided tissue regeneration are needed. In the case of PRGs with double root formation, the affected tooth can be preserved via root canal therapy, removal of the small root and filling with apical restorative material, and intentional replantation.@*Conclusion@#In cases of severe combined periodontal-endodontic lesions due to palatal radicular grooves occurring in double-rooted maxillary lateral incisors, clinical presentation and imaging can prevent missed diagnoses, and appropriate treatment should be based on the length and depth of lingual grooves extending toward the roots, periodontal conditions, and pulpal status of the affected teeth.

Multi-disciplinary treatment of severe palatal radicular groove of maxillary lateral incisor: A case report and literature review / 中南大学学报(医学版)

Palatal radicular groove is a developmental malformation of maxillary incisors, lateral incisors in particular, which often causes periodontal destruction. This paper reports a case of combined periodontal-endodontic lesions induced by palatal radicular groove, which was initially misdiagnosed as a simple periapical cyst. After root canal therapy and periapical cyst curettage, the course of disease was prolonged, resulting in the absence of buccal and maxillary bone plates in the affected tooth area. After the etiology was determined, the affected tooth was extracted and guide bone tissue regeneration was performed at the same time, followed by implantation and restoration at the later stage, leading to clinical cure. The palatal radicular groove is highly occult, and the clinical symptoms are not typical. If the abscess of the maxillary lateral incisor occurs repeatedly, and the abscess of the maxillary lateral incisor has not been cured after periodontal and root canal treatment, cone-beam computed tomographic and periodontal flap surgery should be considered.

Cone-beam computed tomography study of C-shaped root canal of mandibular premolars / 口腔疾病防治

Objective@#To investigate the incidence and morphology of C-shaped root canals in mandibular premolars by cone-beam computed tomography (CBCT) imaging, which provides a reference for clinical diagnosis and treatment.@*Methods @#The CBCT scanning data of 964 mandibular first premolars and 907 mandibular second premolars in 508 cases were collected, and the root canal morphology, incidence of C-shaped root canals, bilateral symmetry and location of radicular grooves were analyzed.@*Results@#The incidence of C-shaped root canals in mandibular first premolars was 4.1% and that in mandibular second premolars was 0.6%. The incidence of C-shaped root canals of mandibular first premolars was significantly higher than that of mandibular second premolars (χ2=25.775, P < 0.001). The symmetrical ratio of C-shaped root canals in the mandibular first premolars was 29%. There were no symmetrical C-shaped root canals in the mandibular second premolars. There were significant differences in the distribution of the C-shaped root canal configuration in the root canal (P < 0.001). The C-shaped configuration mainly existed in the middle axial and apical level of the mandibular premolars. The C2 type was more common. No C-shape was found in the coronal level of the mandibular premolars. Vertucci I single tube type was the most common type of root canal for the mandibular premolars included in this study; the incidences were 81.7% and 98.3% for the mandibular first and second premolars, respectively, and the difference was statistically significant (χ2=140.544, P < 0.001). The other root canal types of mandibular first premolars were more than those of mandibular second premolars. The incidences of Vertucci Ⅱ, Ⅲ, Ⅳ, and Ⅴ and C-shaped root canals in mandibular first premolars were significantly higher than those in mandibular second premolars. C-shaped root canal mandibular premolars had radicular grooves, and most of them were located at the mesiolingual side.@*Conclusion@# The morphology of the C-shaped root canal in mandibular premolars was complicated. CBCT can provide direct and accurate imaging evidence for clinical diagnosis and treatment.

Root canal morphology and root variation of the mandibular first premolar: A study by cone-beam computed tomography / 医学研究生学报

Objective Few studies are reported on the radicular groove and root canal variation of the mandibular first premolar.This study aimed to observe the root canal system and root variation of the mandibular first premolar by cone-beam computed tomography (CBCT).Methods We selected CBCT images of 643 mandibular first premolars of 336 patients and subjected the data obtained to statistical analysis.Results Of the 643 mandibular first premolars, 637 (99.1％) had a single root and the other 6 had double roots;502 (78.1％) had a single root canal, 133 (20.7％) had two, 5 (0.78％) had three, and 3 (0.47％) presented C-shaped root canal morphology.The average length of the 643 mandibular first premolars was (13.2±1.5) mm and the mean distance from the apical foramen to the anatomical apical end of the root was (0.93±0.35) mm.Totally, 123 (19.1％) of the mandibular first premolars had a radicular groove, of which 94 (76.4％) had double root canals and the root canal systems included typesⅠ in 24 (19.5％), Ⅱ in 2 (1.6％), Ⅲ in 19 (15.4％), Ⅳ in 1 (0.8％), Ⅴ in 69 (56.1％), and Ⅶ in 3 (2.4％).Conclusion The root canal system of the mandibular first premolar has a significant variation.CBCT can reveal the complex anatomical structure of the mandibular first premolar and provide reliable evidence for the root canal treatment.

Intentional replantation for the treatment of palatal radicular groove with endo-periodontal lesion in the maxillary lateral incisor: a case report / 华西口腔医学杂志

Palatal radicular groove leads to severe endo-periodontal lesion in lateral incisors. The groove occurs on the labial and lingual root surfaces, while the localized periodontal pocket develops along the lingual groove length. The complicated root canal system, extensively destroyed bone lamella, and persistent fistula pose a challenge for root canal therapy, tooth retention, and thorough infection control inside and outside of the root canal. Combining microscopic root canal therapy with intentional replantation and nano-biomaterial application facilitates infection control, tooth retention, and formation of newly periodontal attachment.

Surgical management with intentional replantation on a tooth with palato-radicular groove

A palato-radicular groove (PRG) is a developmental anomaly primarily found in the maxillary lateral incisors. It is a potential communication path between the root canal and the periodontium that decreases the survival prognosis of the affected tooth, therefore compromising the stability of the dental structure in the oral cavity. The aim of this case report is to present an original technique where a PRG was treated by means of intracanal disinfection, PRG sealing with glass ionomer, replantation with intentional horizontal 180 degree rotation of the tooth, and an aesthetic veneer placed to provide adequate tooth morphology. The clinical and biological benefits of this novel technique are presented and discussed.

Surgical management with intentional replantation on a tooth with palato-radicular groove

A palato-radicular groove (PRG) is a developmental anomaly primarily found in the maxillary lateral incisors. It is a potential communication path between the root canal and the periodontium that decreases the survival prognosis of the affected tooth, therefore compromising the stability of the dental structure in the oral cavity. The aim of this case report is to present an original technique where a PRG was treated by means of intracanal disinfection, PRG sealing with glass ionomer, replantation with intentional horizontal 180 degree rotation of the tooth, and an aesthetic veneer placed to provide adequate tooth morphology. The clinical and biological benefits of this novel technique are presented and discussed.

Lingual radicular rift valley in a mandibular right first premolar root: report of a rare case and review of the literature / Surco radicular lingual en la raíces del primer premolar mandibular derecho: reporte de un raro caso y revisión de la literatura

Irregular root configurations which often challenge the requirements of successful root canal treatments are always misleading doctors to incorrect clinical judgments and treatment planning. In this article we describe a rare case of CBCT C-shaped mandibular premolar with a huge area of invagination measuring 6 mm ´ 3 mm, which we termed a "radicular rift valley" from a 76-year-old man. Considering the complex process of differential diagnosis, the overall status of disease condition and the will of the patient we proposed five treatment plans and finally conservatively chose plan B composed of both RCT and periapical scaling. A related literature review is also added into this article to describe the whole situation of root invagination, to stress the importance of the vigilance of diagnosis and to provide reference views for future similar diseases.

Las configuraciones radiculares irregulares que a menudo desafían las exigencias de un tratamiento de canal radicular exitoso, son siempre engañosas llevando al especialista a juicios clínicos y planificación de tratamientos erróneos. En este artículo se describe, en un hombre de 76 años de edad, un raro caso de un premolar mandibular que mediante CBCT se observa la forma de C con un área enorme de invaginación midiendo 6 mm x 3 mm, lo que hemos denominado un "Rift valley radicular ". Teniendo en cuenta el complejo proceso de diagnóstico diferencial, el estado general de enfermedad y la voluntad del paciente, se propusieron cinco planes de tratamiento y, finalmente, se eligió el plan B conservador compuesto por el tratamiento del canal radicular y tratamiento periapical. Una revisión de la literatura relacionada se añade en este artículo para describir las situación de invaginación radicular, haciendo hincapié en la importancia del diagnóstico y para proporcionar referencias para enfermedades similares futuras.

Management of lateral incisor with palatal radicular groove.

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.