The radicular groove is an anatomical formation that most often occurs on the palatal or lateral surfaces of the lateral incisors, but can sometimes continue linearly up to the apex region of the root. Similar cases occur quite rarely with a frequency of 2.8-8.5%, and are most often recorded precisely in the region of the upper lateral incisors.
Directed bone regeneration in the treatment of an additional root
Radicular grooves, depending on the degree of severity, are classified into three types: type I — the groove is limited to the crown third root, type II — the furrow extends beyond the crown root of the root, while it is shallow and does not affect the shape of the pulp; type III — a long and deep groove that extends beyond the crown root of the root and provokes changes in the root canal system.
It has been suggested that the radicular groove is a kind of subspecies of dens invaginatus, since the formation of this is caused by a slight inversion of the enamel organ and the epithelial cells of the root Herwig membrane into the inside during the process of tooth formation. The root groove is an excellent place for reserving microorganisms and accumulating plaque, which, in turn, can provoke the appearance of periodontal pockets. With significant periodontal pockets, provoking factors can disrupt the viability of the pulp and, thus, stimulate the development of combined periodontal-endodontic lesions.
Treatment of the root groove involves: curettage of the affected periodontal tissue, sealing the groove with biocompatible material, saucerization of the indentation, endodontic treatment in the pathology of the root canals, and the use of surgical methods of treatment (directed tissue regeneration and targeted replantation). In most anatomical studies, it has been proven that incisors of the upper jaw always have the same root, but there are clinical cases in which it has been possible to detect lateral incisors with two or even three roots. The additional root of the tooth represents an anatomical deviation, in which the number of roots exceeds the established classical norm.
This article describes the case of treatment of the lateral incisor of the upper jaw with an additional root and inherent radicular groove III type, which provoked the development of periodontal endodontic pathology. The protocol of treatment provided for the use of both surgical and non-surgical methods of iatrogenic intervention.
Clinical case
The 32-year-old patient applied for dental care to the endodontic chair of the Qazvin dental institute with a major complaint about the mobility of the maxillary left lateral incisor. In the course of the clinical examination, a localized periodontal pocket with a depth of 7 mm was found from the palatinal side of the 10 tooth
From all other sides of the tooth, there were no violations of the depth of the gingival groove. Tooth No. 10 did not respond to electrodontometry (Analytic Technology, Redmond, Wash., USA), a cold test (Roeko Endo-Frost; Roeko, Langenau, Germany); percussion and palpation; After CBCT scanning and the preparation of periapical radiographs, the presence of a radicular groove and a large X-ray translucent region adjacent to the site of the left lateral incisor.
On X-ray patterns, we also found an additional supercomplex root. Taking into account the history, clinical and radiographic methods of examination, the necrotic lesion of pulp and localized periodontitis of secondary nature, provoked by the presence of a radicular groove, was diagnosed. The patient was presented with various treatment options, including an integrated approach with endodontic intervention and periodontal therapy. The patient was informed that due to the length and depth of the radicular groove, an unambiguous long-term prognosis of the 10 tooth is controversial.
Endodontic treatment
After performing local infiltration anesthesia (supraperiostal) using lidocaine (2% lidocaine with epinephrine, 1 80000, Darupakhsh, Tehran, Iran) and proper isolation proceeded to form an access cavity. Endodontic treatment was carried out by the Protaper system (Dentsply Maillefer, Ballaigues, Switzerland) in accordance with the manufacturer’s instructions. The input hole of the additional channel was not found after the numerical attempts. Irrigation was carried out with 2.5% sodium hypochlorite (Kimia Tehran Acid, Tehran, Iran), and obturation with side condensation technology of gutta-percha (Gapadent Co., LTD, Korea) using AH26 siller (DeTrey, Dentsply, Konstanz, Germany). The access cavity was sealed with Cavit (Coltosol, AriaDent, Tehran, Iran)
Surgery
After aseptic preparation and local anesthesia (2% lidocaine with epinephrine, 1 80000, Darupakhsh, Tehran, Iran), a sulkulary incision was made from the vestibular side from 9 to 11 teeth. In order to improve access, another loosening incision was made from the distal side of the 11 tooth. After the separation of the full-tissue muco-periosteal flap and the removal of all granulation tissues by curettage, an additional root was removed and the area of the radicular groove was saucerized.
In the area of root removal, it has not been possible to detect the endodontic estuary or even a hint of the opening of the root canal. Additional root and surrounding tissues were sent to the laboratory for histological examination. Thereafter, a directional tissue regeneration procedure was performed using decalcified lyophilized bone allograft consisting of particles ranging in size from 500 to 1000 μm (Cenobone, Tissue Regeneration Corporation, Kis Island, Iran) and a bioresorbable collagen membrane of size 20? 25 mm (0.4 to 0.6 mm thickness)
The flap was set in place and sealed. The tooth was restored by means of a composite and stabilized with a semi-rigid tire. At first the tire was placed on the vestibular side of the tooth, but after 4 weeks, for aesthetic reasons, it was transferred to the lingual side. The patient was prescribed chlorhexidine for rinsing and 4? 400 mg of ibuprofen with 3? 500 mg of amoxicillin per day for a week. The sutures were removed two weeks after the operation, and the tire operated for two months. After the tire was removed, the tooth stabilized, signs of mobility disappeared. The results of the histological examination confirmed that the structure of the additional root was normal, no dysplastic cells were detected. The surrounding tissues consisted of connective tissue and inflammatory cells
After 12 months no signs of inflammation or re-injury were recorded: the depth of sounding did not exceed 3 mm, and the x-ray picture of the 10 tooth area showed no pathologies, except for a slight difference in density between the bone and the graft.
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