Diagnosing palatogingival groove: A Systematic Review

Abstract

Introduction Palatogingival groove (PGG) is an uncommon developmental anomaly that typically starts near the cingulum of the maxillary incisors, frequently lateral, and extends along the roots at varying lengths and depths.(1–3) Severe grooves extend to the root apex and lead to complex combined periodontal-endodontic lesions.(4,5) Affected teeth are difficult to diagnose, treat, and save as it is often overlooked and results in endodontic - periodontal treatment failure. Hence the accurate diagnosis of PGG is a must for favorable long-term outcomes. (6–8) Aim To conduct a systematic review on methods used for diagnosing palatogingival groove. Methods This article follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The literature search was performed in PubMed, Wiley Online Library and ScienceDirect databases. Articles were published between 2017 and 2022 in English language. After screening 9 publications were identified as relevant to the topic considering inclusion and exclusion criteria. Case reports or case series of thoroughly described PGG diagnostic methods in maxilla incisors were included. Quality was assessed using JBI critical appraisal tools for case reports and case series. (9) Studies were analyzed by the authors. Results Clinically patients with PGG complain of dull intermittent or acute pain, tooth mobility, pain on percussion, discharge of pus along with sinus tract formation, swelling of gingiva or periodontal pocket formation along the groove and a breakdown of the periodontal attachment. (10–18) PGG should be suspected when mentioned symptoms appear in nonvital maxillary anterior teeth bereft signs of caries, crack, and traumatic dental injury. (19) Two-dimensional radiographs are used for initial evaluation, as teardrop or line-like radiolucency can be observed. (8,10,11) However, they do not allow accurate examination due to PGG being able to present as C-shaped root canal, root invagination, mesial/distal accessory root canal, or vertical root fracture (VRF). (11–13,15) Three-dimensional (3-D) imaging modalities were used for explication as axial view allowed to confirm the presence of PGG while sagittal view - the extent of groove. (8,13,19,20) Elevation of the periodontal flap can also accommodate confirmation of PGG diagnosis as it can be confused with a purely periodontal or endodontic lesion. (11,12,14,15,17) Diagnosis of other dental anomalies must be declined along with the presence of local plaque retention and traumatic factors as they might cause similar symptoms. (10–13) Consequently, both clinical and radiological evaluation is crucial for diagnosing PGG. (21) Conclusions Primarily PGG presents as a local plaque retention site with gingiva swelling in the region of maxillary incisors that eventually evolves to palatal periodontal pocket with breakdown of periodontal attachment and later advances to localized periodontitis with or without pulpal pathosis. Identifying and differentiating PGG is challenging, therefore, additional usage of radiological assessment in early stages can alleviate its’ recognition and is essential to save affected teeth. However, in consideration of the radiation exposure that the patients receive, the use of CBCT should be limited to cases in which conventional imaging fails to provide adequate information.