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| LETTER TO EDITOR |
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| Year : 2014 | Volume
: 4
| Issue : 3 | Page : 160-161 |
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Palatoradicular groove
Jothi M Varghese1, Vasudev Ballal2
1 Department of Periodontics, Manipal College of Dental Sciences, Manipal University, Karnataka, India
2 Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal University, Karnataka, India
| Date of Web Publication | 6-Aug-2014 |
Correspondence Address:
Jothi M Varghese
Department of Periodontics, Manipal College of Dental Sciences, Manipal University, Manipal 576 104, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1658-5984.138175
How to cite this article:
Varghese JM, Ballal V. Palatoradicular groove. Saudi Endod J 2014;4:160-1 |
Sir,
I read with great interest the article entitled "Management of endodontic-periodontic lesion of a maxillary lateral incisor with palatoradicular groove" authored by Vishwas et al., which was published in your esteemed journal 2014;4:83-86. Such cases usually are challenging to the clinicians. I truly appreciate the efforts put forward by the authors towards reporting complex cases with successful management which provide wider understanding on treatment planning.
However, there were a few queries and suggestions, I would like to share on this case. First, the authors have reported in the case presentation that the intraoral periapical radiograph showed diffuse radiolucency at the apex and a radiolucent line was seen adjacent to the root canal mimicking two canals and angular bone defect on mesial side of the tooth. But, [Figure 1] displays the similar radiographic presentation on distal aspect of the tooth. Further, rationale of regenerative periodontal flap surgical procedures are to provide better visibility and accessibility to the root surface and bone defects. However, does not provide clear visibility of the extent of palatoradicular groove and the angular bone defect which is well-defined on the intra oral periapical radiograph. Secondly, the authors have stated that both endodontic and periodontal lesions have different healing pattern, and healing of endodontic lesion will not affect periodontal outcome and vice versa. In Endo-perio lesions, the prognosis and treatment planning differs depending on the type of lesion. In a primary endodontic disease with secondary periodontal involvement, endodontic therapy should be the first line of treatment phase. Further, a period of 3 months is recommended prior to considering periodontal treatment. This time frame allows adequate time for tissue healing and better assessment of the periodontal condition. [1],[2] Incase of a primary periodontal disease with secondary endodontic involvement and/or a true combined lesion, both endodontic and periodontal therapies are usually instituted simultaneously. In many cases, the apical progression of the periodontal disease via the lateral canals or apical foramen, affects the pulp leading to necrosis. [3] Hence, both endodontic and periodontal therapies are performed sequentially so as to prevent further progression of the disease and obtain complete benefits from both the periapical and periodontal zone. Nevertheless, prognosis primarily depends upon severity of the periodontal disease and response of supporting tissues to treatment. [3] However, in this particular case, being a state of combined endo-perio lesion, and with the palato-radicular groove being the cause for involvement, an endodontic therapy is essential along with the periodontal regenerative therapy to achieve regeneration of the lost periodontal structures and bone. Hence, I do feel endodontic healing is beneficial and contributes effectively as an adjunct to periodontal therapy in order to enhance the healing of the periodontal area. Third, the reason for not using regenerative alloplastic substitutes (bone grafts and barrier membranes) in this case was that, it may complicate the healing process and affect the outcome of the treatment. Although, there is appreciable literature related to the benefits of mineral trioxide aggregate (MTA), [4],[5] reports regarding complete new bone regeneration using MTA are inconsistent. [6] These types of lesions with osseous defect would provide better results, if bone grafts could be combined with this repair material. The osseous graft material provides as Scaffold, which progressively gets resorbed, thus enhancing bone regeneration. [7] Placement of barrier membrane would have provided attempts to prevent down growth of the epithelium during the healing phase, thus enhancing a new attachment. Based on the classification proposed on rationale of guided tissue regeneration (GTR) principal in endodontics, incase of an apico-marginal communication, the membrane approach is employed to regenerate periapical and marginal tissues at the same time. [8] Fourthly, this article mentions about various materials used to obliterate the groove which include amalgam, composite, MTA and glass ionomer cement. However, reference for this statement has not been quoted.
| References | |  |
| 1. | Paul BF, Hutter JW. The Enodontic-periodontal continuum revisited: New insights into etiology, diagnosis and treatment. J Am Dent Assoc 1997;128:1541-8. 
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| 2. | Chapple IL, Lumley PJ. The periodontal-endodontic interface. Dent Update 1999;26:331-6, 338, 340-1.
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| 3. | Rotstein I, Simon JH. The endo-perio lesion: A critical appraisal of the disease condition. Endod Topics 2006;13:34-56.
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| 4. | Toranbinejad M, Chivian N. Clinical applications of mineral trioxide aggregate. J Endod 1999;25:197-205.
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| 5. | Holland R, De Souza V, Nery MJ, Otoboni Filho JA, Bernabé PF, Dezan Júnior E. Reaction of rat connective tissue to implanted dentin tubes filled with mineral trioxide aggregate or calcium hydroxide. J Endod 1999;25:161-6.
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| 6. | Torreira GM, Dos Santos AA, Cobos R, Boquete F, Abelleira C. The osteoinductive potential of mineral trioxide aggregate. A histologic study in rabbits. Eur J Anat 2004;8:101-5.
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| 7. | Sreedevi P, Varghese N, Varugheese JM. Prognosis of periapical surgery using bonegrafts: A clinical study. J Conserv Dent 2011;14:68-72.
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| 8. | von Arx T, Cochran DL. Rationale for the application of the GTR principle using a barrier membrane in endodontic surgery: A proposal of classification and literature review. Int J Periodontics Restorative Dent 2001;21:127-39.
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