Treatment of periodontal patients-current clinical concepts

The main goal of the treatment of patients with periodontitis is to establish adequate infection control.To satisfy demands for acceptable aesthetics and chewing function with good long-term prognosis in patients with periodontitis requires the establishment of adequate infection control.Pocket instrumentation (scaling and root planing with or without flap elevation),combined with effective self-performed supragingival plaque control measures,constitutes the basic treatment modalities.

The palatal radicular groove represents a developmental anomaly that mainly affects the maxillary incisor teeth. This anomaly is probably caused by an infolding of the enamel organ and Hertwig's epithelial root sheath during odontogenesis. The groove often originates in the central fossa or cingulum and continues towards the root apex for various distances. The anatomical defect can act as a funnel for plaque and, therefore, result in extensive bone and attachment loss. A complete lack of closure of the calcified tissues along the groove, that is a direct communication between pulp and periodontium, rarely occurs. However, accessory canals between the pulp cavity and periodontal tissues frequently exist along the groove and are main entrances of infectious material into the pulp cavity, facilitating the development of endodontic lesions. Grooves can also complicate restorative therapy or interfere with the accessibility for scaling and root planing. Patients usually present with pain and gingival inflammation in the maxillary incisor region. Bleeding on probing and increased pocket depths are strictly confined to the area of the groove in an otherwise periodontally healthy patient. Radiographs may show a parapulpal line that represents the radiographic image of the groove. Treatment of the anomaly by scaling and root planing alone or in combination with procedures such as odontoplasty, flap surgery, application of an enamel matrix derivative or guided tissue regeneration can be successful. A short case report of a patient treated successfully with an enamel matrix derivative for localized attachment loss due to this anomaly is presented.