Type III Radicular Groove Management: Root Resection And Guided Regeneration

This case report describes the successful management of a bifurcated maxillary lateral incisor with type III radicular groove through accessory root resection combined with guided tissue regeneration. A 36-year-old male complained of discoloration in a left upper front tooth. Clinical examination revealed a palatal radicular groove on the maxillary left lateral incisor, extending apically from the cingulum, accompanied by a 5-mm mesial periodontal pocket and a vital pulp. A cone-beam computed tomographic scan demonstrated an accessory mesial root with apical radiolucency, while the main canal remained unaffected. Therefore, accessory root resection, groove sealing with bioceramics and guided tissue regeneration were performed. At 6-month follow-up, the patient remained asymptomatic and a 3-mm pocket was present. Radicular groove (RG), also known as radicular dens invaginatus, is a developmental anomaly originating from the infolding of Hertwig’s epithelial root sheath. Among Gu’s classification, type III presents as the severest one and includes an accessory root with a corresponding canal. The narrow groove can retain bacteria, triggering pulp necrosis and periodontal inflammation. This case highlights the therapeutic imperative for RG management to eliminate infection while achieving periodontal regeneration. The treatment of RG still poses great challenges and a favorable outcome requires a specified therapeutic approach based on pulp diagnosis. In this study, surgical root resection and guided tissue regeneration were adopted to achieve periodontal healing and vital pulp preservation, providing future reference for the treatment of RG.