Endodontic-periodontal Management of Palato-gingival Groove: A Report of Two Cases

The Palato-Gingival Groove (PGG) is a rare developmental anomaly most frequently affecting maxillary incisors, predisposing the tooth to plaque retention, localised periodontal destruction, and combined endodontic-periodontal lesions. Owing to its complex anatomy, the diagnosis and management of PGG remain a significant clinical challenge. This case report describes the management of a severe PGG in a 26-year-old male who presented with mobility and a deep periodontal pocket in the maxillary right lateral incisor. Clinical and radiographic examination, including Cone-Beam Computed Tomography (CBCT), confirmed the presence of a deep PGG associated with periapical radiolucency. Root canal therapy was performed, followed by a full-thickness flap surgery. The groove was saucerised and sealed with mineral trioxide aggregate to prevent microleakage and promote healing. Bone grafting was performed to facilitate periodontal regeneration, and the flap was repositioned and sutured. Follow-up evaluations at one, three, and five months demonstrated a significant reduction in probing depth, radiographic evidence of bone fill, and restoration of periodontal stability. The second case involved a 35-year-old male with a history of trauma to the maxillary left central incisor and previous root canal treatment, who reported recurrent pain and swelling. Clinical and CBCT examination revealed a palatal radicular groove associated with periapical pathology. Nonsurgical endodontic retreatment was performed, followed by flap surgery. The groove was sealed with light-cured Glass Ionomer Cement (GIC) to achieve a smooth surface, prevent microleakage, and enhance periodontal healing. Bone grafting and periodontal dressing were placed to promote regeneration. Follow-up evaluations at three and five months showed complete resolution of symptoms, bone fill, and satisfactory gingival healing. This report of two cases emphasises the importance of early recognition of the PGG as an etiological factor in persistent endo-perio lesions. A comprehensive approach involving endodontic, periodontal, and restorative procedures was essential in achieving favourable outcomes. The novelty of this report lies in highlighting the role of multidisciplinary management in preserving a tooth with an otherwise poor prognosis, thereby reinforcing the need for awareness and timely intervention in such rare anatomical anomalies.