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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 9  |  Issue : 5  |  Page : 36-38

Labiogingival groove: A rare developmental tooth anomaly


Department of Periodontology and Implantology, Himachal Dental College, Sundernagar, Himachal Pradesh, India

Date of Web Publication15-Sep-2017

Correspondence Address:
Shiva Chauhan
Department of Periodontology and Implantology, Himachal Dental College, Sundernagar, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJDS.IJDS_80_17

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  Abstract 

Labiogingival groove is a congenital morphologic dental anomaly, in which an infolding of the inner enamel epithelium and Hertwig's epithelial root sheath create a groove extending varying depth into root. Epithelial attachment can be breached by gingival irritation secondary to plaque accumulation creating a periodontal defect that spreads to the pulp causing primary periodontal/secondary endodontic. A 12-year-old boy reported with the complaint of painful tooth with pus discharge from labial gingival surface in the maxillary right lateral incisor for 4 months. Intraoral examination revealed bluish red gingiva with loss of contour in relation to maxillary right lateral incisor and purulent discharge in relation to it. A provisional diagnosis of localized gingival abscess in relation to maxillary right incisor (primary periodontic and secondary endodontic involvement) was given, and required treatment was carried out. On exposure of the involved tooth, a labiogingival groove was noticed which could have been a contributing factor for the progression of the condition.

Keywords: Endodontic involvement, extraction, labiogingival groove, periodontal disease


How to cite this article:
Chauhan S, Puri C, Jindal V, Jaggi D, Gupta J. Labiogingival groove: A rare developmental tooth anomaly. Indian J Dent Sci 2017;9, Suppl S1:36-8

How to cite this URL:
Chauhan S, Puri C, Jindal V, Jaggi D, Gupta J. Labiogingival groove: A rare developmental tooth anomaly. Indian J Dent Sci [serial online] 2017 [cited 2019 Nov 22];9, Suppl S1:36-8. Available from: http://www.ijds.in/text.asp?2017/9/5/36/214937


  Introduction Top


The labiogingival groove/notch is a developmental phenomenon that can be easily misdiagnosed and improperly treated. The labiogingival notch seen on the central incisors was first described by Brin and Ben-Bassat in 1989 with 6.5% prevalence on at least one central incisor. They found a labiogingival notch in 123 children, with 6.5% prevalence on at least one central incisor. In 96 (5.1%) of the children, the notch appeared unilaterally, whereas, in 27 children (1.4%), the notch appeared bilaterally.[1] The labiogingival notch appears as an enamel depression close to the cementoenamel junction (CEJ), with a depth that varies from a shallow depression to a deep groove. It can be identified using a periodontal probe. The gingival margin closely follows the normal contour of the enamel, whereas in the case of a deep notch, it acquires an irregular contour because of extension of the gingival tissue into the defect. Brin and Ben-Bassat stated that this defect is due to trauma during childhood.[2] Thus, one must enquire about the possibility of any injury during childhood when such a defect is noted. A shallow defect may not be visible unless probed, whereas a deeper defect may require treatment for esthetic purposes. In such cases, placement of a restoration and gingival recontouring may be considered.

In the present case report, unilateral labiogingival groove was diagnosed in a 12-year-old boy in Department of Periodontics, which was associated with the formation of periodontal pocket, mobility, and bone loss. Interdisciplinary approach was followed to manage the case of labiogingval groove present on maxillary right lateral incisor.


  Case Report Top


A 12-year-old boy patient reported to the Department of periodontics with a chief complaint of painful tooth which pus discharge from labial gingival surface in the maxillary right lateral incisor for 4 months. There was no history of trauma to the teeth with a noncontributory medical history. Clinical examination revealed a sinus on labial gingival surface associated with maxillary right lateral incisor [Figure 1]. Miller Class 1 gingival recession with probing depth 6 mm in midbuccal region with respect to maxillary lateral incisor was seen. The tooth had Grade II mobility. Intraoral periapical radiograph [Figure 2] showed circumscribed radiolucency and resorption of root due to the eruption pathway of canine and also gutta-percha cone visible indicating root canal treatment (RCT) of the same tooth.
Figure 1: Preoperative photograph

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Figure 2: Preoperative radiograph

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A provisional diagnosis of localized gingival abscess in relation to maxillary right incisor (primary periodontic and secondary endodontic involvement) was given. The tooth was already RCT treated. Patient was recalled after 1 month and curettage and irrigation were done. During the follow-up visit, the sinus tract was still present, and there was pus discharge from labiogingival surface. Then, surgical treatment, i.e., apicectomy of the involved tooth was planned. A labial infiltration was given in relation to maxillary central and lateral incisor and full-thickness flap was elevated from mesial aspect of maxillary central incisor to distal aspect of maxillary lateral incisor [Figure 3]. Complete curettage of granulation tissue was done, and site was irrigated with saline. Apicoectomy with respect to 12 was not required after flap reflection as there was already Grade III mobility and root resorption present and the buccal radicular groove was evident on flap reflection, so as tooth had a poor prognosis. Extraction of the same was done [Figure 4]. The flap was repositioned, and simple interrupted suture was placed [Figure 5]. The area was covered using Coe-Pak periodontal dressing. Patient recalled after 14 days and suture and co-pack removed [Figure 6]. The healing in the particular area was uneventful.
Figure 3: Labiogingival groove

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Figure 4: Labiogingival groove in extracted tooth

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Figure 5: Sutures placed

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Figure 6: Three-month follow-up

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  Discussion Top


A labiogingival notch appearing on the enamel of maxillary central incisors seems to be a potential factor for compromised gingival and dental health.[1] It is a congenital morphologic dental anomaly, in which an infolding of the inner enamel epithelium and Hertwig's epithelial root sheath create a groove extending varying depth into root. Epithelial attachment can be breached by gingival irritation secondary to plaque accumulation creating a periodontal defect that spreads to the pulp causing primary periodontic/secondary endodontic.[1],[2] It is a notch which starts on the cervical enamel and extends to the radicular surface and has also been termed as labial-cervical vertical groove (LCVG) or labiogingival notch. In a study conducted by Shpack et al.,[3] out of 1250 patients examined, 66 exhibited LCVG (5.3%) in one of the upper incisors. LCVG was present mostly in a single configuration (71.2%) with a significantly more distribution in the central incisors (94%). Earlier the etiology of this defect was thought to be due to trauma to the developing tooth bud,[4] but recently, it has been considered as a developmental defect due to the vertical extension of the mamelon groove.[5] Various morphologic anomalies can predispose to periodontal diseases that include cervical enamel projection, palato-radicular grooves, and enamel pearls.[6],[7] The radicular groove involves the external surface of both the crown and root; this unique clinical feature allows localized periodontal disease to develop readily and breakdown the fragile sulcular attachment adjacent to the defect.[8] The groove can vary in depth, extent, and complexity; mild grooves are gentle depression of the coronal enamel which terminates at or immediately after crossing CEJ. However, in our case report, labiogingival groove was reported. The labiogingival groove appears as enamel depression close to the CEJ, whose depth varies from a shallow depression, which can be identified primarily by probing to deep groove.[8],[9] The gingival margin closely follows the enamel contour, appearing almost normal in case of a shallow groove while in case of a deep groove, it acquires an irregular contour because extension of the gingival tissue into the defect, groove is not always easy as patients may present with pulpal involvement in teeth that have no caries or history of trauma.[10],[11] The gingiva adjacent to the groove is often edematous, erythematous, or cyanotic. Periodontal probing is recommended for these patients. In our case report, radiographically, no labiogingival groove was revealed and no other clinical findings. Differential diagnosis must include a long-standing crack on the crown or a vertical root fracture.[6] The prognosis of teeth with radicular grooves depends on the severity of the periodontal problem, accessibility of the defect, and the type of groove (shallow-deep short/long). Based on these, the treatment that has been put forth are gingivectomy or subgingival curettage, combined endodontic and periodontal treatment in severe cases, odontoplasty or saucerization, and conservative treatment by eliminating the grooves with restorative materials.[12],[13] The last treatment option for the presence of the labiogingival groove in a tooth with hopeless prognosis is extraction.[9],[10],[14]

This case reported here was treated successfully by an interdisciplinary approach which consisted of periodontal, endodontic, and extraction of that tooth.


  Conclusion Top


The diagnosis of presence of a palatogingival groove is an important factor in the determination of the prognosis and success of a combined periodontal and endodontic lesion. It serves as a contributing factor for periodontal as well as endodontic problems. Often this goes undiagnosed but if it is diagnosed carefully and treated in a proper way it may solve both the periodontal and endodontic problems.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Ben-Bassat Y, Brin I. The labiogingival notch: An anatomical variation of clinical importance. J Am Dent Assoc 2001;132:919-21.  Back to cited text no. 1
    
2.
Brin I, Ben-Bassat Y. Appearance of a labial notch in maxillary incisors: A population survey. Am J Phys Anthropol 1989;80:25-9.  Back to cited text no. 2
    
3.
Shpack N, Dayan T, Mass E, Vardimon AD. Labial cervical vertical groove (LCVG) distribution and morphometric characteristics. Arch Oral Biol 2007;52:1032-6.  Back to cited text no. 3
    
4.
Srinivas TS, Pradeep NT. Bilateral facial radicular groove in maxillary incisor. J Interdiscip Dent 2012;2:41-3.  Back to cited text no. 4
    
5.
Mass E, Aharoni K, Vardimon AD. Labial-cervical-vertical groove in maxillary permanent incisors – prevalence, severity, and affected soft tissue. Quintessence Int 2005;36:281-6.  Back to cited text no. 5
    
6.
Lee KW, Lee EC, Poon KY. Palato-gingival grooves in maxillary incisors. A possible predisposing factor to localised periodontal disease. Br Dent J 1968;124:14-8.  Back to cited text no. 6
    
7.
Peikoff MD, Trott JR. An endodontic failure caused by an unusual anatomical anomaly. J Endod 1977;3:356-9.  Back to cited text no. 7
    
8.
Kozlovsky A, Tal H, Yechezkiely N, Mozes O. Facial radicular groove in a maxillary central incisor. A case report. J Periodontol 1988;59:615-7.  Back to cited text no. 8
    
9.
Pécora JD, Sousa Neto MD, Santos TC, Saquy PC.In vitro study of the incidence of radicular grooves in maxillary incisors. Braz Dent J 1991;2:69-73.  Back to cited text no. 9
    
10.
Goon WW, Carpenter WM, Brace NM, Ahlfeld RJ. Complex facial radicular groove in a maxillary lateral incisor. J Endod 1991;17:244-8.  Back to cited text no. 10
    
11.
Priya P, Shiva R, Abhishek T, Ipshita I. Labiogingival groove. A hidden culprit. Int J Prev Clin Dent Res 2014;1:43-5.  Back to cited text no. 11
    
12.
Shah MP, Gujjari SK, Shah KM. Labial-cervical-vertical groove: A silent killer-Treatment of an intrabony defect due to it with platelet rich fibrin. J Indian Soc Periodontol 2014;18:98-101.  Back to cited text no. 12
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13.
Ashwini S, Singh N, Shetty B. Labial cervical vertical groove: Hidden route to periodontal destruction. J Dent Orofac Res 2016;1:36-40.  Back to cited text no. 13
    
14.
Sultana R, Alam S. Palato-gingival groove: An innocuous culprit for endo-perio lesion. Bangabandhu Sheikh Mujib Med Univ J 2016;9:156-9.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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