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a 33-year - old patient with good health presented to the outpatient department with the complaints of pain and salty discharge in the left upper anterior quadrant of the jaw for the past 6 years .
the left maxillary lateral incisor ( # 22 ) [ figure 1 ] had an intact crown without caries / fracture , with negative vitality testing and positive to percussion .
the mobility of tooth was grade ii ; on examination , there was a 9-mm pocket and purulent exudate from the gingival sulcus of the palatal aspect . on probing ,
a deep groove extending from the cingulum to mid - root area was noted on distopalatal aspect of the tooth [ figure 2 ] .
lateral incisor showing palatoradicular groove and its management lateral incisor showing palatoradicular groove and its management radiographic examination [ figure 3 ] revealed a radiolucent parapulpal line superimposed over the root canal and a pear - shaped radiolucency in the coronal aspect was present .
a circumscribed radiolucent area with irregular borders having crestal bone loss was found in the region of # 22 .
preoperative radiograph after oral prophylaxis , endodontic treatment [ figure 4 ] was done under rubber dam isolation .
full thickness mucoperiosteal flap was elevated ; granulation tissue was curetted in periradicular area [ figure 5 ] .
since the root apex was infected for a long duration , apicectomy was performed [ figure 6 ] .
thorough scaling and root planing were performed over the groove and the diseased granulation tissue was curetted out to leave the soft tissue more conducive to regeneration .
radicular groove was eliminated by means of radiculoplasty using round bur [ figure 7 ] .
a chemical conditioning of the groove was performed by using 10% polyacrylic acid , and glass ionomer cement type 1 was applied into the defect .
the area was kept isolated of blood and tissue fluids during the setting of the cement by using local hemostatic gelatin sponge .
patient was instructed on post - surgery precautions and maintenance protocol , which included rinsing with 0.12% solution of chlorhexidine twice a day for 5 weeks . during this period ,
sutures were removed 14 days after the surgery . at this time , complete soft tissue closure was still demonstrable . probing
six - month [ figure 11a ] and 1-year follow - up radiographs [ figure 11b ] revealed the complete disappearance of radiolucency in relation to the lateral incisor .
post - obturation radiograph elevation of mucoperiosteal flap apicectomy and root end filling radiculoplasty done with round bur platelet - rich plasma to be packed flap approximated with sling sutures follow - up periodontal probing ( 2 months ) ( a ) follow - up radiograph ( 6 months ) ( b ) follow - up radiograph ( 1 year ) a 20-year - old male patient reported with a complaint of painful , discolored left upper front tooth ( # 21 ) with deposits on it .
patient had a history of trauma to his upper front primary teeth at the age of 2 years .
on clinical examination , a horizontal groove with brown discoloration around the cervical region of # 21 was observed , resembling circular enamel hypoplasia [ figure 12a ] .
intraoral periapical radiograph showed loss of enamel around the cervical region of the tooth [ figure 12b ] with no other abnormalities .
a test cavity was prepared in # 21 and the tooth had no response , indicating non - vitality .
the treatment plan included root canal therapy [ figure 13 ] followed by jacket crown .
( a ) clinical picture showing turner 's hypoplasia ( b ) preoperative radiograph postoperative radiograph
a 33-year - old patient with good health presented to the outpatient department with the complaints of pain and salty discharge in the left upper anterior quadrant of the jaw for the past 6 years .
the left maxillary lateral incisor ( # 22 ) [ figure 1 ] had an intact crown without caries / fracture , with negative vitality testing and positive to percussion .
the mobility of tooth was grade ii ; on examination , there was a 9-mm pocket and purulent exudate from the gingival sulcus of the palatal aspect . on probing ,
a deep groove extending from the cingulum to mid - root area was noted on distopalatal aspect of the tooth [ figure 2 ] .
lateral incisor showing palatoradicular groove and its management lateral incisor showing palatoradicular groove and its management radiographic examination [ figure 3 ] revealed a radiolucent parapulpal line superimposed over the root canal and a pear - shaped radiolucency in the coronal aspect was present .
a circumscribed radiolucent area with irregular borders having crestal bone loss was found in the region of # 22 .
preoperative radiograph after oral prophylaxis , endodontic treatment [ figure 4 ] was done under rubber dam isolation .
full thickness mucoperiosteal flap was elevated ; granulation tissue was curetted in periradicular area [ figure 5 ] .
since the root apex was infected for a long duration , apicectomy was performed [ figure 6 ] .
thorough scaling and root planing were performed over the groove and the diseased granulation tissue was curetted out to leave the soft tissue more conducive to regeneration .
radicular groove was eliminated by means of radiculoplasty using round bur [ figure 7 ] .
a chemical conditioning of the groove was performed by using 10% polyacrylic acid , and glass ionomer cement type 1 was applied into the defect .
the area was kept isolated of blood and tissue fluids during the setting of the cement by using local hemostatic gelatin sponge .
patient was instructed on post - surgery precautions and maintenance protocol , which included rinsing with 0.12% solution of chlorhexidine twice a day for 5 weeks . during this period ,
sutures were removed 14 days after the surgery . at this time , complete soft tissue closure was still demonstrable . probing
six - month [ figure 11a ] and 1-year follow - up radiographs [ figure 11b ] revealed the complete disappearance of radiolucency in relation to the lateral incisor .
post - obturation radiograph elevation of mucoperiosteal flap apicectomy and root end filling radiculoplasty done with round bur platelet - rich plasma to be packed flap approximated with sling sutures follow - up periodontal probing ( 2 months ) ( a ) follow - up radiograph ( 6 months ) ( b ) follow - up radiograph ( 1 year )
a 20-year - old male patient reported with a complaint of painful , discolored left upper front tooth ( # 21 ) with deposits on it .
patient had a history of trauma to his upper front primary teeth at the age of 2 years . on clinical examination , a horizontal groove with brown discoloration around the cervical region of # 21
intraoral periapical radiograph showed loss of enamel around the cervical region of the tooth [ figure 12b ] with no other abnormalities .
a test cavity was prepared in # 21 and the tooth had no response , indicating non - vitality .
the treatment plan included root canal therapy [ figure 13 ] followed by jacket crown .
( a ) clinical picture showing turner 's hypoplasia ( b ) preoperative radiograph postoperative radiograph
presence of palatoradicular groove ( case 1 ) is considered to be an important contributing factor for the development of localized periodontitis .
it acts as a  plaque trap  , facilitating the development of a combined periodontic  endodontic lesion .
perio lesion in the present case seems to be a primary periodontic lesion with secondary endodontic involvement .
it was because of the fact that there was no history of trauma and/or discoloration of the tooth .
though the lesion was principally periodontal , the manifestation of the pathology is diagnosed by the vitality tests .
the groove had a funnel - like shape and irregularities on the external surface that promoted the accumulation of bacterial plaque and calculus , resulting in the onset and progression of periodontal disease .
as a result of this breach in the epithelial attachment , the progression of bacterial products through dentinal tubules could secondarily compromise the pulp tissue , causing a primary periodontic / secondary endodontic lesion which necessitated both pulpal and periodontal therapy .
a favorable outcome can be achieved only with the comprehensive treatment approach that effectively manages all local factors contributing to the disease process .
the rationale behind the selected treatment plan was the following : 
 removal or saucerization of the radicular portion of the groove ( radiculoplasty ) to eliminate bacterial plaque , calculus , and to prevent bacterial recolonization.cleaning and sealing of the coronal portion of the groove to prevent bacterial recolonization . 
 
removal or saucerization of the radicular portion of the groove ( radiculoplasty ) to eliminate bacterial plaque , calculus , and to prevent bacterial recolonization .
although mineral trioxide aggregate sets in the presence of moisture , it might get washed off from the transgingival defect . instead , glass ionomer cement was chosen because it does not have this limitation .
the technique of conditioning and sealing the groove with glass ionomer cement is a very conservative approach for eliminating deep palatoradicular grooves .
conditioning of the groove removes the surface debris , increases the wettability , and increases the bond strength of glass ionomer cement .
glass ionomer cement was used since it has an antibacterial effect , chemical adhesion to the tooth structure , and good sealing ability .
clinical and histological studies have reported that there is an epithelial and connective tissue adherence to glass ionomer cement during the healing process .
the same clinical observation was also found in this case . in the present case , since the groove was extended onto the root surface with substantial periodontal destruction , a flap procedure , including curettage of granulation tissue and root planing , was undertaken . in the present case
although the palatal surgical approach is difficult to access , saving the tooth is a more conservative treatment plan .
moreover , the tooth was in the esthetic zone and the papillary reconstruction would have been difficult after extraction and implant placement .
therefore , an approach for saving the tooth was chosen instead of the more complex and costlier implant procedure .
the brown discoloration occurs due to disturbances in ameloblastic layer , leading to defective matrix formation caused by traumatic injuries , but the stretched inner enamel epithelium continues to induce the differentiation of new odontoblasts , and hence the dentin formation is not affected .
severe pulpal infection of primary teeth results in excessive osteolysis of inter - radicular bone and early exposure of the succedaneous tooth before adequate root length formation .
these structurally defective teeth are not only weak but also provide favorable area for colonization of bacteria .
the hypoplastic permanent teeth are seven times more sensitive to carious attack compared to those without hypoplasia .
the hypoplastic tooth had turned non - vital without any history of trauma or any carious insult .
the tooth would have turned non - vital because of the defective enamel and open dentinal tubules which act as a nidus for bacterial entry into the pulp space , thereby leading to pulp necrosis . delayed treatment on affected deciduous and permanent teeth
the need for a careful examination and early detection of all possible developmental defects in the permanent dentition and the importance of preventive measures should be stressed for maintaining the vitality of the tooth .

 the key to achieving favorable results in these types of developmental anomalies is accurate diagnosis and treatment planning.deep radicular grooves can predispose to pulp necrosis and the establishment of combined periodontic 
endodontic lesions.it is advisable to detect enamel hypoplasia as early as possible to prevent the teeth from turning non - vital . 
 
the key to achieving favorable results in these types of developmental anomalies is accurate diagnosis and treatment planning .
it is advisable to detect enamel hypoplasia as early as possible to prevent the teeth from turning non - vital .
anatomic aberrations are seen in human dentition . 
 the maxillary incisor region of the permanent dentition where these anatomical aberrations are commonly seen is considered an area of embryonic hazard . 
 aberrations affecting the internal and external morphology can at times be the cause of complex pathological conditions involving the pulpal and periodontal tissues and can pose a challenge to the clinician for the diagnosis and clinical management . detecting and treating the anomalies at an early phase is essential as it poses a threat for the loss of vitality of the concerned teeth . 
 the aim of this paper is to highlight the fact two different developmental anomalies of maxillary incisors , namely palatoradicular groove and turner 's hypoplasia , led to the loss of vitality of the same .