Developmental dental anomalies and secondary pathosis • 277 



Figure 6. Periodontal abscess (clinical case). 



Creaven (1975:79-80) also mentioned periapical lesions 

 caused by dens invaginatus in teeth where the pulp was 

 viable. 



According to Everett (1968:287-288), Prichard was the 

 first to state that the palato-gingival grooves on maxillary 

 incisor teeth are a predisposing factor to localized severe 

 periodontal destruction. However, Brabant et al. (1958:87) 

 called attention to the fact that as early as 1949, Dechaume 

 reported that the palato-gingival groove may be responsible 

 for the infection of the palatal gingiva and for inducing retro- 

 grade apical pulpitis. 



In a deep palato-gingival groove the surface is covered by 

 bacterial plaque and infected granulation tissue (Lee et al. 

 1968:17). On the basis of the investigation of Withers et al. 

 (1981:42) the Plaque, Gingival and Periodontal Disease In- 

 dex is statistically significant in the case of this anomaly. 

 Tooth mobility is also increased, but there is no connection 

 between the mobility and the groove. The pathomechanism 

 of the gingivitis predisposed by this anomaly is similar to that 

 known in the case of enamel formation (Simon et al. 

 1971:824). The periodontal lesion, developing locally, leads 

 to recession, abscess formation and, from time to time, pulp 

 death. In the case of deep grooves the pulp disease is in a 

 direct or indirect association with the formation of the per- 

 iapical pathosis (Lee et al. 1968:16; Simon et al. 1971:824; 

 Aboyans and Ghaemmaghami 1976:63; Walker and Glyn 

 Jones 1983:33). 



CASE REPORT 



A 19-year-oid female patient was presented at the Depart- 

 ment of Dentistry and Oral Surgery with a swelling on the 

 area of the roots of the upper right incisors (Figure 6). At the 

 clinical examination the teeth in question showed a vital 

 dental reaction, recession formation and periodontal abscess 

 vestibularly, and a groove vestibularly and palatinally. Radi- 

 ography revealed that the upper right lateral incisor had two 



Zujirch Pateoptithnlo}i\ Symp. 1988 



Figure 7. X-rays of two roots with palato- 

 gingival groove in maxillary right lateral 

 incisor (clinical case). 



roots mesiodistally (Figure 7), and the upper left lateral in- 

 cisor had a palato-gingival groove distally (Figure 8). The 

 periodontal abscess formed by developmental anomaly was 

 removed surgically. Three months later periapical pathosis 

 was observed. The pulp in the distal chamber was necrotic 

 (Figure 9). The tooth was treated endodontally and provided 

 with root filling (Figure 10). 



Investigating paleoanthropological material we have ob- 

 served bone defects (granuloma and cyst cavities) in the area 

 of incisors. These teeth showed less abrasion and no caries 

 (Figure 11). In such cases we can think of trauma as an 

 etiological factor, but we have to think of developmental 

 anomalies too, as predisposing factors to the above- 

 mentioned pathological processes. On the other hand, we 

 have also seen some localized alveolar bone resorption with 

 palato-gingival groove (Figure 12); presumably the palato- 

 gingival groove caused the localized bone resorption in this 

 case. 



Summary 



Two developmental anomalies, dens invaginatus and palato- 

 gingival groove, both occurring on upper incisors, are re- 

 viewed. The purpose of our investigation was mainly to de- 

 termine the prevalence of these anomalies in maxillary lateral 

 incisors and to draw attention to the fact that these conditions 

 may cause periodontic and pulpal pathosis. 



Neither in our recent nor in our paleoanthropological ma- 

 terial do the frequencies of the dens invaginatus and of the 

 palato-gingival groove differ from the literature data. It is 



