diverse morphological tooth anomalies are found in various shapes , textures , and prevalence . they can be sporadic or syndromes , nutritional , environmental , genetic , and ethnic related .
most of these tooth - born deformations ( e.g. , shovel - shaped incisors , tuberculum carabelli , variations in number and shape of cusps , dens invaginatus , taurodontism , palatogingival groove ) have been extensively investigated .
labial - cervical - vertical groove ( lcvg ) , which starts on the cervical enamel and extends to the radicular surface , has also been described as a notch .
it is assumed that this malformation is a developmental anomaly in which an infolding of the enamel organ and hertwig 's epithelial root sheath create a groove on the labial surface of permanent maxillary incisors .
causative factors for this malfunction may be due to trauma , disease , and nutritional issues , or can be genetic or idiopathic .
lcvg runs vertically from the crown surface to the root , starting at the enamel on the crown and extends apically , crossing the cementoenamel junction and resembling a short furrow .
this furrow gradually grows deeper in the apical direction and may , occasionally , run throughout the root surface .
anatomic factors , such as cervical enamel projections , enamel pearls , and radicular grooves are associated with advanced localized periodontal destruction .
the presence of lcvg may exacerbate some clinical aberrations , such as esthetic deficiency of the gingival marginal contour , accumulation of plaque and , consequently , gingival pocket with bone loss as well as failure in endodontic and periodontal treatments .
describe a 25-year - old female in which a periodontal lesion with vertical bone loss was directly related to the labial groove on a maxillary central incisor .
this type of dental deformity has been scarcely investigated and reported in the dental literature . to the best of our knowledge and based on the available data , there are no reported cases of intrabony defect associated with lcvg treated with platelet rich fibrin ( prf ) .
this article reports the effectiveness of prf for the treatment of intrabony defect associated with lcvg in the area of maxillary left central incisor .
a 47-year - old male patient reported to the department of periodontology , with a chief complaint of pus discharge from maxillary left central incisors with dull intermittent pain .
the patient was a non - smoker . on clinical examination , a localized gingival inflammation was present with soft edematous tissue with the accumulation of plaque and calculus with # 11 and # 21 .
periodontal examination depicts a pocket depth of 11 mm on mesial aspect and 8 mm on midbuccal aspect of # 21 [ figure 1 ] with no mobility .
fremitus was found to be negative precluding the possibility of trauma from occlusion and tooth was found to be vital electric and thermal pulp testing . on radiographic examination , a tear - shaped radiolucency was present with localized bone loss in # 21 [ figure 2a ] . on careful examination ,
clinical symptoms subsided , but the deep pocket was still present and hence a periodontal surgery was carried out to eradicate the underlying problem .
the procedure was explained to the patient and the consent was obtained for the same .
routine blood investigations were done . after assuring surgical asepsis , a pre - procedural rinse with 0.2%
after administration of local anesthetic ( 2% lignocaine with 1:80000 adrenalin ) , the papilla preservation flap ( takei et al . ) was adopted since there was sufficient space between the maxillary central incisors .
the exposed root surfaces were thoroughly scaled and root planed and bone defect carefully curetted .
lcvg noted on # 21 [ figure 3a ] , terminated in the cervical third of root surface was sealed with glass ionomer cement ( fuji ii ; gc corporation , tokyo , japan ) [ figure 3b ] .
pre operative pocket depth of 11 mm on mesial aspect and 8 mm on midbuccal aspect of # 21 ( a ) pre operative radiolucency with # 21 ; ( b ) post operative radiograph with # 21 at 6 months ( a ) lcvg noted on # 21 ; ( b ) lcvg was sealed with glass ionomer cement the prf was prepared following the protocol developed by choukroun et al .
briefly , the procedure of prf preparation : 10 ml intravenous blood was collected by venepuncture at the antecubital fossa .
this was transferred into 10 ml sterile tube without anticoagulant and immediately centrifuged at 3000 rpm for 10 min .
fibrin clot formed in between the acellular plasma on top and the red blood cells at the bottom were separated using sterile tweezers and scissors [ figure 4 ] .
amoxicillin 500 mg thrice for 7 days and analgesic  aceclofenac 100 mg twice for 3 days .
prf was placed in the intrabony defect with # 21 then , 1 week postoperatively , the dressing was removed and saline irrigation was done .
the patient was monitored at regular intervals and was under maintenance therapy . at the end of 3 months and 6 months
the clinical measurements were repeated and compared to the baseline values . on examination during subsequent follow - ups , treated area showed satisfactory healing without any post - operative complications .
the pocket depth was 2 mm on mesial and 1 mm on midbuccal aspect at 6 months [ figure 6 ] .
periodontal health was stable and bone regeneration was noticed in radiograph [ figure 2b ] .
post operative pocket depth of 2 mm on mesial and 1 mm on midbuccal aspect of # 21 at 6 months
periodontitis is a multifactorial infectious disease affecting primarily a subset of subjects and subset of sites .
recent microbiological data have acknowledged that before disease progression can occur , a susceptible host and site are required , in addition to the presence of pathogenic bacteria .
retrospective studies clearly suggest a strong association between anatomic aberrations ( lcvg ) and periodontal attachment loss .
anatomic aberrations like root grooves can occur here , which form stagnant sites or ecological niches favoring the retention and growth of micro - organisms .
grooves may facilitate plaque growth by providing surface areas sheltered from cleaning efforts as well as host defense mechanisms .
later , bacterial selection and growth may be influenced by anaerobic conditions established inside the grooves .
these grooves can be classified into mild , moderate , and complex based on its depth and extent .
it has been pointed out that defect may vary from a simple , shallow developmental groove , to a complete lack of closure of calcified tissues , allowing for a direct soft tissue connection between the pulp and the periodontium .
the presence of lcvg may exacerbate some clinical aberrations , such as esthetic deficiency of the gingival marginal contour , accumulation of plaque and , consequently , gingival pocket with bone loss , as well as failure in endodontic and periodontal treatments .
describe a 25-year - old female in which a periodontal lesion with vertical bone loss was directly related to the labial groove on a maxillary central incisor .
we have also observed an intrabony defect directly related to lcvg on # 21 . in the presence of periodontal disease , the therapeutical options for lcvg consist of grinding and flattening the affected area of the tooth or placement of a physical barrier between the tooth and soft tissue flap . the intra osseous defect , if present can be grafted with various bone graft materials .
it is considered as a second - generation platelet concentrate and has been used in various surgical procedures in an attempt to enhance wound healing .
it is prepared from the patient 's own blood thereby eliminating the possibility of disease transmission or foreign body reactions .
blood is drawn into standard glass / silica coated blood collection tubes and centrifuged at a predetermined speed to ensure cell separation .
this unique preparation technique allows prf to trap at least 95% of the platelets of the collected blood into a fibrin mesh .
the fibrin mesh can then be easily manipulated into a membrane that allows it to be transferred to any surgical site . here , high concentrations of the collected platelets allow for the slow release of growth factors ( gfs ) from the platelet granules .
these gfs include vascular endothelium growth factor ( vegf ) , platelet - derived growth factor ( pdgf ) , fibroblast growth factor ( fgf ) , epidermal growth factor ( egf ) , hepatocyte growth factor ( hgf ) , insulin - like growth factor ( igf ) , and transforming growth factor- ( tgf- ) .
all of these play a role in replacing lost tissue , resurfacing of the wound , and restoring vascular integrity . compared to other
platelet concentrates , prf releases these factors at a sustained rate over a longer period , thereby optimizing wound healing .
recently , prf has also been shown to stimulate the growth of osteoblasts and periodontal ligament cells , both of which are significant for the regeneration of periodontal defects .
currently , prf has been successfully tested in a number of procedures including maxillofacial surgery , periodontal surgery , and implantology .
mazor et al . successfully used prf as the only grafting material in a series of sinus augmentation procedures . in a similar 6-year
follow - up study , simonpeiri et al . were able to demonstrate that using prf as a sole grafting agent was a viable long - term option in sinus augmentation procedures .
prf has also been used successfully to treat periodontal defects . in a series of clinical trials conducted by pradeep and sharma
it was shown that prf could be used as a guided tissue regeneration ( gtr ) membrane to affect periodontal regeneration in three wall bony defects and degree ii furcation lesions .
published several case reports showing the successful use of prf membranes in the management of both single and multiple gingival recession defects .
and shah confirmed this observation and showed that prf could be used for root coverage procedures . in the presented case ,
lcvg was sealed with glass ionomer cement ( fuji ii ; gc corporation , tokyo , japan ) and associated intrabony defect was treated with prf .
the lcvg is a potential problem area , which should be evaluated and treated accordingly .
the groove can lead to combined endodontic periodontic lesions , which are difficult to deal with ; attention has been brought to its presence and clinical significance .
 a 47-year - old male patient reported to the department of periodontology , with a chief complaint of pus discharge from maxillary left central incisors with dull intermittent pain . on clinical examination , a localized gingival inflammation was present with soft edematous tissue with the accumulation of plaque and calculus with # 11 and # 21 . 
 periodontal examination depicts a periodontal pocket depth of 11 mm on mesial aspect and 8 mm on midbuccal aspect of # 21 with no mobility . on radiographic examination , 
 a tear - shaped radiolucency was present with localized bone loss in # 21 . 
 on careful examination , labial - cervical - vertical groove ( lcvg ) was found on # 21 which was extending into gingival sulcus . 
 this article reports the effectiveness of platelet rich fibrin for the treatment of intrabony defect associated with labial - cervical - vertical groove of # 21 . 
INTRODUCTION
CASE REPORT
DISCUSSION