Aim: The purpose of the case report was to describe missed diagnosis of a deep palatogingival groove (PGG) associated with an endodontic-periodontal lesion which was subsequently managed using a regenerative surgical procedure.
Clinical considerations: The PGG often predisposes the teeth to severe periodontal defects and pulp necrosis which complicates the diagnosis. This case illustrated a persistently sensitive tooth that was initially diagnosed as a combined endodontic-periodontal lesion, with an associated PGG identified at a later stage. The collaborative management of combined endodontic-periodontal lesion with endodontic therapy, ultrasonic debridement of groove, sealing with MTA and composite resin, and guided tissue regeneration resulted in substantial healing of the periradicular radiolucency at 24 months.
Conclusion: It is imperative to exercise caution during the biomechanical preparation of the root canal, when there is a reduced amount of dentin between the PGG and the root canal wall to prevent potential complications and ensure the integrity of the remaining tooth structure.