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How I Passed EVERY ATI Proctored Exam (Level 2 +)

Hello all! I noticed my ATI blog post has easily been my best performing blog post views-wise (see that post here ). I decided to create a general blog post describing how to study for ATI procted exams in general. My method was a bit different for some exams compared to others, but pretty much the same. This post will delve into that. If you are interested, keep reading!

*Disclaimer: This post will not disclose any acutal content contained on the ATI examinations. This post’s sole purpose is to provide preparation tips for the exam based on personal experiences. The tips given in this post do not guarantee a certain score.

Take the practice exam before you begin.

• This gives you a baseline on topics you may be strong or weak in. This is also what my nursing program required us to do. We always had to take a practice exam before the proctored. I did not study for the practice exams in order to provide myself with a true basline.

Take the focused review seriously.

• So after you complete the ATI practice exam, you will recieve your score as well as a proctored exam. My program required that we spend a certain amount of time based on the level we achieved via. the ATI Focus Review. Level 0: 4 hours, Level 1: 3 hours, Level 2: 2 hours, Level 1: 1 hour. We also had to handwrite three focused review points per topic missed.

If your program requires you to do this, please take it seriously. If you are not required to do it, I would recomend you do this anyway. Completing the focused review helps you go through and potentially remember the questions you missed. This helps you see where you went wrong and how ATI really wants you to think.

Retake the practice test.

• Yes, I want you to retake it. Retake the exam until you achieve above an 85%. This helps reinforce the content you reviewed and helps makes you more familiar with the question style and where you went wrong.

Practice, Practice, Practice.

• I cannot state this enough. Practice problems are the key to success with ATI Proctored Exams. While you are preparing for ATI Proctored exams, you will more than likely still be studying for course exams, working on care plans, group assignments, etc. Practice problems are your best bet.

I would complete 50-100 questions a night before I went to bed. I made sure to create a controlled environment and I READ THE RATIONALES. Please read your rationales thoroughly and do as many questions as possible. The more questions, the better (hint, hint). PLEASE DO PRACTICE PROBLEMS! I know I am shouting via text, but PLEASE!

• Practice problems can be found under your ATI account under the “Test” Tab. Utilize the Learning Systems tool and click on “Quiz by Category” in the middle. Jackpot!!

Don’t read every book, but read every book…

• I NEVER read the book cover to cover for most of the exams (only OB, Nutrition, Leadership and Community). The Nutrition, Leadership and Community books were short, so I was able to read those twice: once during the course and once more after taking the practice Proctored exam. I would make sure to read these three at least because ATI does not provide many practice problems for these Proctored exams.

• I also completed the OB book while completing the course, but made an effort to read as much as I could after the practice, because OB is always a weakpoint for me.

• If you feel want to utilize the book in your study routine, use it to read up on topics you stuggle with. I will be honest when preparing for the Pharmacology Proctored, I tried to read the book and returned to strictly practice problems. I ended up doing solid on the Pharmacology Proctored…

• Mind you I know it sounds like I am saying to not touch the books, but you SHOULD. When? As soon as you start the course. My program incoporated ATI into our classes by including what chapter we ‘should’ be reading each week. Take the time and read them. You will be suprised how much you will retain from the semester.

Random Tips

Alright now that I have given you the same format by which I studied for each exam I am going to throw out some tips based on ATI exams as they come.

• Stay calm when taking the exam and read the questions slowly. You don’t want to miss a simple questions by misreading.
• Read all the answer choices carefully and treat them like true/false statements. (This includes select-all-that-apply)
• You may want to take some time to study for the Medical Surgical Proctored, I found that one the most content heavy.
• When taking the Pharmacology Practice and completing practice questions pay attention to what kind of drugs ATI likes to ask about. There is a trend…
• Do not let the Pharm exam overwhelm you. If the book stresses you out just go to practice problems and read those rationales!
• ONLY use ATI resources to study for ATI Proctored exams.
• If you are an audio learner, you may appreciate Cathy Parkes videos via. Youtube. Personally, I am did not find them engaging enough as self study, but many students have had great success because of her!

Well, this is how I passed every one of my Proctored Exams wih a Level 2 or higher (many times borderline Level 3). Hopefully this helps!

Thanks for reading!

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• Open access
• Published: 04 September 2024

Palatal groove associated with periodontal lesions: a systematic review illustrated by a decisional tree for management

• Yvan Gaudex 1 , 2 ,
• Vianney Gandillot 1 , 2 , 7 ,
• Isabelle Fontanille 3 ,
• Philippe Bouchard 1 , 2 ,
• Stephane Kerner 1 , 2 , 4 , 5 &
• Maria Clotilde Carra 1 , 2 , 6  

BMC Oral Health volume  24 , Article number:  1037 ( 2024 ) Cite this article

Metrics details

Palatal groove represents a relatively uncommon developmental root anomaly, usually found on the palatal aspect of maxillary incisors. While its origin is controversial, its presence predisposes to severe periodontal defects.

This study aimed to provide a systematic review of the literature focusing on the varied diagnostic techniques and treatment modalities for periodontal lesions arising from the presence of palatal groove. Based on the existing evidence and knowledge, the study also provides a comprehensive decisional tree, guiding clinicians in the challenging decision-making process face to a palatal groove.

The literature search was conducted on Medline and Cochrane databases by two independent reviewers, who also performed the screening and selection process, looking for English written articles reporting on diagnosis and management (all treatment approaches) of periodontal lesion(s) associated with a palatal groove. Based on this literature, a comprehensive decisional tree, including a standardized palatal groove evaluation and tailored treatment approaches, is proposed. Moreover, a clinical case is described to demonstrate the practical application of the developed decisional tree.

Over a total of 451 articles initially identified, 34 were selected, describing 40 patients with 40 periodontal lesions associated with palatal grooves. The case report illustrates a deep, large, circumferential intra-bony defect on the palatal side of the tooth #22 associated with a shallow, moderately long palatal groove in an 18-year-old male patient. Following reevaluation, a single flap surgery was deemed necessary, combined with a regenerative procedure. At 2 years post-treatment, the tooth #22 is healthy, in a functional and esthetic position. The decision-making process, based on local and systemic patient’s conditions, should allow an early and precise diagnosis to prevent further complications and undertake an adequate treatment.

Palatal grooves are relatively rare; however, they are frequently associated with severe periodontal defects. The identification, diagnosis, prompt, and tailored management of the associated lesion is essential to mitigate potential periodontal and endodontic complications related to the presence of palatal groove.

Systematic Review Registration

[ https://www.crd.york.ac.uk/prospero/ ], identifier [C CRD42022363194].

Peer Review reports

Introduction

Palatal groove (PG) is defined as an anatomic anomaly characterized by the presence of a developmental groove on a dental root that, when present, is usually found on the palatal aspect of maxillary incisors [ 1 ]. Over the years, several terms have been used to describe this anomaly, including palatal or palate-gingival groove [ 2 , 3 ], developmental radicular anomaly [ 4 ], distolingual groove [ 5 ], radicular lingual groove [ 6 , 7 ], palatoradicular groove [ 8 , 9 ], radicular groove [ 10 ], and cinguloradicular groove [ 11 ].

The origin of the PG is controversial, but it is assumed to be related to the infolding of the enamel organ or Hertwig epithelial root sheath during the tooth development [ 12 ]. Additional hypogenetic root formation [ 13 , 14 ] as well as an altered genetic mechanism [ 15 ] have also been suggested.

PG is relatively rare. Everett et al. [ 5 ] reported a prevalence of PG on 2.8% of lateral incisors whereas Withers et al. [ 16 ] observed a PG on 2.3% of maxillary incisors (4.4% of maxillary laterals and 0.28% of maxillary centrals). Kogon et al. [ 8 ] examined 3168 extracted maxillary central and lateral incisors and found PG on 4.6% of them (3.4% of maxillary centrals and 5.6% of maxillary lateral incisors), with over half of the PG extending more than 5 mm apical to the cementoenamel junction leading to a localized periodontal lesion. The most recent study by Mazzi-Chevez et al. [ 17 ] observed 150 maxillary central incisors, lateral incisors, and canines with a micro-CT and found that PG affected 2% of central incisors and 4% of lateral incisors. In 100% of cases, the PG originated in the enamel.

As the term implies, PG is formed around the cingulum of the tooth and continues apically down from the cementoenamel junction, terminating at various depths and length along the root [ 18 ]. In contrast to maxillary bicuspids, incisors generally display a U-shaped groove.

This anatomic anomaly is frequently associated with a breakdown of the periodontal attachment involving the groove; a self-sustaining localized periodontal pocket can develop [ 4 ], where the PG itself provides a site for bacterial accumulation. The subsequent progressive inflammation along the PG and its apical portion may lead to periodontal and endodontic pathologic conditions [ 19 ]. Furthermore, there may be communication between the pulp canal system and the periodontium through the pulp cavity and/or accessory canals, which may also lead to combined endodontic-periodontal lesions [ 20 ]. According to the 2017 classification of periodontal and peri-implant diseases and conditions [ 21 ], PG can be classified as a localized tooth-related factor that modifies or predisposes to plaque-induced gingival diseases/periodontitis [ 22 ], and can be associated with periodontal abscess in non-periodontitis patients.

The prognosis for teeth with PG extending apically is often poor [ 12 ], highlighting the critical need for prompt and accurate diagnosis to avert further periodontal and endodontic complications, ultimately preventing tooth extraction. This study is fundamentally motivated by the scarcity of consolidated guidelines for managing such complex dental conditions. Hence, the objective of this study was to conduct a systematic review of the existing literature, focusing on the diagnosis and management of periodontal lesions linked to PG. Based on this review, the goal was to develop a comprehensive decisional tree, thereby proposing a standardized treatment protocol to aid in the clinical decision-making. This study also includes a clinical case report to demonstrate the practical application of the developed decisional tree, reinforcing its clinical relevance and utility.

Material and methods

Development of the systematic review protocol.

A protocol covering all aspects of the systematic review methodology was developed before starting the review. The protocol included the definition of: a focused question; the literature search strategy; the study selection criteria; the outcome measures; the screening methods; the data extraction; and the data synthesis. The protocol was registered in PROSPERO (CRD42022363194).

Defining the focused question

The research question was formulated according to the PICOS (Population, Intervention, Comparison, Outcome, Study) strategy, which identify the search and selection criteria as follows:

P: Patients with periodontal lesion(s) associated with a PG

I: PG identification (diagnosis) and management. All treatment approaches (non-surgical, surgical, with or without the adjunctive use of potentially regenerative materials, i.e. barrier membranes, grafting materials, growth factors/proteins and combinations thereof) were considered.

C: alternative treatment approach or no comparison.

O: periodontal parameters, including clinical attachment level (CAL, measure in mm), probing pocket depth (PPD, measured in mm), recession (REC, measured in mm), plaque index (PI, any validated clinical score), bleeding on probing (BOP) or other inflammatory indexes, radiographic bone loss.

S: Any type of human studies including case reports, with a minimum of 6 weeks follow-up after treatment. Only studies published in English were considered. Studies written in languages other than English, review articles, cell and/or animal studies, letters, editorials, conference summaries, commentaries, and studies considering PG with only an endodontic involvement or that used self-report assessment of treatment outcomes were not considered.

So, the focused question was formulated as follows: what is the efficacy of treatments for periodontal lesions associated with PG?

Search strategy

The literature was searched for articles published up to June 2022 on MEDLINE and Cochrane databases. Multiple combinations of pertinent search terms were employed (Supplemental Table 1). The reference lists of the included studies were also evaluated in order to identify additional articles. To ensure its reproducibility, the PRISMA guidelines were followed [ 23 ], and the PRISMA flowchart was filled [ 24 ] (Fig.  1 ).

PRISMA flow diagram on the selection process of the studies included in the systematic review

Literature screening and data extraction

The titles and abstracts of the initially identified studies were screened by two independent reviewers (Y.G. and V.G.). Then, the pre-selected studies underwent a full text evaluation to assess the final inclusion or not. All records for which inclusion was obtained “uncertain” for on reviewer, disagreement was solved by discussion between authors. Whenever needed, the authors of the selected studies were contacted to provide missing data.

Study screening and selection was carried out by using the Rayyan online software [ 25 ], which assisted the reviewers in the different step of the literature review process. Duplicate references were removed automatically using Mendeley software. Data extraction was carried out on a dedicated excel spreadsheet. The risk of bias assessment was carried out by using the Joanna Briggs Institute (JBI) scale [ 26 , 27 ].

The literature search resulted in 451 potentially relevant publications (Fig.  1 ). After the first selection step, based upon the title and abstract, 88 articles were pre-selected. After full-text evaluation, 34 articles were included and analyzed. All of them were case series and case reports. A total of 40 patients were described, of which 23 women (57.5%). The characteristics of the selected studies are presented in Table  1 . Their quality assessment is reported in Table  2 .

Qualitative synthesis of the literature

Among those 40 clinical cases, 12 cases report failed to provide a clinical description of the PG. Four studies described the PG depth alone, 17 studies described the PG length alone, and 7 studies provided a combined description of depth and length of the PG. From a periodontal point of view, the periodontal lesion morphology was correctly described (depth and width) in only 4 cases, 2 of which also reported the number of bony walls. Among the 22 cases reporting a diagnosis, 17 (77.3%) described combined endo-periodontal lesions, whereas 5 were purely periodontal lesions.

Endodontic involvement was present in 29 cases: 22 cases presented with a pulp necrosis, and 7 cases with an endodontic treatment. Pulp vitality was present in 10 cases and 1 case failed to report the endodontic status.

The endodontic treatment consisted in either a temporary filling (calcium hydroxide) later replaced by a definitive filling (gutta percha), or directly with a definitive filling (gutta percha) when indicated. Among those 29 endodontically treated teeth, 9 underwent an apicoectomy (using mineral trioxyde aggregate) at the surgical phase.

PG sealing was performed in 16 cases using mainly glass-ionomer cement but also mineral trioxide aggregate (MTA), tricalcium silicate cement, composite flow and amalgam. In 5 cases, an extra-oral filling of the groove was performed before the tooth reimplantation. In all cases, radiculoplasty was performed either for groove removal when it was shallow or by saucerization to allow a proper filling when grooves were deep.

To treat the PG associated periodontal defect, several different intervention types were described, using: allogenic bone, xenogeneic bone, alloplastic materials, barriers, growth factors and biological factors (and combinations thereof). These surgical regenerative procedures were reported in 25 cases. Only 2 cases [ 3 , 40 ], justified the use of biomaterials and flap designs in relation to the analysis of the associated periodontal lesion after PG management.

All cases reported clinical healing except for 2 cases of failures following tooth reimplantation due to external root resorption leading to tooth removal after 36 months [ 33 ] and 2 failures after 6 months following a surgery without regeneration or root filling [ 29 ]. The case with the longest follow-up (324 months) indicated that following an endodontic treatment with a periodontal regeneration and an orthodontic treatment, a recurrent periodontal breakdown occurred 11 years, leading to tooth extraction and implant placement [ 35 ].

Case-report

We describe the case of an 18-year-old male patient referred to the periodontics department of the Rothschild Hospital (AP-HP) in Paris. Written informed consent was obtained for the publication of clinical data and images included in this article. The patient was experiencing pain due to the inflammation on the palatal side of tooth #22 with intermittent suppuration. The clinical examination revealed a central, shallow, and of moderate length (up to 70% of the root length) PG on the tooth #22, with a probing pocket depth of 12 mm on the palatal side associated with a tooth mobility 3 (Mühlemann 1951). The tooth responded positively to electrical test. At the radiographic evaluation, bone loss could be noted mesially and distally of #22 (Fig.  2 ).

Case report. Clinical and radiographical initial situation of the tooth #22 presenting with a palatal groove. The periodontal charting showed deep periodontal pockets on the palatal probing sites associated with bleeding and plaque accumulation

A slight bony bridge could be distinguished between #21 and #22 in the coronal portion. Thus, a localized periodontal defect due to the presence of subgingival PG was diagnosed.

The periodontal treatment first consisted in a non-surgical debridement performed in one session. Tooth splinting was performed from #21 to #23 to minimize mobility (Fig.  3 ).

Root planning and flattening of PG on tooth #22: initial occlusal view of #22 ( a ); Manual scaling 22 ( b ); flattening of PG 22 in the coronal part ( c )

At the re-evaluation 8 weeks later, the tooth presented no superficial inflammation, but a persistent periodontal pocket of 12 mm deep on the palatal side. Surgery was indicated due to the presence of a large, deep, 3-wall intra-bony defect around tooth #22 (Fig.  4 ).

Regenerative therapy: view at the periodontal re-evaluation, 2-months after the initial treatment ( a ); large and deep 3-walls intra-bony defect ( b ); application of EMD ( c ); application of DBBM (soft tissue support, osteoconductive) ( d ); sutures ( e ); radiographic image at the 2-month follow-up ( f )

A SFA (Single Flap Approach) was designed with a surgical access limited on the palatal side for esthetic reason and optimal visualization. A full periosteal flap was raised, and the granulation tissue was removed. The aberrant local anatomy was corrected up to the most apical part and a regenerative procedure combining enamel matrix derivates with a bone substitute was applied to avoid soft tissue shrinkage and collapse. Sutures with a non-resorbable monofilament 6/0 were made using U-crossed and single points. A postoperative radiograph was taken (Fig.  4 f). An antibiotic therapy with amoxicillin (1 g twice a day for 7 days) was administered. Paracetamol was prescribed as a painkiller and a mouthwash containing 0.12% chlorhexidine gluconate were prescribed for 2 weeks postoperatively. Healing was uneventful and sutures were removed 10 days postoperatively.

At the 6 months reevaluation, the periodontal pocket was no deeper than 4 mm on the palatal side with no bleeding on probing. A recession of 1 mm was observed. Radiographically, a mineralized tissue could be observed up to both bony peaks mesially and distally to #22 (Fig.  5 ).

Re-evaluation at 6 months ( a ); 18 months ( b ) and 30 months ( c )

At the 1-year follow-up, periodontal health was maintained and an orthodontic treatment was undertaken. After 2 years of treatment, tooth #22 is still healthy with a CAL gain of 7 mm, a functional and esthetic position resulting in the patient’s satisfaction. These results support that periodontal regeneration can be effectively carried out also for deep intra-bony defect associated with PG, once the local risk factor has been adequately managed.

The results of the present systematic review indicate that PG are relatively uncommon root anomaly, but they are frequently associated with periodontal lesion that require treatment. The selected studies showed that PG can be managed concomitantly with periodontal regeneration, with or without associated endodontic treatment. It must be noted that the presence of a PG may play a significant role in exacerbating periodontal lesions. This could be explained, at least partly, by the mediation role of inflammatory factors like the TGF-B1, which is involved in the regulation of the inflammatory response and in the remodeling of periodontal tissues, as highlighted by recent studies [ 58 , 59 ]. These findings necessitate a nuanced and well-defined diagnostic and therapeutic approach, which should consider not only on the anatomical challenges linked to the presence of a PG but also on the underlying inflammatory mechanisms, in order to ensure an effective treatment and prevent potential endodontic complications.

A variety of treatments approaches has been described in case reports and case series and summarized in the present review. The appreciation of the morphology and origin of PG on maxillary incisors may be challenging and thus delay the diagnosis and treatment planning. Therefore, developing a standardized approach based on the available literature is advisable.

A PG can be classified according to its location, length along the root, and depth of the groove towards the pulp cavity [ 60 ]. The analysis of the associated periodontal lesion is also a key parameter to consider. Based on the work of Kim et al. [ 60 ], a simplified version including the groove description and the periodontal parameters has been suggested. Such a classification (Table  3 ) would provide the clinician with precise criteria to justify the therapeutic approach.

Groove location was disregarded in most cases, only one case [ 40 ] reported a distal location of the PG. It can be explained by the fact that this parameter will not affect the prognosis or the treatment sequence. In the latest study done on extracted teeth, PG appeared to originate in the distal area of the cingulum margin in most cases (65%), followed by the central fossa (25%), and the mesial area of the cingulum margin (10%) [ 61 ].

In terms of depth, only 7 cases reported a shallow PG (50%) and 7 cases reported a deep PG (50%) and no closed tube has been described. This finding is in accordance with Kogon’s study [ 8 ] where 44% percent of the PG were described as shallow depressions, 42% as deep depressions, and 4% as closed tubes.

Considering the groove length, 4 cases reported an extension in the cervical third of the groove (17%), 6 in the middle third (25%) and 14 cases in the apical third (58%). According to Pinheiro’s study [ 61 ], those grooves extended rarely only to the cervical third (5%), followed by the middle thirds (45%) and the apical thirds of the root in most cases (50%). It is of paramount importance for clinicians to understand the combination of both variations of groove depth along with their length to adapt an adequate treatment considering the fact that PG with deeper grooves and greater degree of extension are the determinants and predictors of poor prognosis periodontally and endodontically wise [ 5 , 31 , 42 ].

Considering the groove description in the selected studies, most of them failed to adequately report it. Only 7 of the 40 cases described the depth and length of the PG. This lack of analysis might result in an inadequate treatment highlighting the need for a classification.

Considering the periodontal approach of the associated intra-bony defect, the selection of the regenerative biologic principle (or material) to use with the soft tissue surgical approach dependeds on the morphology of the intra- bony defect (width, depth, and number of residual bony walls) and on the amount (and quality) of the soft tissues available to cover it [ 62 ]. As a general rule, deep and wide defects with only one residual bony wall require a mechanical stabilizer of the blood coagulum (membrane and/or bone filler), whereas in defects with lower defect angles and a greater number of bony walls, biologic mediators of the healing process (e.g. enamel matrix derivates) are indicated [ 62 ]. In the present study, only 2 cases [ 3 , 40 ] succeeded in justifying the use of their regenerative procedure based on the description and analysis of the associated intra-bony lesion. As for PG anatomy, this lack of description of the associated periodontal lesion morphology could mislead the diagnosis and result in a non-optimal treatment. The PG issue had mostly been a concern for endodontist based on those case reports coming from endodontic journals, which might explain the few periodontal parameters reported and the lack of a clear description of the intra-bony defect associated to justify the different management of the periodontal defect. Moreover, the selected case reports do not cover all potentially applicable regenerative techniques, which continue to evolve [ 63 , 64 , 65 ] and should be further investigated in the particular context, from the microbiological and inflammatory perspectives, of PG-associate lesions.

Based on the presented literature review and in order to guide clinicians towards a comprehensive and complete evaluation of PG associated lesion, we suggested a decisional tree (Fig.  6 ) that introduces the periodontal parameter in the PG assessment, after evaluating the endodontic status. Indeed, the successful management of a tooth with a PG is firstly dependent on endodontic status, which should be systematically assessed. In cases of negative pulp response and periapical lesions, an endodontic treatment has to be undertaken in the first place [ 66 ]. But, the periodontal evaluation is also cardinal to obtain a successful and long-lasting management of PG.

Decisional tree. This graph proposes a decision-making process for the management of PG-associated lesions that takes into account the endodontic status, the characteristics of the palatal groove, and the presence of intra-bony defect

The recognition and management of PG for tooth survival has been reported in details in a study done by Kim et al. [ 60 ] in 2017. In the rest of the considered literature, half of the treatments described were made without a clear initial diagnosis or proper description of the associated lesions to justify the type of regenerative strategy and flap design approached. Another interesting observation made in this review is that in the case of intentional replantation, among the 5 reported cases, 2 resulted in a failure necessitating the tooth removal [ 33 ]. This suggests that replantation strategy should be used as a the latest resort for complex cases involving a PG to the apex with a deep groove.

It must be acknowledged that the available literature and thus the present systematic review present several limitations. Firstly, as mentioned above, there is a lack of standardization in the diagnostic and treatment processes, with a high heterogeneity among the selected articles, most of the times case reports or case series. Secondly, the follow-up time was mostly set between 6 and 24 months, which may be too short to assess treatment outcomes or observed complications and relapse. Indeed, after a 36 months follow-up, failures have been reported [ 33 ] and after 10 years, a periodontal breakdown occurred on a treated tooth [ 35 ] and both resulted in the tooth removal. No re-entry surgery and/or histologic evaluations were described and no prospective longitudinal studies evaluating the stability of the clinical and radiographic parameters and the absence of the recurrence of disease were found. Thus, any conclusion about the success achieved with the treatments described in the present review should be drawn with caution as the long-term prognosis of the treatment of PG-associated lesions of teeth remains to be determined. Updates of case series and case reports that could describe results after 5, 10 and 15 years from the initial PG diagnosis are advocated. Finally, the level of the body of evidence on PG is considered as low. Although the nature of PG as rare condition may explain why mainly case reports or case series are published, future clinical and comparative studies should be designed to investigate PG management and treatment success at long term. Nonetheless, based on the currently available literature, a decisional tree (Fig.  6 ) has been proposed to guide clinicians and create a reference for PG management to respond to a patient’s health condition. This should be periodontally updated as new evidence emerges but in the meantime, it can be useful to provide a clinical guidance as well as a model for the standardization of the diagnostic and treatment processes in clinical cases dealing with PG management.

Teeth with PG represent a challenge for clinicians. Despite their rarity (2% of maxillary lateral incisors), the complexities associated with PG, such as diverse anatomical features and clinical scenarios, underscore the necessity for accurate diagnosis and tailored treatment approaches. This study provides a systematic review of pertinent literature, consisting mainly in case reports, and culminates in the proposal of a decision tree, which aims to assist clinicians in the decision-making process through a structured evaluation of the PG characteristics guiding the treatment approach. The ultimate goal is to mitigate potential periodontal and endodontic complications of PG while providing a successful management. In parallel, the present study highlights the need of future research on this topic, particularly with clinical studies with a sufficiently long follow-up to monitor the treatment outcomes and their stability over time. Indeed, further evidence is needed to develop standardized diagnostic and treatment protocols for PG.

Availability of data and materials

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.

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Service of Odontology, Rothschild Hospital (AP-HP), 5 Rue Santerre, Paris, 75012, France

Yvan Gaudex, Vianney Gandillot, Philippe Bouchard, Stephane Kerner & Maria Clotilde Carra

Department of Periodontology, UFR of Odontology, Université Paris Cité, 5 Rue Garanciere, Paris, 75006, France

Service of Odontology, CH Eure Seine Hospital, Evreux, France

Isabelle Fontanille

Cordeliers Research Centre, Laboratory of Molecular Oral Physiopathology, Paris, France

Stephane Kerner

Department of Periodontology, Loma Linda University School of Dentistry, Loma Linda, CA, USA

INSERM- Sorbonne Paris Cité Epidemiology and Statistics Research Centre, Paris, France

Maria Clotilde Carra

Institution Nationale Des Invalides, Paris, France

Vianney Gandillot

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Y.G. and V.G. drafted the manuscript text, and were involved in the literature review, data acquisition, analysis, and interpretation. Y.G. and V.G. prepared Tables 1 and 2 . Y.G., P.B. and I.F. Contributed the case report and Figs.  2 , 3 , 4 and 5 M.C.C and S.K. prepared Table  3 and Fig.  6 . M.C.C., P.B. and S.K revised the draft of the manuscript and contributed to the general criticism. All authors reviewed and approved the manuscript.

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Gaudex, Y., Gandillot, V., Fontanille, I. et al. Palatal groove associated with periodontal lesions: a systematic review illustrated by a decisional tree for management. BMC Oral Health 24 , 1037 (2024). https://doi.org/10.1186/s12903-024-04771-z

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Received : 20 August 2023

Accepted : 19 August 2024

Published : 04 September 2024

DOI : https://doi.org/10.1186/s12903-024-04771-z

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