literature review early years

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Best start in life: a research review for early years

A three-part subject-based curriculum research review focused on early years education.

Applies to England

Best start in life part 2: the 3 prime areas of learning, best start in life part 1: setting the scene.

This research review explores literature that relates to early years education and draws on a range of sources, including academic and policy literature. The review focuses on the pre-school age range, from birth to 4 years and has been produced to support early years practitioners to raise the quality of early years education.

The ‘Best start in life’ research review:

• ‘part 1: setting the scene’ examines the factors that contribute to a high-quality early education
• ‘part 2: the 3 prime areas of learning’ explores the factors that contribute to developing young children’s knowledge and skills in the 3 prime areas of learning in the early years foundation stage ( EYFS )

The next part of the review will look at the 4 areas of learning.

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Added 'Best start in life part 2: the 3 prime areas of learning'.

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Early years learning and development: literature review

Purpose of the review is to consider the original sources on children’s development as well as the critical reviews of these. The focus is on research findings published since 2000 as the ultimate goal was to update, rather than to repeat, the evidence base on which the EYFS was originally based.

• child development
• early child care and education
• early childhood
• Early Years
• early years
• literature reviews
• research report

A literature review of the impact of early years provision on young children, with emphasis given to children from disadvantaged backgrounds

• January 2004

• University of Oxford

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Early years learning and development : literature review

Evangelou, Maria , Department for Children, Schools and Families (DCSF), corp creator. (2009) Early years learning and development : literature review. [ Research report ]

Literature Review (2010)

I. Literature Review

The last decade has brought a growing consensus on the range of skills that serve as the foundation for reading and writing ability (Dickinson & Neuman, 2006; National Reading Panel Report, 2000; Neuman & Dickinson, 2001; Snow, Burns, & Griffin, 1998). To become a skilled reader, children need a rich language and conceptual knowledge base, a broad and deep vocabulary, and verbal reasoning abilities to understand messages that are conveyed through print. Children also must develop code-related skills, an understanding that spoken words are composed of smaller elements of speech (phonological awareness); the idea that letters represent these sounds (the alphabetic principle), the many systematic correspondences between sounds and spellings, and a repertoire of highly familiar words that can be easily and automatically recognized (McCardle & Chhabra, 2004; McCardle, Scarborough, & Catts, 2001).

But to attain a high level of skill, young children need opportunities to develop these strands, not in isolation, but interactively. Meaning, not sounds or letters, motivates children’s earliest experiences with print (Neuman, Copple, & Bredekamp, 2000). Given the tremendous attention that early literacy has received recently in policy circles (Roskos & Vukelich, 2006), and the increasing diversity of our child population, it is important and timely to take stock of these critical dimensions as well as the strengths and gaps in our ability to measure these skills effectively.

In the following sections, we first review the important skills that are related to early language and literacy achievement. We then provide recommendations for updating ECRR workshops.

I.1 The Critical Dimensions of Language and Literacy in Early Childhood

Language. Verbal abilities are consistently the best predictors of later reading achievement (Scarborough, 2001). Skilled readers typically draw upon multiple levels of the language system (Dickinson, McCabe, Anastasopoulos, Peisner-Feinberg, & Poe, 2003), with abilities encompassing vocabulary, syntax, and discourse. Vocabulary size in optimal settings may increase exponentially in the early years (some estimate about seven words a day) (Snow et al., 1998), with children learning to comprehend words spoken to them before they are able to produce them on their own. Word knowledge, however, is not just developed through exposure to increasingly complex language, but to knowledge-building language experiences (Neuman, 2001) that involve children in developing and refining networks of categorically-related concepts.

With opportunity and practice, children’s word knowledge is put to use in syntactic structures that grow in length and complexity. Children’s sentences often start at two words (Bloom, 1970), but quickly lengthen to four or more words as children communicate their ideas increasingly through language. Snow and colleagues (Snow, Baines, Chandler, Goodman, & Hemphill, 1991) have shown that conversations that are physically removed from immediate objects or events (i.e., ‘what if?’) are tied to the development of abstract reasoning and related to literacy skills like print production and narrative competence.

With word learning occurring so rapidly, children begin to make increasingly fine distinctions of words not only based on their meaning but also based on their sound. They begin to make implicit comparisons between similar sounding words, a phenomenon described by linguists as lexical restructuring (Goswami, 2001; Metsala, 1999). For example, a two-year old child probably knows the words “cat” from “cut;” “hot” from “not.” Distinguishing between these similar sounding words both quickly and accurately, children begin to hear sequences of sound that constitute each known word. Children with large vocabularies become attuned to these segments and acquire new words rapidly; children with smaller vocabularies may be limited to more global distinctions. Consequently, vocabulary size and vocabulary rate are important for lexical restructuring (i.e., making sound distinctions between words) (Goswami, 2001), and are strongly tied to the emergence of phonological awareness.

Recent analyses (Dickinson et al., 2003) have made it abundantly clear, however, that oral language skills, and more specifically vocabulary development, not only play a role in phonological awareness but also are critical skills for the development of reading comprehension later on. Therefore, it is essential for quality indicators in early childhood programs to recognize that oral language and vocabulary development is the foundation for all other skills critical to successful reading.

Phonological awareness. Based on a massive body of research (Burgess, 2006; Lonigan, 2006), phonological awareness is a critical precursor, correlate, and predictor of children’s reading achievement. Discriminating units of language (i.e., words, segments, phonemes) is strongly linked to successful reading (National Reading Panel Report, 2000). It is, however, as described above, both a cause and a consequence of vocabulary development and learning to read (Ehri & Roberts, 2006). Typically developing children begin first to discriminate among units of language (i.e., phonological awareness), then within these units (i.e., phonemic awareness). Phonological awareness refers to the general ability to attend to the sounds of language as distinct from its meaning. Phonemic awareness is the insight that every spoken word can be conceived as units of sounds that are represented by the letter of an alphabet (Snow, Burns, & Griffin, 1998).

Evidence (Lonigan, 2006; Whitehurst & Lonigan, 1998) suggests that children achieve syllabic sensitivity earlier than they achieve sensitivity to phonemes, and sensitivity to rhyme before sensitivity to phonemes. Children’s entry to these skills typically begins with linguistic activities such as language games and nursery rhymes (Maclean, Bryant, & Bradley, 1987) that implicitly compare and contrast the sounds of words, and include alliterative phrases (i.e., bibbily bobbily boo begins with /b/). But implicit comparisons, alone, may be insufficient. Phonological awareness and phonemic awareness are meta-linguistic abilities (Adams, 1990). Children must not only be able to recite and play with sound units, they must also develop an understanding that sound units map onto whole or parts of written language.

Phonological awareness should not be confused with phonics. The term phonics, or decoding, assumes that children understand the phonemic composition of words, and the phoneme-grapheme (sound/letter) relationship. Studies that have attempted to accelerate learning through early phonics training have shown no effects (Snow et al., 1998); in fact, evidence suggests that such training, without a firm understanding of phonemic awareness, may be detrimental to remembering words and learning to spell.

Recent reviews and analyses (Dickinson et al., 2003; Scarborough, 2001) have placed phonological awareness as a critical part of a complex braid of language abilities which include strands of phonology, semantics, syntax, pragmatics, and discourse. Its tie to children’s ability to decode has been clearly established. At the same time, quality indicators would do well to recognize that phonological awareness skills are integrally connected to other important language skills which need to be strongly bolstered in these early education and care programs.

Letter knowledge: Knowledge of the alphabet letters is a strong predictor of short- and long-term reading success (Bond & Dykstra, 1967; Chall, 1990). However, its influence on later reading is not about knowing the letter names, per se. Rather, the learning of letter names mediates the ability to remember the sounds associated with the letters (Ehri, 1979). Once again, there is a reciprocal relationship between skills: Letter knowledge plays an influential role in the development of phonological awareness, and higher levels of letter knowledge are associated with children’s abilities to detect and manipulate phonemes. For example, the child who knows the letter ‘b’ is likely to remember the sound of /b/. Consequently, letter knowledge may reflect a greater underlying knowledge and familiarity with literacy related skills such as language and print.

Research (Gibson & Levin, 1975) indicates that children differentiate letters according to their visual form, that is, their horizontal, vertical and diagonal segments. Given the complexities of the visually distinct forms of letters (upper case, lower case, printed form), current learning theory (Adams, 1990) suggests that simultaneously teaching two versions of letters with their confusable sounds and labels may be overwhelming to the young child. However, there is no substantial evidence to suggest which particular form (upper or lower case) should be taught first.

A growing body of research suggests that a variety of extrinsic and intrinsic factors influence the development of letter knowledge. Exposure to letters is a primary vehicle for alphabet knowledge. Children who participate frequently in adult-child writing activities that include a deliberate focus on print have better alphabet knowledge relative to those who may spend time on other activities like shared reading (Aram & Levin, 2004). Further, some letters tend to be learned earlier by children than others. In a recent investigation, Justice and her colleagues (Justice, Pence, Bowles, & Wiggins, 2006) reported that the single largest advantage for learning letters were the child’s first initials, compared to the lesser advantage of phonological features of the letters themselves. Given the variability among children in the specific letters they know, multiple methods for gaining letter knowledge are recommended.

Background Knowledge. For children to become skilled readers (Neuman & Celano, 2006), they will also need to develop a rich conceptual knowledge base and verbal reasoning abilities to understand messages conveyed through print. Successful reading ultimately consists of knowing a relatively small tool kit of unconscious procedural skills, accompanied by a massive and slowly built-up store of conscious content knowledge. It is the higher-order thinking skills, knowledge, and dispositional capabilities that enable young children to come to understand what they are reading.

Children’s earliest experiences become organized or structured into schemas, building blocks of cognition. Schemas (Anderson & Pearson, 1984) provide children with the conceptual apparatus for making sense of the world around them by classifying incoming bits of information into similar groupings. Stein and Glenn (1979), for example, provided a compelling case for schemas and their usefulness for recalling information about stories. Well-read to children internalize a form of story grammar, a set of expectations of how stories are told which enhances their understanding. Knowledge becomes easier to access (Neuman, 2001), producing more knowledge networks. And those with a rich knowledge base find it easier to learn and remember.

Quality indicators of a rich content base for instruction in early childhood programs include a content-rich curriculum in which children have opportunities for sustained and in-depth learning (Neuman, Dwyer, & Newman, submitted for publication), including play; different levels of guidance to meet the needs of individual children; a masterful orchestration of activity that supports content learning and social-emotional development; and time, materials and resources that actively build verbal reasoning skills and conceptual knowledge.

Print conventions. Recognizing that concepts about print in the English language are not intuitive, Marie Clay (1979), in her pioneering work with Maori children in New Zealand, identified a set of conventions that could be understood without being able to read. These conventions included, among others, the directionality of print in a book (left-to-right, top-to-bottom, front-to-back), differences between pictures and print, uses of punctuation, and definitional characteristics of a letter and a word. Knowing these conventions, she found, helped in the process of learning to read.

With the exception of a study by Tunmer and colleagues (Tunmer, Herriman, & Nesdale, 1988) demonstrating the relationship of these skills to later reading success, however, there is little evidence to suggest the predictive power of these skills on later achievement. Rather, print conventions act as an immediate indicator of children’s familiarity with text, and are not integrally related to the other language based skills associated with reading success. Therefore, while such conventions might be helpful to young children in navigating through books, these skills may not in the long run play a powerful role in learning to read.

Children who are English language learners experience each of these critical dimensions in the context of learning two languages, which only increases the complexity of the processes of language and literacy development. In order to become proficient in their second language, young children will need to familiarity with the phonology to the [second language], its vocabulary (typical everyday discourse as well as academic vocabulary, its morphology and grammar (Geva, 2006). Further, to become literate in a second language, it is important to have an adequate level of oral proficiency in that language (Bialystock, 2007). Research with second language learners has shown that oral language and literacy skills in the first language contribute to the development of those skills in the second language. For example, phonological awareness skills in the first language have been found to predict phonological awareness sand word recognition in the second language (Chiappe & Siegel, 1999; Cisero & Royer, 1995; Durgunglu, 1998). Although much more research is still needed about the ways in which English language learners develop literacy skills, this knowledge can help guide the development of further interventions.

In sum, research supports a particularly strong linkage between oral language, phonological awareness, letter knowledge, background knowledge, and to a much lesser extent, print conventions, in the preschool years. These skills are highly interdependent. Phonological awareness appears to influence vocabulary development and vocabulary rate. Letter knowledge supports phonological awareness. Code-related skills are highly predictive of children’s initial early reading success while oral language skills and background knowledge become highly predictive of comprehension abilities and later reading achievement. Each of these skills, when integrated in meaningful activity, has an important role to play in children’s literacy development.

I. 2 Research on Constrained/Unconstrained Skills

In 2002, the National Early Literacy Panel (NELP, 2008) was convened to conduct a synthesis of the scientific research in the development of early reading skills for children ages 2-5. Their report, recently issued (2008), indicated that the most powerful predictors of reading achievement were alphabet knowledge, phonological awareness, rapid automatic naming, and that oral language and vocabulary were only moderate predictors of achievement.

Paris (2005), however, has most recently demonstrated the flaws in what has come to be understood as this traditional view. Early literacy skills, such as letter knowledge (knowing the letters of the alphabet), phonological awareness (sensitivity to the sounds in words), and concepts of print are best described as constrained skills-—skills that predict later achievement early on but that quickly asymptote after the age of 5. Contrary to constrained skills are vocabulary, comprehension and background knowledge; these skills are unconstrained, essentially never asymptote as children get older. These skills have the potential to grow throughout one’s lifetime, and can dramatically influence children’s long-term abilities both in reading and content areas.

This research has significant implications for teaching and our focus on the skills necessary for children to read. It suggests that although letter knowledge, phonological awareness, and concepts of print are initially important and should be taught, they lead only to temporary gains on skills, and do not predict long-term outcomes. The critical skills are vocabulary, comprehension, and background knowledge—skills that take more time to teach and review and these skills should be a major focus in helping children learn how to read.

I.3 Features of the Environment that Support Literacy Development

The environment can play a major role in promoting these critical skills for literacy development. The organization, structure, and complexity of the early childhood setting influence patterns of activity and engagement. For example, a fairly sizable number of studies (Morrow, 1990; Neuman & Roskos, 1992, 1997; Vukelich, 1994) have revealed the powerful influence of access to literacy tools on young children’s involvement in literacy activities. This research indicates that in settings carefully constructed to include a wide access of literacy tools, books, and play materials, children read more (Neuman & Roskos, 1992), and engage more in literacy-related play themes (Morrow, 1990), with resulting effects on literacy improvement (Neuman & Roskos, 1990).

The use of space in settings influences learning (Roskos & Neuman, 2001). Children use space and its boundaries to regulate and guide their own responses. For example, studies (Morrow, 1988; Neuman & Roskos, 1997) find that smaller, well defined niches and nooks seem to encourage greater language and collaboration with peers and adults. Children are likely to use these more intimate settings to interact in longer and richer conversation with others.

Relatedly, studies (Fernie, 1985) show evidence that the physical environment can have behavioral consequences. Some materials seem to encourage more sustained activity than others and invoke children’s attention at different ages. Materials that involve children in constructive activity, for example, tend to generate more language than “pull toys” (Rosenthal, 1973). Some materials elicit greater social interaction and cooperation, like block building, whereas others encourage more solitary and or parallel play, such as puzzles (see review, Roskos & Neuman, 2001).

The physical placement of objects, as well, influences children’s engagement in literacy-related activity. Children become more involved in sustained literacy play when objects are clustered together to create a schema or meaning network. For example, in one study (Neuman & Roskos, 1993), placing props associated with mailing letters together in a play setting (envelopes, writing instruments, stamps and stationary) led to longer play episodes than when these props were scattered throughout the room. Further, props that were authentic, familiar and useful to common literacy contexts, like telephones in the kitchen area, or mailboxes in the office area, encouraged more complex language interactions and routines.

The proximity of quality books at children’s eye view supports involvement in literacy-like enactments (Morrow & Weinstein, 1986; Neuman, 1999). In one of the first intervention studies of its type, Morrow and Weinstein (1986) examined the influence of creating library corners in early childhood settings. These library corners were specially constructed to include the following elements: (a) a clear location with well-defined borders; (b) comfortable seating and cozy spots for privacy; (c) accessible, organized materials; and (d) related activities that extended whole- and small-group book activities. Morrow and Weinstein (1986) found that the frequency of use rose significantly when library corners were made more visibly accessible and attractive. Similarly, in a large-scale study in 500 child care settings (Neuman, 1999), library settings were created to “put books in children’s hands” (p. 286). Observations indicated that children spent significantly more time interacting with books when they were placed in close proximity to children’s play activities.

Consequently, there is clear and abundant evidence that certain physical design features in environments support young children’s literacy engagement and subsequent achievement. Physical design features, uses of space, and resources, may help to focus and sustain children’s literacy activity, providing greater opportunity to engage in language and literacy behaviors. This research indicates, therefore, that a more deliberate approach to the selection and arrangement of materials according to specific design criteria may enhance children’s uses of literacy objects and related print resources.

Libraries might benefit from this research on the ecological features of environment. Creating cozy areas for children to sit and read together; constructing play spaces that help them learn to engage in playful behaviors that mimic library activities; and clustering objects such as books, toys, and writing implements together to encourage their sustained use of materials might enhance children’s independent engagement in the library areas.

I.4 Interactional Supports for Literacy Learning

Environments include not only physical settings, but psychological settings for literacy learning as well (Tharp & Gallimore, 1988). Children are influenced by the participants present in a setting, their background experiences, their values and it is the integration of place, people, and occasion that support opportunities for learning. These individuals act as social and psychological resources that provide information and feedback through demonstrations and interactions. From a Vygotskian perspective (Vygotsky, 1978), the participants in the setting have the potential to help children perform at a higher level than they would be able to by interacting with their physical environment alone. It is the contrast between assisted and unassisted performance that differentiates learning from development.

A great corpus of research (Dickinson & Neuman, 2006; Neuman & Dickinson, 2001) identifies the types of supports that promote children’s language and literacy development. Essentially, they highlight both instructional and relational components. Since language represents the foundational basis for literacy learning in the early years, there is evidence that the amount of verbal input in settings enhances children’s language development (Hart & Risley, 1995; Hoff-Ginsberg, 1991). Children whose teachers engage them in rich dialogues have higher scores on tests of both verbal and general ability (Whitehurst et al., 1994). This is especially the case when discussions consist of adults encouraging, questioning, predicting and guiding children’s exploration and problem-solving (Palinscar, Brown, & Campione, 1993). Such verbal interactions contribute to children’s vocabulary growth which, in turn, is strongly correlated with phonological awareness, comprehension, and subsequent reading achievement.

Adults also engage in activities that are highly supportive of literacy development. Reading stories to children on a regular basis is regarded as one of the more potent supports for literacy learning (Bus, Van Ijzendoorn, & Pellegrini, 1995). Studies (Dickinson & Smith, 1994; Whitehurst & Lonigan, 1998) have shown that a parent’s style or approach to reading storybooks to children has both short-term and long-term effects on language and literacy development. Shared book reading activities, such as dialogic reading (Whitehurst et al., 1994), for example, and repeated readings (Biemiller, 2006) have been widely studied and identified as an important source of knowledge about vocabulary, about letters, and about the characteristics of written language. Recent studies (Beck & McKeown, 2007; Duke, 2000) also highlight the importance of introducing children to a wide variety of books in different genres such as information books, poetry, and popular folk tales.

Attention to and support of emergent writing (Clay, 1991) has also been shown to strongly connect with children’s developing phonological awareness, phonemic awareness and readiness skills. Activities involve ‘driting (drawing and writing), and adult scaffolding help to build the alphabetic principle (Adams, 1990). Further, interactions in literacy-related play have been shown to relate to children’s length of utterances, and sustainability in play themes (Neuman & Roskos, 1992). Taken together, activities that engage children in reading, writing, talking, and playing create occasions for meaningful communicative interactions involving language and print.

This research highlights the central role of the caregiver who evokes children’s interest and engagement in literacy learning. According to Bus, Van Ijzendoorn, and Pellegrini (1995), children build a mental representation of their interactions with caregivers that influence their expectations and responses to activities. When children feel secure, they engage in learning; when insecure in situations, they may use digressive tactics to avoid activity. For example, in a cross-sectional study of interactive reading with 18-, 32-, and 66-month children, Bus and van Ijzendoorn (1995) found that the atmosphere surrounding book reading was more positive among securely attached caregiver-child dyads than anxiously attached dyads. For securely attached children, book reading was ultimately an enjoyable task, tied to learning improvement; for insecurely attached children, it was negative, with caregivers often using verbal and nonverbal cues to discipline behavior.

Other studies (Blair, 2002; Blair & Razza, 2007; Hamre & Pianta, 2005; Miles & Stipek, 2006; Pianta, La Paro, Payne, Cox, & Bradley, 2002), as well, support the linkage between children’s emotional security and cognitive activity. For example, Howes and Smith (1995) report that in settings rich with creative play activities and staffed by adults who provide children with emotional security, children not only thrive socially but cognitively as well. Similarly Peisner-Feinberg and her colleagues (Peisner-Feinberg et al., 2001) found that the influence of close attachments between caregivers and children yielded even stronger positive effects for children from disadvantaged backgrounds than for children from more advantaged backgrounds. Recent studies (Hamre & Pianta, 2005) have shown that these emotional supports may have important moderating effects during the elementary school years as well. Shown in a recent study by Powell and his colleagues (Powell, Burchinal, File & Kontos, 2008), these types of supportive adult interactions are more likely to occur in small group and one-to-one instructional settings, rather than in whole group instruction.

1.5 Addressing the Needs of English Language Learners

All of these environmental supports are especially important for young English language learners (ELL). Their numbers have increased dramatically in the past 15 years in the United States. For example, in 1990, 1 in every 20 children was ELL, that is, a student who speaks English either not at all or with enough limitations that he or she cannot fully participate in mainstream English instruction. Today the figure is 1 in 9 (Goldenberg, 2008). Although these children come from over 400 different language backgrounds, by far the largest proportions of students are Spanish-speakers (over 80%) (U.S. Department of Education, 2005).

Recent syntheses of research (August & Shanahan, 2006; Rolstad, Mahoney, & Glass, 2005; Slavin & Cheung, 2005) suggest that when feasible, children should be taught in their primary language. Primary language instruction helps to promote bilingualism and, eventually, biliteracy. Further, children will need support in transferring what they know in their first language to learning tasks presented in English. Engaging children actively in meaningful tasks and providing many opportunities for them to participate at their functional levels will enable children to feel more efficacious, and to become contributing members in mainstream classrooms.

Adults will need to make adjustments and accommodations—sometimes described as ‘instructional scaffolding’—to support children who are beginning English speakers (Goldenberg, 2008). They may have to speak slowly and somewhat deliberately, with clear vocabulary and diction; they may need to use pictures or other objects to illustrate the content being taught; or ask for children to respond either non- verbally (e.g., pointing or signaling) or in one- or two-word utterances (Snow et al., 1998). ELL’s language needs are complex. These young children are not only learning a new language, but also a new set of social rules and behaviors that may be different from their home. Given the great variability among ELL children, adults will need to know the different stages of language learning to be able to implement the most appropriate accommodations (for addition information on accommodations (see Carlo et al., 2004; Francis et al., 2006; Vaughn et al., 2006). Consequently, these and other factors are especially important to ensure that these ELL children have many opportunities to use their second language (i.e., English) and their native language in meaningful and motivating situations.

From an ecological perspective, therefore, the physical and psychological environments play vital roles in children’s learning about literacy. These supports mediate opportunities for literacy engagement and practice, and will likely influence children’s attitudes and efforts to engage in literacy activities despite difficulties they may encounter as they learning to read proficiently.

To summarize, program features that support literacy development include:

• A supportive learning environment in which children have access to a wide variety of reading and writing resources. • Developmentally appropriate practices that actively engages children’s minds and builds language and conceptual development. • Adult engagement in children’s learning through conversations, discussions, and contingent responses to children’s questions and queries. • A daily interactive book reading routine that introduces children to multiple genres, including information books, narrative, poetry, and alphabet books. • Activities that support small group and one-to-one interactions and differing levels of guidance to meet the needs of individual children. • A masterful orchestration of activities that supports play, learning and social-emotional development. • Adjustments and accommodations for English Language Learners that allow them to successfully engage in learning activities in the classroom.

1.6 Potential Avenues for Revisions of ECRR materials

The ECRR kit includes activities that support six critical skills: Print motivation, phonological awareness, vocabulary, narrative skills, print awareness, and letter knowledge. All of these skills are important. At the same time, however, the library community might wish to do the following:

• Rename some of the skills to be better aligned with current research. This would include: phonological awareness, vocabulary and oral language development, print concepts that include letter knowledge and specific concepts about print, and background knowledge and comprehension. Specifically, the library community would be wise to emphasize the informational aspects of book reading and its important relationship to background knowledge and conceptual development.

• Some skills, particularly in these early years are more important than others. The library community might consider focusing on language, vocabulary and its relationship to comprehension and reading success. Letter knowledge, print concepts are constrained skills, with limited predictive power in the long-run for children’s achievement.

• The research literature clearly focuses on the importance of materials and interactions, as well as the social components in learning. The library community might consider adding these ecological factors which are critical for literacy motivation and learning.

Literature Reviews

• What is a Literature Review?
• Steps for Creating a Literature Review
• Providing Evidence / Critical Analysis
• Challenges when writing a Literature Review
• Systematic Literature Reviews

Developing a Literature Review

1. Purpose and Scope

To help you develop a literature review, gather information on existing research, sub-topics, relevant research, and overlaps. Note initial thoughts on the topic - a mind map or list might be helpful - and avoid unfocused reading, collecting irrelevant content.  A literature review serves to place your research within the context of existing knowledge. It demonstrates your understanding of the field and identifies gaps that your research aims to fill. This helps in justifying the relevance and necessity of your study.

To avoid over-reading, set a target word count for each section and limit reading time. Plan backwards from the deadline and move on to other parts of the investigation. Read major texts and explore up-to-date research. Check reference lists and citation indexes for common standard texts. Be guided by research questions and refocus on your topic when needed. Stop reading if you find similar viewpoints or if you're going off topic.

You can use a "Synthesis Matrix" to keep track of your reading notes. This concept map helps you to provide a summary of the literature and its connections is produced as a result of this study. Utilizing referencing software like RefWorks to obtain citations, you can construct the framework for composing your literature evaluation.

2. Source Selection

Focus on searching for academically authoritative texts such as academic books, journals, research reports, and government publications. These sources are critical for ensuring the credibility and reliability of your review. 

• Academic Books: Provide comprehensive coverage of a topic.
• Journal Articles: Offer the most up-to-date research and are essential for a literature review.
• Research Reports: Detailed accounts of specific research projects.
• Government Publications: Official documents that provide reliable data and insights.

3. Thematic Analysis

Instead of merely summarizing sources, identify and discuss key themes that emerge from the literature. This involves interpreting and evaluating how different authors have tackled similar issues and how their findings relate to your research.

4. Critical Evaluation

Adopt a critical attitude towards the sources you review. Scrutinize, question, and dissect the material to ensure that your review is not just descriptive but analytical. This helps in highlighting the significance of various sources and their relevance to your research.

Each work's critical assessment should take into account:

Provenance:  What qualifications does the author have? Are the author's claims backed up by proof, such as first-hand accounts from history, case studies, stories, statistics, and current scientific discoveries? Methodology:  Were the strategies employed to locate, collect, and evaluate the data suitable for tackling the study question? Was the sample size suitable? Were the findings properly reported and interpreted? Objectivity : Is the author's viewpoint impartial or biased? Does the author's thesis get supported by evidence that refutes it, or does it ignore certain important facts? Persuasiveness:  Which of the author's arguments is the strongest or weakest in terms of persuasiveness? Value:  Are the author's claims and deductions believable? Does the study ultimately advance our understanding of the issue in any meaningful way?

5. Categorization

Organize your literature review by grouping sources into categories based on themes, relevance to research questions, theoretical paradigms, or chronology. This helps in presenting your findings in a structured manner.

6. Source Validity

Ensure that the sources you include are valid and reliable. Classic texts may retain their authority over time, but for fields that evolve rapidly, prioritize the most recent research. Always check the credibility of the authors and the impact of their work in the field.

7. Synthesis and Findings

Synthesize the information from various sources to draw conclusions about the current state of knowledge. Identify trends, controversies, and gaps in the literature. Relate your findings to your research questions and suggest future directions for research.

Practical Tips

• Use a variety of sources, including online databases, university libraries, and reference lists from relevant articles. This ensures a comprehensive coverage of the literature.
• Avoid listing sources without analysis. Use tables, bulk citations, and footnotes to manage references efficiently and make your review more readable.
• Writing a literature review is an ongoing process. Start writing early and revise as you read more. This iterative process helps in refining your arguments and identifying additional sources as needed.  

Brown University Library (2024) Organizing and Creating Information. Available at: https://libguides.brown.edu/organize/litreview (Accessed: 30 July 2024).

Pacheco-Vega, R. (2016) Synthesizing different bodies of work in your literature review: The Conceptual Synthesis Excel Dump (CSED) technique . Available at: http://www.raulpacheco.org/2016/06/synthesizing-different-bodies-of-work-in-your-literature-review-the-conceptual-synthesis-excel-dump-technique/ (Accessed: 30 July 2024).

Study Advice at the University of Reading (2024) Literature reviews . Available at: https://libguides.reading.ac.uk/literaturereview/developing (Accessed: 31 July 2024).

Further Reading

Frameworks for creating answerable (re)search questions  How to Guide

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A Literature Review on Leadership in the Early Years

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sameer nayak

Trevor Male

This is a theoretical and reflective examination of research into school leadership in England which concludes that activity has been both constrained and limited throughout the last 20 years. A review of school leadership development from 1997 indicates that the main government agencies have identified skills, attributes and behaviours, yet these have not been the consequence of robust empirical research. This outcome is compromised further by the way in which two mainstream academic UK journals, which ostensibly focus on the field of leadership in education, have less than 20 per cent of published papers in the years 2014 and 2015 on school leadership in England. I conclude, based on the samples of outputs examined, that this represents an alarming lack of evidence underpinning our understanding of the demands of school leadership in the rapidly changing nature of education in England. From this discussion, I call for two outcomes: greater opportunity for publication of domestic research within UK journals and national conferences and a determination from major agencies and institutions to support more substantial, detailed and focused research into school leadership.

Leadership and Learning

Linda Bendikson

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Alison Kington , Kenneth Leithwood , Pamela Sammons

Kenneth Leithwood

James Ko , Pamela Sammons , Alison Kington

Purpose – This study aims to explore the impact of school leadership, particularly that of the principal (head teacher), on school improvement in England. Design/methodology/approach – The study adopts a mixed-methods (MM), longitudinal design to investigate the leadership of a sample of academically effective and improving schools identified from analyses of national assessment and examination data sets. In addition, questionnaire surveys of principals and key staff and 20 qualitative school case studies were conducted. The paper reports results from the questionnaire analyses and changes in measures of school performance over three school years using data from 378 primary and 362 secondary schools. Confirmatory factor analysis and structural equation models (SEM) test direct and indirect effects of school leadership and school and classroom processes in predicting changes in schools’ academic results. Findings – The analyses identified robust underlying dimensions of leadership and school and classroom processes and highlighted strategies and actions that school principals and staff had adopted to raise pupil attainment. The SEM models reveal both direct and indirect effects of leadership on a range of school and classroom processes that in turn predicted changes (improvements) in schools’ academic performance. Originality/value – This original empirical study presents new results on the leadership of a large sample of effective and improving primary and secondary schools in England. A dynamic model is presented predicting changes in schools’ academic performance over three years and identifying direct effects of leadership on school and

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• 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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