This report describes malformations of anterior teeth and a case of a palatal radicular groove in an upper lateral incisor with periodontal complications. The patient was first diagnosed with an endodontic problem. Endodontic treatment alone failed to resolve the pain. Therefore, after the palatal groove had been properly diagnosed, a palatal flap procedure was carried out including removal of the granulation tissue and careful scaling and root planing of the area with the groove. No odontoplasty was done. Endodontic therapy of the tooth was completed and periapical healing was evident. The treatment effectively reduced the gingival probing depth and led to an asymptomatic tooth.