literature review on greywater treatment

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Greywater Characteristics, Treatment Systems, Reuse Strategies and User Perception—a Review

Michael oteng-peprah.

1 Department of Health Promotion, Faculty of Health Medicine and Life Sciences, University of Maastricht, Peter Debyplein 1, 6229 HA Maastricht, The Netherlands

2 Department of Chemistry, University of Cape Coast, Cape Coast, Ghana

Mike Agbesi Acheampong

3 Department of Chemical Engineering, School of Engineering, Kumasi Technical University, Kumasi, Ghana

Nanne K. deVries

This paper presents a literature review of the quality of greywater generated in different, especially developing, countries, constituents found in greywater, some treatment systems, natural materials for treatment, some reuse strategies and public perception regarding greywater reuse. The review shows that generation rates are mostly influenced by lifestyle, types of fixtures used and climatic conditions. Contaminants found in greywater are largely associated with the type of detergent used and influenced by other household practices. Many of the treatment systems reviewed were unable to provide total treatment as each system has its unique strength in removing a group of targeted pollutants. The review revealed that some naturally occurring materials such as Moringa oleifera , sawdust, can be used to remove targeted pollutants in greywater. The study further showed that user perceptions towards greywater treatment and reuse were only favourable towards non-potable purposes, mostly due to perceived contamination or lack of trust in the level of treatment offered by the treatment system.

Introduction

The total volume of freshwater on Earth far outweighs the human demands. Out of the overall water resources on Earth, about 97% can be found in the oceans while the remaining 3% remains available for direct exploitation; however, out of this 3%, the quantity of water that is available for use by humans is estimated at one-hundredth (Eakin and Sharman 2010 ; Gleick 1993 ). Uneven distribution of water in both time and space sways the use of water to other geographical areas depriving others of this resource. Biological survival remains one of the key factors of water use with its associated use also for household needs and for food production and other developmental needs. Many parts of the world are hit by acute water shortage, over-exploitation of water resources leading to gradual destruction of these water resources and high levels of freshwater pollution resulting from anthropogenic factors. Currently, it has been estimated that about 800 million people live under a threshold of water stress and this number is expected to reach 3 billion in 2025 (Qureshi and Hanjra 2010 ; UNDP 2017 ). Due to urbanization, industrialization and population growth, the demand for water is evident; however, will the available water resources meet the ever-growing needs in a sustainable manner? Where will the extra water that is required to sustain human activities come from? This question calls for interventions and strategies that will help address these concerns. This is where a cursory look at greywater reuse is worthwhile.

Greywater is defined as wastewater without any contributions from toilet water (Casanova et al. 2001 ; Ledin et al. 2001 ; Ottoson and Stenstrom 2003 ). It is considered high volume, low strength wastewater with high potential for reuse and application. The composition of greywater is varied and depends on the lifestyle, fixtures and climatic conditions (Abedin and Rakib 2013 ; do Couto et al. 2013 ; Katukiza et al. 2014 ). Reuse of greywater has been an old practice, and it is still being done in areas that are water stressed. This practice if given the needed attention can help reduce the over-reliance on freshwater resources and reduce the pollution caused by discharge of untreated greywater into freshwater resources. It can also be a supplementary source to existing water sources in areas where there is acute water crisis or in arid climatic regions. Recycled greywater can be used for different water-demanding activities including potable and non-potable uses such as toilet flushing and agriculture. The major concerns with greywater reuse have been issues with public health perceptions and inappropriate technology for the reuse option (Vigneswaran and Sundaravadivel 2004 ). Many researchers have studied characteristics of greywater with respect to fixtures, life style patterns and type of settlement (Alsulaili and Hamoda 2015 ; do Couto et al. 2013 ; Katukiza et al. 2014 ). However, the aim of this study is to assess the performance of greywater treatment system, to further review greywater reuse perceptions, to identify gaps of greywater systems with emphasis on developing countries and to identify scope for further research. This review used resources from peer reviewed journals, documents from the internet and text books. The methodological framework that guided this review is presented in Fig.  1 .

Methodological framework

Greywater Quantity

Greywater reuse has been considered as a reliable method of ensuring water security as compared to other methods of water capture such as rainwater harvesting which is dependent on hydrological conditions. The amount of greywater produced in a household can vary greatly ranging from as low as 15 L per person per day for poor areas to several hundred per person per day. Factors that account for such huge disparities are mostly attributed to geographical location, lifestyle, climatic conditions, type of infrastructure, culture and habits, among others. Greywater accounts for up to 75% of the wastewater volume produced by households, and this can increase to about 90% if dry toilets are used (Hernandez Leal et al. 2010 ). It has also been estimated that greywater produced accounts for about 69% of domestic water consumption (Jamrah et al. 2011 ). Table ​ Table1 1 presents different greywater generation rates in some reported studies in different countries.

Greywater generation rates in different studies

Greywater Composition

The composition of greywater varies, and it is largely a reflection of the lifestyle and the type and choice of chemicals used for laundry, cleaning and bathing. The quality of the water supply and the type of distribution network also affect the characteristics of greywater. There will be significant variations in the composition of greywater in both place and time which may be due to variations in water usage in relation to the discharged quantity. The composition may also be affected by chemical and biological degradations of some compounds within the transportation and storage network . Generally, greywater contains high concentrations of easily biodegradable organic materials and some basic constituents which are largely generated from households. These include nutrients such as nitrates and all its derivatives, phosphorus and its derivatives, but others include xenobiotic organic compounds (XOCs) (Fatta-Kassinos et al. 2011 ) and biological microbes such as faecal coliforms, salmonella and general hydrochemical constituents. Recent studies have however found pharmaceuticals, health and beauty products, aerosols, pigments (Eriksson et al. 2003 ) and toxic heavy metals such as Pb, Ni Cd, Cu, Hg and Cr (Aonghusa and Gray 2002 ; Eriksson et al. 2010 ) in appreciable concentrations in greywater. The presence of these contaminants in greywater is an indication of the gradual increase in the level of complexity in the composition of greywater.

Physical Constituents

These are constituents that are associated with the physical appearance of greywater and include temperature, turbidity, electrical conductivity and suspended solids, among others. Greywater normally has temperature range of between 18 and 35 °C, and the rather high temperature may be originating from warm water used for personal hygiene and cooking activities. These high temperatures may favour microbiological growth which is undesirable and may also cause precipitation of certain carbonates such as CaCO 3 and other inorganic salts which become less soluble at high temperatures. The concentration of total suspended solids in greywater can range within 190–537 mg/L as has been reported (Edwin et al. 2014 ; Oteng-Peprah et al. 2018 ). Greywater with much of the water originating from the kitchen and laundry accounts for the relatively high values of total suspended solids (TSS), and this may be due to washing of clothes, shoes, vegetables, fruits, tubers and many others which may contain sand, clay and other materials that could increase TSS. The ranges recorded for electrical conductivity in greywater is between 14 and 3000 μS/cm (Ciabatti et al. 2009 ; Prathapar et al. 2005 ). Groundwater sources and water scarce areas are mostly associated with high electrical conductivity due to dissolved materials. Poor or old plumbing materials also contribute to the increase in electrical conductivity due to leaching into greywater sources. The range of turbidity recorded for greywater is between 19 and 444 NTU, and it is mostly influenced by the water use activities. Greywater that has most of its sources originating from the kitchen and laundry is expected to become more turbid due to the presence of suspended matter.

Chemical Contaminants

To identify the different chemical constituents in greywater, it is important to understand the sources of contaminants. Significant chemical constituents in greywater are from chemicals used for cleaning, cooking and bathing purposes. The pH in greywater to a large extent depends on the pH and alkalinity in the water supply and normally is within the range of 5–9. Greywater with most of its sources originating from the laundry will generally exhibit high pH due to the presence of alkaline materials used in detergents. The major chemical constituents found in greywater which is generated as a result of cleaning or washing activities are surfactant. These surfactants serve as the main active agent in most cleaning products. They can be either cationic or anionic in nature with a majority of cleaning and laundry products being anionic (Jakobi and Lohr 1987 ). Cationic surfactants are generally salt based, and they constitute a source of ammonium in the greywater. Other constituents found in greywater also include nitrates and phosphate which are reportedly from ammonium and cationic surfactants and laundry disinfectants respectively (Eriksson et al. 2002 ). Other constituents such as sodium which is also from cooking and preservation activities in the kitchen can also be found in appreciable levels. Sodium-based soaps also contribute significant quantity of sodium into greywater. Other additives such as builders control water hardness in detergents and also serve as the main source of phosphate contaminant in greywater (Lange 1994 ). Nutrients such as N and P are associated with kitchen and laundry activities. Greywater sources with high nutrients concentrations are mostly made up of a high fraction of kitchen and laundry sources (Boyjoo et al. 2013 ). Kitchen waste are the primary source of nitrogen in greywater and range between 4 and 74 mg/L while washing detergents are the primary source of phosphates found in grey water which also range between 4 and 14 mg/L (Boyjoo et al. 2013 ).

The conventional wastewater parameters such as biochemical oxygen demand (BOD 5 ) and chemical oxygen demand (COD) always show a dominance of COD over BOD 5 . The biodegradability of greywater is determined by the BOD 5 /COD ratios. The ratio determines the ease with which bacteria can decompose the organic matter in the greywater. Mostly, all types of greywater show good biodegradability in terms of the BOD 5 /COD ratios (Li et al. 2009 ). The average BOD 5 /COD ratios in greywater have ranged between 0.31 and 0.71 which is an indication that almost half of the organic matter in greywater is biodegradable (Halalsheh et al. 2008 ). However, other studies have recorded ratios as high as 4:1 (Boyjoo et al. 2013 ). The dominance of COD to BOD 5 has largely been due to the presence of XOCs that increases COD. XOCs are synthetic organic compounds that are present in household chemicals and pharmaceuticals such as bleaches, surfactants, softeners and builders and beauty products. XOCs can also be formed by partial modification of chemicals in chemical or biological treatment of greywater (Fatta-Kassinos et al. 2011 ). XOCs are recalcitrant to conventional treatment protocols and can easily accumulate in plants and animals and subsequently pose risks to the natural environment (Fatta-Kassinos et al. 2011 ). Eriksson et al. ( 2002 ) identified 900 potential XOCs in greywater solely based on the ingredients of different cosmetics and detergents in Denmark. Le-Minh et al. ( 2010 ) identified the presence of antibiotics in greywater which may lead to proliferation of resistant bacteria strains. Revitt et al. ( 2011 ) also identified the presence of benzene and 4-nitrophenol in greywater in appreciable concentrations. Other hazardous substances such as brominated flame retardants, polycyclic aromatic hydrocarbons, monocyclic aromatics, triclosans and phthalates have been identified in greywater (Palmquist and Hanaeus 2005 ). Table ​ Table2 2 presents some selected physicochemical parameters of greywater with their concentrations in some selected high- and low-income countries.

Physicochemical characteristic of greywater s in low- and high-income countries

a Parjane and Sane ( 2011 )

b Pathan et al. ( 2011 )

c Hu et al. ( 2011 )

d Al-Mughalles et al. ( 2012 )

e Jokerst et al. ( 2011 )

f Birks and Hills ( 2007 ); Pidou et al. ( 2008 )

g March and Gual ( 2007 ); March et al. ( 2004 )

h Merz et al. ( 2007 )

Biological Characteristics

Greywater contains microorganisms such as bacteria, protozoa and helminths which are introduced into it by body contact. Inappropriate food handling in the kitchen and direct handling of contaminated food have been identified as sources of enteric pathogenic bacteria such as Salmonella and Campylobacter into greywater (Maimon et al. 2014 ; Ottoson and Stenstrom 2003 ). Faecal contamination is also common in greywater and is largely associated with poor personal hygiene and disposal of greywater which contains washed nappies. Pathogenic Escherichia coli and enteric viruses have been detected in greywater with majority of the water originating from laundry sources during a microbial monitoring programme in Melbourne Australia (O’Toole et al. 2012 ). In this study, 18% of samples contained enteric viruses, 7% enterovirus and 11% of E. coli . The most common indicators used to assess faecal contamination are coliform bacteria and E. coli . Studies conducted by Eriksson et al. ( 2002 ) and Ottoson and Stenstrom ( 2003 ) revealed a large collection of excreta-related pathogens associated with greywater . Other studies have further identified a number of pathogens in greywater, and these are Pseudomonas (Benami et al. 2015a ; Khalaphallah and Andres 2012 ), Legionella (Birks et al. 2004 ), Giardia (Birks et al. 2004 ; Birks and Hills 2007 ), Cryptosporidium (Birks et al. 2004 ) and Staphylococcus aureus (Benami et al. 2015a ; Kim et al. 2009 ; Maimon et al. 2014 ; Shoults and Ashbolt 2017 ) in greywater. Table ​ Table3 3 presents some selected biological parameters with their concentrations as reported in other studies.

Biological characteristic of greywater in low- and high-income countries

Treatment Systems

Management of greywater graduates from simple to extremely complex when the necessary strategies and technology is not in place or not properly implemented. Many developed countries have however implemented from simple to advanced methods of handling, managing and treating greywater with some countries recycling the greywater for both potable and non-potable uses. Treatment systems have been used to reduce the level of contamination in greywater before reuse or final disposal. They are contaminant-specific, and each is applied along the conventional wastewater treatment sequence (pre-treatment, primary, secondary and tertiary treatment). Each of these systems adopts either a physicochemical or biological means of treatment. Physicochemical methods adopt physical and/or chemical methods of treatment including filtration, adsorption and reverse osmosis, among others. Biological treatment methods adopt a combination of microbes, sunlight and oxygen manipulation; examples of such systems include activated sludge systems, trickling filters, waste stabilization ponds, rotating biological contactors and many others. The widely used systems have mostly been filtration, rotating biological contactors, membrane bioreactors, constructed wetlands and upflow anaerobic sludge blankets (UASBs). These systems have found their application in addressing the emerging greywater pollution experienced in most developing countries. This review therefore discusses the performance of these systems.

Filtration involves removal of particulate matter which is not removed by preceding processes. In filtration systems, both physical and biological processes remove solids; however, this review considers only physical removal of solids because that is the method adopted in most greywater treatment schemes. Filtration media could be in the form of sand, gravel, fine mesh and many others. Gross et al. ( 2007 ) studied the performance of a filtration system in greywater treatment using pebbles of 2 cm thick placed over drain holes and followed by a 12-cm middle layer consisting of 12 cm of plastic filter media and finally topped by 4 cm thick layer of peat. Dalahmeh et al. ( 2012 ) also studied the performance of a filtration system using pine bark, activated charcoal, polyurethane foam and sand as filter media in treating greywater. The performance of a coarse filtration system followed by slow sand filtration with a hydraulic retention time of 8 and 24 h respectively was studied by Finley et al. ( 2009 ). Parjane and Sane ( 2011 ) used coconut shell, coarse sawdust, charcoal, bricks and sand as filter materials to assess the performance of greywater treatment. A four-barrel filtration unit has been used to investigate greywater treatment by Al-Hamaiedeh and Bino ( 2010 ). These barrels were arranged in series, and the first three were loaded with gravels of 2–3 cm diameter. The final barrel was used to collect the treated effluent for irrigation. Gross ( 2008 ) adopted a hybrid filtration system utilizing a 130-μm net filtration, a tuff filter, a sand filter and followed by electrolysis in Israel. Zuma et al. ( 2009 ) used a mulch tower system to treat greywater in South Africa. This was constructed by using mulch, coarse sand, fine and coarse gravel. This was contained in a 650-mm high plastic column of 150 mm diameter with a stainless-steel sieve mesh placed on top to remove big particles. From the reviewed filtration systems, only bark filters were able to meet the pH criteria for reuse. More so, only the bark and charcoal filters could meet the BOD 5 regulatory standard for reuse. Removal rates of total phosphorous were high in bark, charcoal and sand filters. The performance of filtration systems discussed is presented in Table ​ Table4 4 .

Treatment efficiencies of some selected greywater treatment systems

a Al-Hamaiedeh and Bino ( 2010 ); Dalahmeh et al. ( 2012 ); Finley et al. ( 2009 ); Gross ( 2008 ); Parjane and Sane ( 2011 ); Zuma et al. ( 2009 )

b Gross ( 2008 ); Gross et al. ( 2007 ); Travis et al. ( 2010 )

c Hernandez Leal et al. ( 2010 ); Krishnan et al. ( 2008 ); Lamine et al. ( 2007 ); Scheumann and Kraume ( 2009 )

d Friedler et al. ( 2011 ); Gilboa and Friedler ( 2008 ); Pathan et al. ( 2011 )

e Atanasova et al. ( 2017 ); Huelgas and Funamizu ( 2010 ); Jong et al. ( 2010 ); Merz et al. ( 2007 )

f Abdel-Shafy et al. ( 2015 ); Elmitwalli et al. ( 2007 ); Hernandez Leal et al. ( 2010 )

Constructed Wetland

Constructed wetland (CW) is an artificial wetland constructed utilizing ecological technology to mimic conditions that occur in a natural wetland. The technology adopts special flora and fauna, soil and microorganisms to remove pollutants of interest. They are normally classified under three main types namely subsurface flow, surface flow and floating treatment wetland. The subsurface flow systems have been the most widely used constructed wetlands, and they come in two main technologies, vertical flow constructed wetland (RVFCW) and horizontal flow constructed wetland (HFCW). Each removes contaminants by a combination of physical, chemical and biological processes, and the treatment efficiency depends on factors such as loading rate and the availability of electron acceptors (Halalsheh et al. 2008 ). They have high potential of removing BOD 5 , suspended solids and some heavy metals such as Pb, Zn and Fe, among others. The performance of a RVFCW was studied, and it was observed that removal of ammonia nitrate was very low as compared to other systems (Gross et al. 2007 ; Travis et al. 2010 ). Gross ( 2008 ) also investigated the performance of HFCW in greywater treatment and observed that the quality of effluent improved if there was a pretreatment of the greywater . In this study, the average retention time was about 30 h and it was realized that electrical conductivity increased from 170 to 190 mS/m, T-N was reduced from 31 to 23 mg/L and T-P was also reduced from 48 to 46 mg/L representing 25.8 and 4.2% respectively. One major advantage of CW is its ability to run on its own without the attention of an operator. However, its removal rates for Na, Ca and Mg are relatively low and it also leads to increases in electrical conductivity (EC) which might be due to the dissolution of organic matter in the treated water leading to increase in the total dissolved solids (TDS) and subsequently affecting the EC. They are also unable to remove some microbiological agents such as E. coli and helminth eggs and as such will require further treatment if the objective of the treatment is reused. However, CW can produce effluents with BOD 5 and TSS meeting the regulatory limits. The removal efficiencies of this discussed CW are presented in Table ​ Table4 4 .

Rotating Biological Contactors

Rotating biological contactors (RBCs) are fixed bed reactors consisting of rotating disks and mounted on a horizontal shaft. They are partially submerged and rotated as wastewater flows through. The microbes that do the treatment are alternatively exposed to the atmosphere allowing both aeration and assimilation of dissolved organic pollutants and nutrients for degradation. Pathan et al. ( 2011 ) studied the performance of a single-stage RBC on greywater in Pakistan. The RBC was made of plastic sheets and the disks from textured plastic. The greywater was kept in the system for a specified period of time while the rotating discs were submerged up to 40% in the greywater . Friedler et al. ( 2011 ) studied the potential of RBC to remove indicator bacteria (faecal coliforms, heterotrophic bacteria) and specific pathogens ( Pseudomonas aeruginosa sp., Staphylococcus aureus sp.). The study concluded that RBC removed 88.5–99.9% of all four bacteria groups. Gilboa and Friedler ( 2008 ) studied the performance of RBC on removal of faecal coliforms (FC), Staphylococcus Aureus sp., Pseudomonas aeruginosa sp. and Clostridium perfringens sp. in greywater using RBC followed by sedimentation. The study concluded that the system removed up to 99% of all these microorganisms which were in the greywater. RBC systems perform well with respect to pH, BOD 5 , COD, reduced microbial loads and produced effluents that meet discharge guidelines. Performance of the system is presented in Table ​ Table4 4 .

Sequencing Batch Reactor

A sequencing batch reactor (SBR) is a type of activated sludge process used for wastewater treatment. All the treatment process takes place in batches in the reactor tank. The batch is sequenced through a series of treatment stages and performs equalization, biological treatment and secondary clarification in a single tank using a time-controlled sequence. Lamine et al. ( 2007 ) conducted a study on greywater treatment using SBR in a student house. This study assessed the performance of treatment by varying the hydraulic retention times (HRTs), and it revealed an effect on nitrification with the varying HRTs . A similar study by Scheumann and Kraume ( 2009 ) also used a pilot scale SBR by varying the retention time and observed the removal of COD, NH 4 -N and TN was sufficient to meet discharge reuse guidelines; however, there was nitrification in this study as also reported by Lamine et al. ( 2007 ). In this study, feedstock concentration of COD 250 mg/L, NH4-N 11.9 mg/L and TN = 17.1 were reduced to 18.9, 4.1 and 0.37 mg/L respectively, all being below the mandatory values for reuse applications. Krishnan et al. ( 2008 ) investigated the performance of greywater treatment from residential houses in Malaysia on a square bottom SBR at fixed HRT. An SBR has also been used in a demonstration project in the Netherlands to treat greywater from 32 houses (Hernandez Leal et al. 2010 ). SBRs have removal efficiencies of up to 98% for BOD 5 and COD, up to 80% TN and up to 99% for NH 4 -N . The HRT has been found to be a limiting factor in the performance of SBRs since difference HRTs result in different effluent qualities as is shown in the different studies (Lamine et al. 2007 ; Scheumann and Kraume 2009 ). The performance of this system is presented in Table ​ Table4 4 .

Membrane Bioreactor

A membrane bioreactor (MBR) is a perm-selective process integrated with a biological process for treating greywater. It works on a combination of biological, microfiltration and ultrafiltration systems to achieve treatment. It is an appropriate solution that can be used for greywater treatment and reused in densely urbanized areas, where space has high value, due to its compact size. Atanasova et al. ( 2017 ) studied the performance of an MBR on greywater treatment in a hotel in Spain. The removal efficiency for COD ranged from 80 to 95%, where COD concentration in the effluent was below the quantification limit 30 mg/L based on the Spanish legislation for water reuse. Ammonia and TN removal were on average at high level 80.5 and 85.1% respectively. The treatment performance of an MBR made up of an ultrafitration membrane was also studied by Merz et al. ( 2007 ) on greywater from a sports complex in Morocco. Huelgas and Funamizu ( 2010 ) studied the treatment of greywater using a laboratory scale MBR under varying pressure. Jong et al. ( 2010 ) also used anaerobic-anoxic-oxic MBR to treat greywater in Korea with microfilter of pore size 0.45 μm. These systems could achieve very good effluent which meets regulatory standards for reuse. A nominal pore size of 0.1 μm has been found to remove faecal coliforms. Performance of this system is presented in Table ​ Table4 4 .

Upflow Anaerobic Sludge Blanket

The upflow anaerobic sludge blanket (UASB) has remained one of the most widely used wastewater treatment system for various types of wastewater streams. It works on an anaerobic process and retains a high concentration of active suspended biomass and produces better settleable sludge than other treatment systems. Greywater from 32 houses in the Netherlands was treated using this system (Hernandez Leal et al. 2010 ). Elmitwalli et al. ( 2007 ) also used this system to study the treatment of greywater in Lubeck Germany by varying the retention time. Abdel-Shafy et al. ( 2015 ) investigated the efficiency of UASB in greywater treatment for unrestricted use in Egypt. The raw greywater characteristics with average concentrations of 95, 392, 298, 10.45, 0.4, 118.5 and 28 mg/L for TSS, COD, BOD 5 , TP, nitrates, oil and grease and TKN respectively were treated in a UASB. After treatment, the effluent concentration was 76.65, 165.4 96.85 and 19.31 mg/L for TSS, COD, BOD 5 and oil and grease respectively. This represents removal efficiencies of 19.3% for TSS, 57.8% for COD, 67.5% for BOD 5 and 83% for oil and grease. UASBs perform better when they are integrated with other systems. The performance of the system is presented in Table ​ Table4 4 .

Naturally Occurring Greywater Treatment Media

These are naturally occurring materials that have been applied as either standalone media or used as a complementary medium in some of the available conventional greywater treatment systems. Many researchers have studied the effect of treatment offered by these media, and their performance is listed in Table ​ Table5. 5 . Unlike other conventional treatment systems, these media are used for removing targeted contaminants and their mode of treatment is either by adsorption, filtration or coagulation.

Naturally occurring materials for greywater treatment

Reuse Strategies

A number of greywater treatment and reuse schemes have been implemented across the globe using both conventional and hybrid systems. Most of these systems have been developed as an environmental intervention measure and have since been operational while some have had their own challenges from both the technical and public point of view. Table ​ Table6 6 presents some examples of successful application of greywater treatment and reuse schemes in some countries.

Greywater reuse strategies in some developing countries

Greywater Reuse Perceptions

Public perception which is a social phenomenon can be seen as the difference between an absolute truth based on facts and virtual truth shaped by popular opinion (Conjucture 2017 ). In implementation of any project, public perception has been recognized as an integral factor in determining the success of the project. Many technically sound and environmentally friendly programs have failed because it was not accepted by the intended beneficiaries. Several studies have been conducted to assess public perception towards greywater reuse in different parts of the world using different strategies. These strategies include interviews, questionnaires, focus group discussions, informal discussions and other equally good social surveys. Most of these surveys identified clear support for the concept of greywater reuse as an environmentally sustainable method of protecting freshwater resources and pollution prevention. It has been reported by Dolnicar and Schafer ( 2006 ), Friedler et al. ( 2006b ), Hurliman and McKay ( 2007 ), Kantanonleon et al. ( 2007 ) and Marks ( 2004 ) that the highest acceptability of greywater reuse schemes are for non-potable uses. Dolnicar and Schafer ( 2006 ) identified reduced levels of acceptance as the recycled water got closer to human contact. A similar study by Jeffery ( 2001 ) in the UK identified that people were more willing to use ‘own’ recycled greywater than to use recycled water from an unknown source. Alhumoud and Madzikanda ( 2010 ) identified that public support was greater for areas which are water stressed and areas with unreliable water supply. The results of a study by Adewumi et al. ( 2010 ) conducted in three universities in South Africa among students and staff concluded that the level of education and level of awareness contribute to the success of greywater reuse. Religious and cultural practices have been identified as factors that influence reuse programs. This is supported by another study by DeSena (2006) and Parkinson ( 2008 ) who identified misinformation, lack of knowledge or instinctive repugnance as accounting for objections in reuse programs.

Potable Reuse Perceptions

The interruption and complete obstruction of many potable water reuse projects by stiff public opposition have been reported by DeSena ( 2006 ), Hurliman and Dolnicar ( 2013 ) and Meehan et al. ( 2013 ). This stiff opposition to potable reuse has been attributed to the close association of greywater with sewage which creates a phenomenon known as wisdom of repugnance. This phenomenon assumes that recycled water is associated with human waste; therefore, it renders it unpalatable from the public’s point of view. A study by Marks ( 2004 ) in three developed countries (Australia, the USA and the UK) identified low public support and acceptance for greywater reuse for potable purposes. The main barrier encountered in these studies were the associated perceived health risk of reusing recycled water in activities that involve direct contact with the user. Other studies identified language of the names given to recycled water as one of the obstacles affecting reuse schemes (Dolnicar and Saunders 2006 ). A study by Friedler et al. ( 2006b ), Omerod and Scott ( 2013 ) and Russell et al. ( 2009 ) identified public trust arising out of a combination of technical and non-technical issues. The study identified strong public opposition to reuse projects, where there is little trust in the implementing body even in the face of the most advanced technology applicable. Currently, most of the research in this area is targeting determinants that increases acceptance of reuse programs.

Conclusions

This study reviewed greywater characteristics, treatment systems, reuse strategies and perception of greywater reuse among users. It shows that there is a wide variation in greywater characteristics and volume generation rates which is largely dependent on the water use, lifestyle patterns and type of settlement. From the list of reviewed conventional treatment systems, filtration methods seem feasible and have the potential of integration with other systems to achieve target specific treatment. The study described different reuse strategies, most using discharged greywater for food production and landscaping while others have been used for poverty alleviation in irrigation farming.

The available technologies have been developed to treat or remove specific pollutants and not offer a full treatment of the greywater. Moreover, quality criteria differ for each type of reuse application, and greywater composition and generation rates vary greatly from one point to the other. It will therefore be prudent if systems are designed to target a specific reuse option taking into consideration the regional variability and complexities such that effluent from a treatment system will meet the required effluent guidelines. All the treatment systems reviewed were applicable on a large scale and cannot be applied at the household level. This in our view discourages local level participation in greywater reuse schemes. From the review, the potential of some natural materials to be used as media in greywater treatment systems also emerged. These natural materials are widely available in most developing countries, and their total integration into the conventional treatment systems should be explored. They can be used to design simple household level greywater treatment systems that target a certain reuse option and thereby increase local level participation.

Perception of greywater reuse has been closely related to the choice of reuse as most users will want to reuse greywater for activities that do not involve personal contact. In general, public perceptions are important to consider when implementing a certain method for a specified use. On the basis of this review, we conclude that to achieve effective greywater treatment and reuse, extensive contributions from technical and non-technical experts in many disciplines are called for. It also requires a comprehensive assessment of the greywater characteristics in order to choose an appropriate method or system of treatment. That notwithstanding, greywater treatment and reuse if embraced and enforced can lead to substantial decline in over-reliance on freshwater resources for non-potable uses.

Contributor Information

Michael Oteng-Peprah, Email: [email protected] , Email: hg.ude.ccu@harpep-gnetoM .

Mike Agbesi Acheampong, Email: moc.oohay@fradaD .

Nanne K. deVries, Email: [email protected] .

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Greywater Characteristics, Treatment Systems, Reuse Strategies and User Perception-a Review

Affiliations.

• 1 1Department of Health Promotion, Faculty of Health Medicine and Life Sciences, University of Maastricht, Peter Debyplein 1, 6229 HA Maastricht, The Netherlands.
• 2 2Department of Chemistry, University of Cape Coast, Cape Coast, Ghana.
• 3 Department of Chemical Engineering, School of Engineering, Kumasi Technical University, Kumasi, Ghana.
• PMID: 30237637
• PMCID: PMC6133124
• DOI: 10.1007/s11270-018-3909-8

This paper presents a literature review of the quality of greywater generated in different, especially developing, countries, constituents found in greywater, some treatment systems, natural materials for treatment, some reuse strategies and public perception regarding greywater reuse. The review shows that generation rates are mostly influenced by lifestyle, types of fixtures used and climatic conditions. Contaminants found in greywater are largely associated with the type of detergent used and influenced by other household practices. Many of the treatment systems reviewed were unable to provide total treatment as each system has its unique strength in removing a group of targeted pollutants. The review revealed that some naturally occurring materials such as Moringa oleifera , sawdust, can be used to remove targeted pollutants in greywater. The study further showed that user perceptions towards greywater treatment and reuse were only favourable towards non-potable purposes, mostly due to perceived contamination or lack of trust in the level of treatment offered by the treatment system.

Keywords: Greywater; Natural media; Reuse; Treatment systems; User perception.

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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

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Institution Nationale Des Invalides, Paris, France

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

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Cyclodextrin complexes for the treatment of chagas disease: a literature review.

1. Introduction

2. flowchart of this study.

3. Brief Review

3.1. cyclodextrin, 3.2. industrial applications, 3.3. complexation mechanism, 3.4. chagas disease, 3.5. biological cycle, 3.6. nifurtimox and benznidazole, 3.7. studies conducted on the treatment of t. cruzi, 4. impact of cyclodextrins on the optimization of drug solubility and efficacy, 5. impact of cyclodextrins with benznidazole in the treatment of chagas disease, 6. impact of cyclodextrins with natural products in the treatment of chagas disease, 7. discussion, 8. final considerations, 9. conclusions, author contributions, conflicts of interest.

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Taio, F.; Converti, A.; Lima, Á.A.N.d. Cyclodextrin Complexes for the Treatment of Chagas Disease: A Literature Review. Int. J. Mol. Sci. 2024 , 25 , 9511. https://doi.org/10.3390/ijms25179511

Taio F, Converti A, Lima ÁANd. Cyclodextrin Complexes for the Treatment of Chagas Disease: A Literature Review. International Journal of Molecular Sciences . 2024; 25(17):9511. https://doi.org/10.3390/ijms25179511

Taio, Fabrice, Attilio Converti, and Ádley Antonini Neves de Lima. 2024. "Cyclodextrin Complexes for the Treatment of Chagas Disease: A Literature Review" International Journal of Molecular Sciences 25, no. 17: 9511. https://doi.org/10.3390/ijms25179511

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A Comparative Analysis of Greywater Quantity and Quality Characteristics in Household and Hostels

• Conference paper
• First Online: 06 September 2024
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• Irshad N. Shaikh   ORCID: orcid.org/0000-0002-2918-4611 13 &
• M. Mansoor Ahammed   ORCID: orcid.org/0000-0002-8466-7528 13  

Part of the book series: Lecture Notes in Civil Engineering ((LNCE,volume 529))

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• International Conference on Sustainable Infrastructure: Innovation, Opportunities and Challenges

With a view to compare the quantity and quality characteristics of greywater from different sources, raw greywater was collected from a household, a girls’ hostel and a boys’ hostel daily for four months. Mixed greywater from the hand basin, bathroom and laundry was collected in each case. The results showed that the mean greywater generation from the household, the girls’ hostel and the boys’ hostel was 60, 85 and 80 L/person/day, respectively. No significant difference in greywater generation was observed for days of the week and the months of the year for a particular source. Greywater from the household was more polluted compared to the greywater from the girls’ hostel and boys’ hostel for different physicochemical and microbiological parameters, and no significant difference was observed in the quality of greywater from the boys’ hostel and the girls’ hostel except for NH 4 -N. Turbidity, COD and NH 4 -N in greywater from the household were 258 NTU, 522 mg/L and 11.63 mg/L, while PO 4 -P and faecal coliforms were 5.94 mg/L and 7.8 × 10 4  CFU/100 ml, respectively. Copper, zinc and chromium concentrations in the greywater from the household were 65.05, 240.43 and 26 µg/L, respectively. The turbidity, organic content, PO 4 -P and faecal coliform concentration in household greywater were at least three times higher than those in hostel greywater, while the concentrations of Cu and Zn were at least two times higher. Results indicated that the quality of greywater was related to the quantity of greywater generation and the source of greywater needs to be considered in the selection of the greywater treatment technology.

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Shaikh, I.N., Mansoor Ahammed, M. (2024). A Comparative Analysis of Greywater Quantity and Quality Characteristics in Household and Hostels. In: Sivakumar Babu, G.L., Mulangi, R.H., Kolathayar, S. (eds) Technologies for Sustainable Transportation Infrastructures. SIIOC 2023. Lecture Notes in Civil Engineering, vol 529. Springer, Singapore. https://doi.org/10.1007/978-981-97-4852-5_61

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