Palatogingival groove (PGG) is a common developmental deformity, which is prone to retain plaque, leading to local periodontal inflammation. Furthermore, the infection can spread to the dental pulp tissue through the PGG, eventually resulting in combined periodontal-endodontic lesions. The treatment methods include PGG treatment, periodontal treatment, endodontic treatment, etc. The abnormal anatomical structure of PGG will influence the treatment and prognosis of the affected tooth. Teeth with combined periodontal-endodontic lesions often have poor curative effect and prognosis. How to early intervene and improve its prognosis has become a hot and difficult issue for dentists in recent years. This article analyzes the challenges in the treatment of PGG and puts forward the corresponding strategies, so as to provide reference for the clinical diagnosis and treatment of PGG.