Cemental tear on a mandibular second molar: a case report

Abstract

A cemental tear is a special kind of root fracture that may cause rapid and localized periodontal destruction. Most cemental tears have been reported on bicuspids and incisors. Here we present a case of cemental tears on both the right mandibular first and second molars. The patient was a 72-year-old man who showed gingival swelling and a deep pocket over his right mandibular second molar as well as a deep periodontal pocket on the distolingual aspect of the first molar. During exploratory flap surgery, a detached root fragment on the mesial side of the second molar and a small root fragment on the lingual surface of the first molar were found and removed for biopsy. After histopathological examination, both root fragments were confirmed to be cemental tears. The periodontal defects were treated by osseous grafting and guided tissue regeneration. A postoperative probing depth of 4 mm on the second molar was recorded at 3 months and remained stable for 5 years. Where marked periapical and periodontal bony destruction are present, a cemental tear should be considered as a possible diagnosis, even in the molar teeth, for early treatment to improve prognosis.

Cemental Tear: Clinical Characteristics and Its Predisposing Factors

“…The MCTS registered teeth were classified as highly suspicious of cemental tears between May 1987 and October 2008 based on one of the following criteria: (1) a discernable radiopacity of separated root structure with a concomitant loss of adjacent periodontal or periapical bone on preoperative radiographs (Figs. 1 and 2) (3, 6); (2) teeth had clinical signs and symptoms and/or persistent periapical radiolucency even after endodontic treatment or retreatment, with or without the presence of suspected radiopaque cementum-like structure (3); and (3) teeth had recurrent periodontal inflammation and/or periodontal bone destruction even after scaling, root planing and curettage, or surgical intervention, with or without a suspicious radiopacity that separated root structure on preoperative radiographs (6). In the MCTS, the structured dental chart for each tooth with a possible cemental tear was designed to record the potential predisposing factors and clinical characteristics.…”

“…Recently, cemental tears are suggested to be a factor for periodontal or periapical tissue destruction (1)(2)(3). The cemental tear-associated lesion often presents itself on the radiograph as a periapical lesion or a periodontal lesion with angular bone loss along the root surface with variable extension, resulting in a deep probing defect because of attachment loss in some cases (1)(2)(3)(4)(5)(6). To rule out the presence of an endodontic-periodontal lesion, the standard of care requires pulp vitality tests and careful radiographic examination to aid in the diagnosis and treatment options.…”

“…The reason for the current state of knowledge results from few studies, limited sample sizes, and difficulty of early diagnosis. Collectively, over the past 30 years, fewer than 15 cemental tearrelated articles involving a total of 35 teeth have been published (6,17) (Table 1). …”

“…Only three cases of cemental tears involving molar teeth are reported (5,6). A cemental tear is defined as a complete or incomplete separation within the root surface along the cementodentinal interface or along an incremental line (1)(2)(3)(4)(5)(6)(7). The cemental tear is different from vertical root fracture (VRF), which affects the long axis of the root and involves the root canal space.…”

Cemental Tear in an Autotransplanted Tooth That Had Been Functioning for 15 Years

“…The cervical type has been described as a periodontal lesion that enables microorganisms to proliferate and initiate active periodontal breakdown 1,2 . There have been a few reports 2,3,5‐12 concerning cemental tears; however, to the best of the authors’ knowledge, reports on tears on autogenous teeth have been conspicuous by their absence.…”