Cemental tear: a case report with nonsurgical periodontal therapy

Damasceno, Leonardo Silveira; Dutra, Walderez Ornelas; Melgaço, Eder Gonçalves; Souza, Paulo Eduardo Alencar; Zenóbio, Élton Gonçalves; Horta, Martinho Campolina Rebello

doi:10.1590/s1980-65232012000100014

Cited by 5 publications

(8 citation statements)

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“…A number of case reports suggested the impact of traumatic occlusion, severe occlusal tooth wear and the abutment tooth of a prosthesis as potential contributing factors (Blum et al, 2013;Borkar & Ataide, 2019;Chawla & Kumar, 2019;Chou et al, 2004;Damasceno et al, 2012;Haney et al, 1992;Harrel & Wright, 2000;Lin et al, 2010;Nathani et al, 2021;Park et al, 2018;Schmidlin, 2012;Tai et al, 2007;Xie et al, 2017). However, strikingly, some of these findings were not supported by Lin and co-workers, as they did not find abutment teeth of prostheses and dentitions with reduced posterior support as significant risk factors (Lin et al, 2011).…”

Section: Occlusal Trauma or Excessive Occlusal Forcementioning

confidence: 99%

“…Typical clinical features associated with cemental tears are gingival bleeding on probing (Damasceno et al, 2012;Lyons et al, 2005;Müller, 1999), swollen gingiva or alveolar mucosa (Blum et al, 2013;Haney et al, 1992;Lin et al, 2010;Ong et al, 2019;Park et al, 2018;Pilloni et al, 2019;Tai et al, 2007;Watanabe et al, 2012;Xie et al, 2017), purulent discharge through the periodontal sulcus or sinus tract (Blum et al, 2013;Camargo et al, 2003;Harrel & Wright, 2000;Leknes et al, 1996;Ong et al, 2019;Park et al, 2018;Schmidlin, 2012;Stewart & McClanahan, 2006;Tai et al, 2007;Watanabe et al, 2012;Xie et al, 2017), increased tooth mobility (Brunsvold & Lasho, 2000;Chawla & Kumar, 2019;Harrel & Wright, 2000;Müller, 1999;Nathani et al, 2021;Ong et al, 2019;Stewart & McClanahan, 2006;Watanabe et al, 2012;Xie et al, 2017) and a root filled tooth with post-treatment disease (Blum et al, 2013;Camargo et al, 2003;Chawla & Kumar, 2019;Damasceno et al, 2012;Jeng et al, 2018;Leknes et al, 1996;…”

Section: Clinical Presentation Of Cemental Tearsmentioning

confidence: 99%

“…Histologically, cemental tears consist of cellular and/ or acellular cementum, which appear as cemental lamellae with or without the presence of cementocytes within the lacunae (Damasceno et al, 2012;Haney et al, 1992;Harrel & Wright, 2000;Ong et al, 2019;Stewart & McClanahan, 2006;Tai et al, 2007;Tulkki et al, 2006;Watanabe et al, 2012) (Figure 1), occasionally with some peripheral root dentine attached to the cemental fragment (Ong et al, 2019;Tai et al, 2007;Xie et al, 2017). The fragment is either embedded within or attached to the periodontal or connective tissue fibres, or adhered to the granulation tissue, inflamed fibrous tissue or fibrous scar tissue (Haney et al, 1992;Stewart & McClanahan, 2006;Tai et al, 2007;Tulkki et al, 2006;Watanabe et al, 2012) (Figure 1).…”

Section: Histopathological Presentation Of Cemental Tearsmentioning

confidence: 99%

“…In order to achieve complete mechanical removal of the cemental fragment, one or more of the following treatment modalities have been suggested: a. Scaling and root planing via nonsurgical (Borkar & Ataide, 2019;Damasceno et al, 2012;Ishikawa et al, 1996;Xie et al, 2017) and/or surgical periodontal treatment (Blum et al, 2013;Camargo et al, 2003;Chou et al, 2004;Haney et al, 1992;Harrel & Wright, 2000;Ishikawa et al, 1996;Lin et al, 2010;Lyons et al, 2005;Marquam, 2003;Müller, 1999;Nathani et al, 2021;Park et al, 2018;Pilloni et al, 2019;Schmidlin, 2012;Tai et al, 2007;Tulkki et al, 2006;Watanabe et al, 2012); b. Apical surgery (Blum et al, 2013;Camargo et al, 2003;Chawla & Kumar, 2019;Kang et al, 2016;Kasaj et al, 2009;Ong et al, 2019;Tai et al, 2007); c. Intentional replantation or d. Extraction, for teeth with unfavourable or hopeless prognosis (Brunsvold & Lasho, 2000;Damasceno et al, 2012;Ong et al, 2019;Stewart & McClanahan, 2006;Watanabe et al, 2012;Xie et al, 2017).…”

Section: Clinical Management Of Cemental Tearsmentioning

confidence: 99%

“…When this is the case, cemental tears can appear clinically as hard tissue fragments that are sheet/piece like (Camargo et al, 2003;Lin et al, 2012), thin (Watanabe et al, 2012), prickle like (Ong et al, 2019) or tear like (Schmidlin, 2012) (Figure 1). They have also been described as resembling a ledge-like projection on the root surface (Marquam, 2003) and a foreign body (Damasceno et al, 2012). Those tears affecting multiple root surfaces usually present as detached U-shaped fragments that frequently involve the apical regions of roots (Lin et al, 2012;Stewart & McClanahan, 2006;Tai et al, 2007;Xie et al, 2017).…”

Section: Clinical Presentation Of Cemental Tearsmentioning

confidence: 99%

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Cemental tear: Literature review, proposed classification and recommendations for treatment

et al. 2021

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Cemental tears are an important condition of relevance to Endodontics but are often overlooked. A cemental tear is the partial or complete detachment of the cementum from the cemento-dentinal junction or along the incremental line within the body of cementum. The limited attention received is most likely due to the limited awareness amongst dental professionals and challenges in accurately diagnosing them, resulting in misdiagnosis and erroneous treatment. The aim of this review is to describe the: (i) epidemiology and predisposing factors; (ii) clinical, radiographic and histological features and (iii) the clinical management and treatment outcomes of cemental tear. The review included 37 articles published in English that comprised eight observational studies and 29 case reports. The prevalence of cemental tears was reported to be lower than 2%; whilst the incidence remains unknown. Internal factors due to the inherent structural weakness of cementum and its interface with the dentine, and external factors that are associated with stress have been proposed as the two mechanisms responsible for the development and propagation of cemental tears. Predisposing factors that have been implicated were tooth type, gender, age, previous root canal treatment, history of dental trauma, occlusal trauma and excessive occlusal force; however, evidence is limited. Common clinical and radiographic manifestations of cemental tears resemble the presentations of primary endodontic diseases, primary periodontal diseases and combined endodontic-periodontal lesions. Clinical management tended to focus on complete removal of the torn fragments and periodontal treatment, often combined with regenerative treatment. In this article, a new classification for cemental tears is developed that consists of classes 0 to 6 and stages A, B, C and D based on the: (i) location and accessibility of the torn cemental fragment; (ii) the pattern and extension of the associated bony defect in relation to the root length and (iii) the number of root surface/s affected by the cemental tear/s and the associated bony defect. Recommendations for treatment strategies are also provided and linked to the classification to aid in streamlining the process of treatment decision making.

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Section: Occlusal Trauma or Excessive Occlusal Forcementioning

confidence: 99%

Section: Clinical Presentation Of Cemental Tearsmentioning

confidence: 99%

Section: Histopathological Presentation Of Cemental Tearsmentioning

confidence: 99%

Section: Clinical Management Of Cemental Tearsmentioning

confidence: 99%

Section: Clinical Presentation Of Cemental Tearsmentioning

confidence: 99%

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Cemental tear: Literature review, proposed classification and recommendations for treatment

et al. 2021

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Cemental tear: To know what we have neglected in dental practice

Jeng

Luzi

Marco-Pitarch

et al. 2018

Journal of the Formosan Medical Association

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Cemental tear is a special kind of root surface fracture, contributing to periodontal and periapical breakdown. However, it is a challenge for doctors to diagnose, resulting in delayed or improper treatment. We reviewed the predisposing factors, location, radiographic/clinical characteristics, diagnosis and treatments of cemental tears. From the literature, patients with cemental tear were mainly males, over 60 year-old. Possible predisposing factors include gender, age, tooth type, traumatic occlusal force and vital teeth. Cemental tears were common in upper and lower anterior teeth, single or multiple, and can be present in cervical, middle and apical third of roots. Morphology of cemental tears can be either piece-shaped or U-shaped. Clinically, cemental tear shows a unitary periodontal pocket and signs/symptoms mimicking localized periodontitis, apical periodontitis and vertical root fractures. Treatment of cemental tears include scaling, root planning, root canal treatment, periodontal/periapical surgery, guided tissue regeneration, bone grafting, and intentional replantation. Recurrence of cemental tear is possible especially when the fracture involves root apex. Extraction is recommended for teeth with poor prognosis. In conclusion, cemental tears can involve both periodontal and periapical area. Dentists should understand the predisposing factors and clinical features of cemental tears for early diagnosis/treatment to prevent bone loss/tooth extraction.

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Unusual imaging appearance of cemental tear in the maxillary first molar on cone‐beam computed tomography: A case report

Kuwada,

Kikuchi,

Kato

et al. 2023

Aust Endodontic J

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A cemental tear (CeT) is a definitive clinical entity and its radiographic appearance is well known in single‐rooted teeth. However, the imaging features of CeT in multi‐rooted teeth have not been clarified. We report a case of CeT which arose in the maxillary first molar and exhibited an unusual appearance in cone‐beam computed tomography images. The torn structure was verified as cementum by micro‐computed tomography and histological analysis. The hypercementosis, most likely induced by occlusal force, might have been torn from the root by a stronger occlusal force caused by the mandibular implant. An unusual bridging structure was created between the two buccal roots. These features may occur in multi‐rooted teeth with long‐standing deep pockets and abscesses that are resistant to treatment.

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Cemental tear: a case report with nonsurgical periodontal therapy

Cited by 5 publications

References 1 publication

Cemental tear: Literature review, proposed classification and recommendations for treatment

Cemental tear: Literature review, proposed classification and recommendations for treatment

Cemental tear: To know what we have neglected in dental practice

Unusual imaging appearance of cemental tear in the maxillary first molar on cone‐beam computed tomography: A case report

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