Cementodentinal tear: a case report with 7-year follow-up

Cemental tears are an uncommon form of root fracture that can lead to rapid localized attachment loss. Typically, the separation of the fragment occurs at the cementodentinal junction. In this report, we present a case of periodontal involvement associated with a cemental tear-like fragment that proved to be a cementodentinal tear. We also review the literature on the clinical presentation of cemental tear associated periodontal lesions.

A 52-year-old male presented with acute pain on the maxillary right second premolar. Clinically, probing depth of 7 mm and inflammation were noted on the distal aspect of tooth #4. Radiographic examination revealed separation of cervical root structure on the distal aspect of the tooth, involving two-thirds of the root length. The root fragment was removed, and the localized defect was treated by open flap debridement along with scaling and root planing. The patient was then placed on a regular periodontal maintenance schedule.

A postoperative probing depth of 2 mm with 1 mm recession was recorded at 3 months, and maintained for 7 years. Histological examination indicated that the detached root fragment contained dentin with overlying acellular cementum and associated periodontal ligament tissue. The fragment was estimated to represent as much as 20% of the total root surface area.

Moderate to severe periodontal attachment loss associated with cemental or cementodentinal tears, even ones constituting a significant portion of the root surface, can be successfully treated with conventional periodontal surgical procedures and maintained long term with a proper maintenance regimen.