The pararadicular radiolucency with vital pulp: Clinicopathologic features of 21 cemental tears

The investigation was conducted to better characterize the clinical, radiographic, and histopathologic features of cemental tears from a review of 21 cases.

This was a retrospective review of consecutive cases collected from patient records of the investigators.

Twenty-one cases were identified during an 8-year period. Maxillary incisors were most often affected (47.6%). All lesions presented with pain. They occurred as radiolucencies along the root of a vital or endodontically treated tooth and were classified as D-shaped (38.1%), thin-vertical-line (23.8%), thick-vertical-line (14.3%), J-shaped (19.0%), or periapical radiolucencies (4.8%). All lesions showed focal destruction of the lamina dura, with 66.7% exhibiting extension into the medullary bone. Histopathologic diagnoses included intramedullary fibrous scar (28.6%) and chronic fibrosing osteomyelitis (71.4%), all associated with embedded cemental fragments. Five associated teeth were also examined: All showed tears beneath the remaining cementum. Four cases were successfully treated with curettage without tooth extraction; endodontic therapy was performed, probably mistakenly, in 8 cases.

Cemental tears produced symptomatic, localized chronic inflammation characterized usually by a vertical radiolucency adjacent to a root. These lesions may not be as rare as previously thought and extraction may not be the best treatment.