Clinical and Histologic Aspects of Cervical Cemental Tear as a Risk for Periodontal Diseases

Cemental tear (CeT) has been classified as a specific type of root fracture. It can lead to rapid periodontal breakdown, and recently not many reports have focused on periodontal concerns. This case report presents macroscopy, light microscopy (LM), and scanning electron microscopy (SEM) observations of fragments of CeT. Progression of periodontal disease is discussed in terms of anatomic characteristics of the cementum.

CeT was observed at a maxillary right central incisor of an 83-year-old male. After clinical examination and initial treatment, surgical periodontal therapy was performed in association with fragment extirpation, apicoectomy, replantation, and simultaneous regenerative treatment. Extirpated torn fragments and granulation tissue masses were subsequently examined by LM and SEM. Bacterial colonies were observed in and around peripheral crevices of cemental fragments.

Characteristics of cervical CeT are similar to common periodontitis features, such as rapid, periodic, sporadic, and site-specific advance, with occasional spiral pattern of pathologic pockets. In this case report, these features correspond to progression of bacterial pollution along the periphery of the overlapping scales of the cementum. In cases with such advanced periodontitis features, CeT should be discussed as a possible diagnosis. Optimum treatment should be more interventional, such as removal of degraded and torn cemental layers, when definite diagnosis is made by intrasurgical inspection.