Diagnosis and treatment of cemental tear: a case series

Cemental tear, characterized by the separation of the cementum from the root surface of a tooth, is commonly observed in patients with localized periodontitis, particularly those with a complex medical history resulting in significant periodontal damage. This condition complicates both diagnosis and treatment, and cone beam computed tomography (CBCT) is a valuable tool for assessing the extent of damage and guiding treatment decisions. This report presents 3 clinical cases of cemental tear. Detailed radiographs and CBCT scans were used to determine the position and size of the lesion, providing guidance for surgical intervention, followed by histopathologic evaluation if the tissue sample was adequate for proper diagnosis. Case 1 involved a 78-year-old woman with swelling around the mandibular left central incisor (tooth 24). The CBCT images revealed no fractures. Debridement and flap surgery were performed, and the symptoms resolved. Case 2 involved a 68-year-old woman who presented with pain and mobility of the mandibular right second premolar (tooth 29), which had previously undergone endodontic treatment. The CBCT images confirmed a cemental tear. Treatment included flap elevation, removal of granulation tissue, and application of enamel matrix derivative, which alleviated the symptoms. Case 3 involved an 82-year-old woman with swelling and mobility of the maxillary right first premolar (tooth 5). The CBCT images revealed extensive bone loss. Flap elevation, removal of granulation tissue, and application of enamel matrix derivative resulted in significant healing. In all of these cases, the size and position of the cemental tears were evaluated by CBCT, facilitating timely intervention that is essential for preventing periodontal tissue damage, enhancing treatment effectiveness, and improving tooth survival rates.