Cemental Tears in Pediatric Patients Secondary to Traumatic Dental Injuries: A Report of Two Cases

Cemental tear (CeT) is a rare clinical finding characterized by a partial or complete detachment of a portion of the cementum from the root surface. CeT is a well-documented condition in the adult population, particularly among older individuals with periodontal disease, occlusal stress, or traumatic dental injuries (TDI). The prevalence of CeT in adults ranges from 0.9% to 2%. However, CeT has not been previously reported in the pediatric population. Approximately, one in three children experiences TDI, which subjects the teeth to a magnitude of force that can lead to cemental separation in both mature and immature anterior teeth. The clinical and radiographic features of CeT overlap with those of endodontic-periodontal lesions. Hence, it is assumed that CeT is seldom encountered in children, leading to missed or delayed diagnosis and treatment. This case series provides reports of a 13-year-old male and a 10-year-old female with CeT following TDI affecting maxillary central incisors. The clinical examination showed signs of TDI, while radiographs demonstrated a detached cemental fragment without pulpal involvement. The location of the finding warranted conservative management. This report reviews incidence, clinico-radiographic diagnosis, and management of CeT. This report also provides a novel radiographic classification of CeT secondary to TDI for early diagnosis and treatment to prevent sequelae and maintain long-term tooth function.