A Decade-Long Follow-Up of Supernumerary Tooth Leading Up to Cemental Tear: A Pediatric Case Report

Cemental tear (CeT), a detachment of the root cementum, is rarely reported in pediatric populations and often misdiagnosed as root fractures or endodontic-periodontal lesions.

This is the first documented instance of CeT in a healthy 12-year-old female, likely a result of the extraction of a supernumerary tooth (mesiodens). The patient had a supernumerary tooth diagnosed at age 2 that was extracted at age 10. Radiograph after 1 year of supernumerary tooth extraction revealed a linear radiopacity adjacent to the left maxillary central incisor, diagnosed as CeT by specialists. Despite the radiographic signs, the tooth remained asymptomatic and vital, with no surgical intervention required. This case underscores the importance of including CeT in the differential diagnosis for pediatric patients with unexplained periodontal changes following surgical or traumatic events. Conservative monitoring was successful, likely due to children's enhanced regenerative capacity. The case also highlights the diagnostic value of angled periapical radiographs in detecting CeT.

Pediatric dentists should be aware of CeT as a potential diagnosis in young patients and consider less invasive management approaches. A revised decision-making algorithm for managing supernumerary teeth is proposed to reflect these findings.