Cemental Tear: Systematic Review and Thematic Analysis of Clinical and Imaging Features with a Proposed Diagnostic...

Cemental tear (CT) is a rare condition with poorly understood prevalence, etiology, and clinical presentation, often mimicking vertical root fractures or endodontic-periodontal lesions. This review aimed to synthesize current evidence on CT and propose a diagnostic framework.

A comprehensive search was conducted in Cochrane Library, Latin American and Caribbean Health Sciences Literature, PubMed, ScienceDirect, Scopus, Web of Science, and grey literature (Google Scholar, ProQuest) for case reports (2000-2024). Inclusion required full clinical and radiographic documentation. Risk of bias was assessed using the Joanna Briggs Institute checklist. Data on epidemiological, clinical, and imaging features were extracted.

Twenty studies reported 24 patients and 39 teeth. Methodological quality was heterogeneous, mostly with moderate risk of bias. CT mainly affected single-rooted teeth, especially incisors (46.1%), in older patients (mean 56.2 years). Frequent clinical findings included deep periodontal pockets (75%), mobility (60%), and fistulas (40%). Radiographically, bone loss (33.3%), radiopaque fragments (28.2%), and lateral radiolucencies (23.1%) were noted. Cone-beam computed tomography proved crucial for detecting buccal/lingual fragments. Histopathology confirmed cementum detachment, often infection-related. Treatments ranged from fragment removal to extraction, with prognosis linked to early diagnosis.

CT is rare and challenging, best identified with high-resolution cone-beam computed tomography and integrated clinical evaluation. Early, precise diagnosis guides prognosis, with conservative fragment removal recommended when feasible.