EPPT-CTG regeneration using rhFGF-2/CO₃Ap for Cemental Tear Defects: A case report

Cemental tear, representing separation of cementum from the root surface, is a rare but challenging condition often mimicking vertical root fracture or endodontic-periodontal lesions. Despite advances in regenerative therapy, a predictable treatment protocol for cemental tears with non-contained bone defects remains lacking. Minimally invasive regenerative surgical techniques, such as the entire papilla preservation technique (EPPT) and connective tissue graft (CTG) wall technique, may optimize wound stability and enhance clinical outcomes when combined with biologic agents.

A 73-year-old male patient presenting with gingival swelling and suppuration in #8 was diagnosed with a two-wall bone defect associated with a cemental tear (Class 3/Stage B) using cone-beam computed tomography (CBCT). Regenerative therapy was performed using recombinant human fibroblast growth factor-2 (rhFGF-2), carbonate apatite (CO₃Ap), and a CTG applied via the EPPT. Clinical parameters and radiographic findings were evaluated at baseline and 1, 3, 6, and 12 months postoperatively.

Healing progressed without postoperative complications such as gingival recession or graft exposure. The probing pocket depth was reduced from 10 to ≤3 mm, and clinical attachment gain of 7 mm was achieved at 12 months. CBCT demonstrated complete radiographic bone fill and reformation of the proximal and labial bone walls.

Combination regenerative therapy using rhFGF-2, CO₃Ap, and CTG with the EPPT achieved stable soft and hard tissue regeneration in an elderly patient with a cemental tear-associated two-wall bone defect. This multidisciplinary, minimally invasive approach shows promise for managing complex non-contained intrabony defects while maintaining gingival aesthetics.

A multidisciplinary regenerative approach combining rhFGF-2, CO₃Ap, and CTG with EPPT resulted in favorable clinical and radiographic outcomes for a cemental tear-associated two-wall bone defect. The CTG wall technique functioned as a protective barrier, minimized gingival recession, and promoted soft tissue stability. Cone-beam computed tomography aided in the accurate diagnosis of cemental tear morphology and postoperative evaluation of bone regeneration. This case underscores the importance of flap design and biologic integration in achieving optimal periodontal and aesthetic results.

This case report describes a new treatment method for repairing bone loss around a tooth caused by a "cemental tear," a type of root surface damage that can lead to gum swelling and bone destruction. A 73-year-old male patient was treated with a combination of a growth factor (rhFGF-2), a synthetic bone substitute (CO₃Ap), and a small piece of gum tissue (CTG) using a minimally invasive surgical technique that preserves the entire gum papilla. Over 12 months, the treatment resulted in significant healing of both bone and gum tissues without recession. This approach may offer a reliable option for saving teeth with similar severe bone defects.