Cemental tear: a risk factor in periodontal attachment loss

The objective of this retrospective study was to evaluate the influence of cemental tear as a risk factor in periodontal attachment loss. Seventeen extracted, single-rooted teeth showing loss of attachment and having one cemental tear surface and one opposite intact surface were examined. The teeth were stained in 0.1% toluidine blue to visualize attached periodontal ligament remnants and examined in a light microscope under incident light. On each tooth, loss of attachment was measured along the long axis of the root from the cemento-enamel junction to the most coronal level of the periodontal ligament on intact as well as on defect surfaces. Cemental tear surfaces demonstrated a significantly greater loss of attachment than opposite intact surfaces (P < 0.0001). In one specimen, the cemental tear fragment was partially attached to the root after the extraction procedure. This specimen was processed for light microscopy to determine the location of the cemental tear fracture. Histological examination clearly revealed that the split between the root and the fragment had occurred along the cemento-dentinal border. The results indicate that cemental tear should be considered as a possible etiologic entity in localized rapid periodontal breakdown.