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Cemental tears: challenges in the diagnosis and management of an unusual finding associated with rapid localized periodontal and peri-radicular bone loss
Cemental tears: challenges in the diagnosis and management of an unusual finding associated with rapid localized periodontal and peri-radicular bone loss Siew Leng Tan Kajal B Patel Julie K Kilgariff Dental Update 2024 49:11, 707-709.
Authors
Siew LengTan
BDS, AKC, MJDF RCSEng, PGCert MedEd
Orthodontic Registrar, Eastman Dental Hospital, University College London Hospitals NHS Foundation Trust
A cemental tear is a rare form of root surface fracture whereby a fragment of cementum partially or completely detaches from the root surface at the cemento-dentinal junction or within the body of cementum. Tears are most prevalent in incisors and lead to the breakdown of periodontal issues. Owing to challenges involved in diagnosis, cemental tears may be misdiagnosed because associated clinical and radiographic features closely resemble those seen in vertical root fractures, periodontal abscesses and endo-periodontal lesions. If incorrectly diagnosed, inappropriate and delayed management may result in treatment failure and tooth loss.
CPD/Clinical Relevance: Correct diagnosis and timely management of cemental tears can prevent further destruction of periodontal tissues, improve treatment outcomes and increase tooth survival.
Article
A cemental tear is a fragment of cementum partially or completely detached from the root surface at the cemento-dentinal junction or within the body of cementum along the incremental lines.1,2 Although rare, cemental tears can also involve part of the root dentine adjacent to the cementum.2 If the tear is not detected and removed in a timely manner, severe bone loss in the location of the tear can occur. This is because it is a localized tooth-related factor predisposing to plaque-induced gingival diseases or periodontitis.3 Correct diagnosis is paramount to avoid treatment delays, inappropriate treatment, treatment failure and potentially tooth loss.
However, cemental tears are rare and, therefore, clinicians may be unfamiliar with them. Misdiagnosis and mistreatment can occur; lesions being erroneously thought associated primarily with periodontal or endodontic disease aetiologies, such as vertical root fractures.4
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