Director Aozora Dental Office koto-ku, Tokyo, Japan
Background and objective: Cemental tear is defined as deep periodontal pockets and attachment loss with radiograph periapical lesion. There are two possible mechanisms for cemental tear: internal factors due to the structural weakness at the cementum-dentin interface and external factors due to stress such as dental trauma, occlusal trauma, and excessive occlusal forces, but there is no clear evidence. This case is a case in which periodontal regenerative therapy was performed on a tooth with cemental tear during the regular maintenance. Materials and
Methods: The patient, a 49-year-female, had no periodontal disease and had been receiving regular maintenance for 15 years. Abscess and deep periodontal pocket of the distal #13 were noted. There was no subgingival calculus, pulp vital test was positive, CT images showed the distal and palatally of #13 with vertical bony defects, no part of the cementum fragment could be detected on the radiographs. Cemental tear was observed when the flap was reflected and the root surface was debrided. Periodontal regeneration therapy was performed with enamel matrix derivative (EMD) and bone graft (Cytrans Granules®)
Results: One year after periodontal regeneration surgery, CT images showed improvement of the vertical bony defects. No periodontal inflammation was observed and the patient's progress is good.
Conclusion: Cemental tear is rare, the exact aetiology, predisposing factors are not clear. Also, in many cases, preoperative radiograph do not show a part of the cementum fragment. The pulpal status of the affected tooth should be assessed, and the possibility of preserving the tooth should be diagnosed based on the extent of the radiographic lesion and the location, size of the fragment, and the treatment plan should be considered.
