(TC11) Endodontic-Periodontal Management of Cemental Tears

Objective: Cemental tears are the incomplete or complete detachment of cementum from the cementodentinal junction. This type of fracture is often misdiagnosed as vertical root fractures or endodontic-periodontal lesions due to lack of knowledge in their clinical presentation and options for treatment. The objective of this case report is to show how cemental tears can present and be managed clinically. Concise description of technique: A 90-year-old female presented with an asymptomatic periapical lesion on an endodontically treated tooth #25 with a deep isolated disto-lingual probing depth. The tooth was diagnosed as previously endodontically treated with asymptomatic apical periodontitis along with having the radiographic appearance of a cemental tear. A combined endodontic-periodontal surgery was performed. After full thickness buccal and lingual flaps were reflected, the cemental tear fragments were removed and collected for biopsy. Endodontic microsurgery was completed with an MTA root-end filling followed by guided tissue regeneration in the vertical defect using Emdogain. The patient was recalled at four weeks, two months, and one year for post-treatment evaluations. At the one-year recall appointment the tooth was asymptomatic and showed signs of radiographic healing.

Conclusion: With accurate diagnosis and interdisciplinary treatment teeth with cemental tears can be managed successfully. In this case a combined approach of endodontic surgery and guided tissue regeneration resulted in a favorable clinical outcome.