Cemental Tears: A Report of Four Cases and Literature Review

Purpose: To present four different cases with a diagnosed cemental tear. The differences in aetiology, clinical diagnosis and treatment of cemental tears are described and discussed in order to provide guidance for clinical practice. Cases: Four patients of different ages presented with gingival swelling and other different complaints. Clinically, localised deep periodontal pockets and inflammation were noted on affected aspects in four cases. Radiographic examination revealed a prickly or flakey structure and bone loss on the affected side of the involved tooth. Different treatments, such as extraction, traditional periodontal initial therapy, periodontal flap surgery, or no clinical intervention were given based on different extents of tooth mobility and bone loss. In the first two cases, teeth with cemental tear were extracted due to poor prognosis. In case 3, deep pockets recovered to a normal condition, while cemental tears on the distal aspect of tooth 21 had no abnormal sensation or clinical symptoms. In case 4, a periapical radiograph showed distal bone loss was interrupted, and the tooth also recovered normal mobility. Histopathological evaluation of the specimens with H&E staining all resulted in a definitive diagnosis of cemental/cementodentinal tears. Conclusions: Cementodentinal or cemental tears are unique, localized, tooth-related factors associated with attachment loss. Aging, trauma and occlusal overload are the main aetiological factors. Early diagnosis and appropriate treatment will avoid unnecessary tooth extraction and result in a better prognosis. Detailed clinical and radiographic examinations as well as explorative surgery may help to make a diagnosis of cemental tears, but histopathological analysis is the only method for a definitive diagnosis. Keywords: aetiology, cemental tear, dental trauma, periodontal attachment loss, therapeutics