(TC29) Diagnosis and Management of Cemental Tears

Abstract: Diagnosing and treating teeth with cemental tears presents a challenging scenario in clinical endodontics, often being misunderstood and misdiagnosed. A cemental tear is a fragment of cementum that has partially or completely detached from the root surface of a tooth. These tears can occur in the apical, mid-root, or cervical portions of the root surface. The etiology of cemental tears remains unknown. Common findings associated with cemental tears include the presence of an abscess, a positive response to sensibility tests, significant tooth wear, and deep periodontal probing defects. Literature suggests that cemental tears are frequently found in incisors, particularly in teeth affected by occlusal trauma. Gender and age have also been reported as potential predisposing factors for cemental tears. Advanced imaging techniques, such as cone beam computed tomography (CBCT), enable accurate detection of cemental tears. Currently, there is no established treatment protocol for managing cemental tears, leaving clinicians in uncertainty and possibly leading to the unnecessary extraction of teeth that could otherwise be saved. The purpose of this table clinic is to review the radiographic and clinical diagnosis of suspected cemental tear cases and the options for their management. Treatment options, including surgical debridement of the cemental fragment, laser assisted ablation of the granulation tissue, and laser root conditioning, will be illustrated. Additionally, histological examination of removed cemental fragments from such cases will be presented.