Section Case Reports
Cemental tear on the first maxillary premolar in the patient with facial palsy: an uncommon type of root fracture
A 56-year-old female patient came to the department complaining of pain in the upper right back tooth region. The patient reported a history of paralysis in the right half of the body. There is neither swelling nor inflammation in the gingiva. No sinus tract is present in the vestibular area. There were no noticeable caries lesions. Right first maxillary premolar with significant periodontal pocket and grade 2 mobility on palpation. There is tenderness in the percussion. The patient refused treatment alternatives and had the tooth extracted. The middle third of the root contains a completely detached fragment in the middle third. The root fragment was sent for biopsy for histological analysis. Cementum, dentin, and inflammatory cells were found during histological examination and were suggestive of cemental tear.
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- Nanci A. Ten Cate's oral histology: Development, structure, and function. 1st South Asia edition. St. Louis, MO: Elsevier; 2018:193-217.
- Yamamoto T, Hasegawa T, Yamamoto T, Hongo H, Amizuka N. Histology of human cementum: Its structure, function, and development Jpn Dent Sci Rev. 2016;52(3):63-74. https://doi.org/10.1016/j.jdsr.2016.04.002
- Lin HJ, Chang MC, Chang SH, Wu CT, Tsai YL, Huang CC, Chang SF, Cheng YW, Chan CP, Jeng JH. Treatment outcome of the teeth with cemental tears. J Endod. 2014;40(9):1315-20. https://doi.org/10.1016/j.joen.2014.05.012
- Jeng PY, Luzi AL, Pitarch RM, Chang MC, Wu YH, Jeng JH. Cemental tear: To know what we have neglected in dental practice. J Formos Med Assoc. 2018;117(4):261-267. https://doi.org/10.1016/j.jfma.2017.09.001
- Ingle JI, Bakland LK, Baumgartner JC, Ingle JI. Ingle's Endodontics 6. 6th ed. Hamilton, Ontario, USA: BC Decker; 2013:676-689.
- Malhotra N, Kundabala M, Acharaya S. A review of root fractures: diagnosis, treatment and prognosis. Dent Update. 2011;38(9):615-28. https://doi.org/10.12968/denu.2011.38.9.615
- Gopikrishna V, Suresh BC. Grossman's endodontic practice. 13th ed. Gurgaon: Wolters Kluwer Health (India); 2014:421-428.
- Tulkki MJ, Baisden MK, McClanahan SB. Cemental tear: a case report of a rare root fracture. J Endod. 2006;32(10):1005-7. https://doi.org/10.1016/j.joen.2006.02.032
- Lee, A.H.C., Neelakantan, P., Dummer, P.M.H. & Zhang, C. Cemental tear: Literature review, proposed classification and recommendations for treatment. Inter Endod J. 2021;54(11):2044-73.
- Lin HJ, Chan CP, Yang CY, Wu CT, Tsai YL, Huang CC, Yang KD, Lin CC,Chang SH, Jeng JH. Cemental tear: clinical characteristics and its predisposing factors. J Endod. 2011;37(5):611-8. https://doi.org/10.1016/j.joen.2011.02.017
- Lin HJ, Chang SH, Chang MC, Tsai YL, Chiang CP, Chan CP, Jeng JH Clinical fracture site, morphologic and histopathologic characteristics of cemental tear: role in endodontic lesions. J Endod. 2012 ;38(8):1058-62. https://doi.org/10.1016/j.joen.2012.04.011
- Pedercini A, Weitz DF, Heyse Jr JD, Pedercini C, Kormas I, Koutlas IG, Johnson DK, McClanahan SB. Cemental tear: an overlooked finding associated with rapid periodontal destruction. A case series. Aust Dent J. 2021;66:S82-7.. https://doi.org/10.1111/adj.12844
- Nagahara T, Takeda K, Inoue S, Wada K, Shiba H. Successful regenerative response of a severe bone defect in a right lower central incisor affected by a cemental tear. Clin Case Rep. 2022;10(11):e6472. https://doi.org/10.1002/ccr3.6472
- Borkar SA, de Ataide IN. Management and 5-year follow-up of tooth with bilateral cemental tear and complete pulp canal obliteration. J Conserv Dent. 2019;22(2):213-214. https://doi.org/10.4103/JCD.JCD_370_18
- Ong TK, Harun N, Lim TW. Cemental Tear on Maxillary Anterior Incisors: A Description of Clinical, Radiographic, and Histopathological Features of Two Clinical Cases.EurEndod J. 2019;4(2):90-95. https://doi.org/10.14744/eej.2019.13007
- Pilloni A, Nardo F, Rojas MA. Surgical Treatment of a Cemental Tear-Associated Bony Defect Using Hyaluronic Acid and a Resorbable Collagen Membrane: A 2-Year Follow-Up. Clin Adv Periodontics. 2019;9(2):64-69. https://doi.org/10.1002/cap.10053
- Nagata M, Nagata M, Kanie T, Shima K. Clinical and Histologic Aspects of Cervical Cemental Tear as a Risk for Periodontal Diseases. Clin Adv Periodontics. 2016;6(4):167-174. https://doi.org/10.1902/cap.2016.150075
- Lin HJ, Chan CP, Wu CT, Jeng JH. Cemental tear on a mandibular second molar: a case report. Odontology. 2010;98(2):173-6. https://doi.org/10.1007/s10266-010-0121-8
- Kasaj A, Gortan-Kasaj A, Briseno-Marroquin B, Willershausen B. Treatment of severe localized periodontal destruction associated with a cemental tear: a case report and review of the literature. Gen Dent. 2009;57(1):e5-9.
- Noriyoshi Noma, Hiroshi Kakigawa, Yoshio Kozono, Makoto Yokota. Cementum crack formation by repeated loading in vitro. J Periodontol. 2007;78(4):764-9. https://doi.org/10.1902/jop.2007.060328