Cemental tear related to rapid periodontal breakdown: a case report.

Cemental tears have been described both in exposed and unexposed cementum. The phenomenon is believed to be elicited by overloading or acute trauma from occlusion. In this case report a patient, with a history of periodontal health, presented with an acute periodontal lesion on the distal aspect of a bridge abutment tooth. Periapical radiographs demonstrated an extensive vertical intrabony defect adjacent to the vital abutment tooth containing a radiopaque "foreign body." Histological examination of the surgically removed "foreign body" revealed a piece of dental cementum with some attached soft tissue. The lesion responded well to a surgical approach. Healing was uneventful and periodontal health was restored. This case illustrates that cemental tear should be considered as a differential diagnostic entity in isolated sites with rapid periodontal breakdown.     

Multiple cemental tears

A cemental tear is a pathologic condition in which a complete or incomplete separation of the cementum occurs along the root surface and is usually accompanied by a deep periodontal pocket. Past articles report that the incidence of cemental tears has usually been limited to 1 tooth per individual. We encountered a clinical case with cemental tears involving 14 teeth in 1 individual. Multiple cemental tears in 1 individual have not been previously described in the dental literature. We present the clinical and pathologic features of this rare case and suggest that the probable cause of multiple cemental tears is structural weakness of the cementum.     

Clinical repair of an osseous defect associated with a cemental tear: a case report

Cemental tears have been described as detachment of cementum caused by trauma or aging. They often result in severe periodontal lesions that may necessitate the extraction of the affected tooth. This case report describes the clinical resolution of a periodontal lesion associated with a cemental tear. A maxillary central incisor was subjected to endodontic treatment twice with no resolution of a deep distobuccal pocket and a palatal sinus tract from its apical region. The preoperative differential diagnosis for the condition present on the tooth included a vertical fracture and a combined periodontal-endodontic lesion. Surgical exploration of the area revealed a cemental tear on the apical third of the tooth. The cementum fragments were removed, root-end resection was performed, and the osseous lesion was treated with an osseous graft and guided tissue regeneration. Clinical examination of the area 1 year after surgery revealed resolution of both the prior pocket and sinus tract. Radiographic examination of the area showed increased radiopacity in the area of the original lesion, suggesting bone fill.     

Treatment of severe localized periodontal destruction associated with a cemental tear: a case report and review of the literature

Cemental tears have been described as a fragment of cementum becoming detached from the root surface, which can lead to severe periodontal breakdown. A 50-year-old woman with no history of periodontal attachment loss had an asymptomatic, isolated deep pocket on the mesial aspect of tooth No. 14. The radiographic examination revealed a thin, chip-like radiopacity along the lateral aspect of tooth No. 14. Periodontal flap surgery revealed a cemental tear on the apical part of the tooth. The root fragment was removed and the intrabony lesion was treated with enamel matrix derivative. A clinical examination one year after surgery demonstrated resolution of the pocket. Radiographic examination revealed an apparent bone fill at the bottom and the mesial wall of the original defect. This case illustrates that severe attachment loss associated with a cemental tear can be treated successfully by removing the cemental fragment and applying enamel matrix derivative.     

Cementodentinal tear: a case report with 7-year follow-up

BACKGROUND: Cemental tears are an uncommon form of root fracture that can lead to rapid localized attachment loss. Typically, the separation of the fragment occurs at the cementodentinal junction. In this report, we present a case of periodontal involvement associated with a cemental tear-like fragment that proved to be a cementodentinal tear. We also review the literature on the clinical presentation of cemental tear associated periodontal lesions. METHODS: A 52-year-old male presented with acute pain on the maxillary right second premolar. Clinically, probing depth of 7 mm and inflammation were noted on the distal aspect of tooth #4. Radiographic examination revealed separation of cervical root structure on the distal aspect of the tooth, involving two-thirds of the root length. The root fragment was removed, and the localized defect was treated by open flap debridement along with scaling and root planing. The patient was then placed on a regular periodontal maintenance schedule. RESULTS: A postoperative probing depth of 2 mm with 1 mm recession was recorded at 3 months, and maintained for 7 years. Histological examination indicated that the detached root fragment contained dentin with overlying acellular cementum and associated periodontal ligament tissue. The fragment was estimated to represent as much as 20% of the total root surface area. CONCLUSION: Moderate to severe periodontal attachment loss associated with cemental or cementodentinal tears, even ones constituting a significant portion of the root surface, can be successfully treated with conventional periodontal surgical procedures and maintained long term with a proper maintenance regimen.     

Cemental tear: a case report

AIM: To report a case of a cemental tear. SUMMARY: A case is reported of a patient with a history of trauma, root canal treatment and retreatment procedures to eliminate recurring sinus tracts. An exploratory surgery, extraction, and biopsy resulted in a diagnosis of cemental tear. KEY LEARNING POINTS: * The detachment of a fragment of cementum is described as a cemental tear. * Cemental tears have been reported in the periodontal literature associated with localized, rapid periodontal breakdown. Common causative factors are aging and traumatic occlusion but the exact aetiology is unknown. * Trauma may be considered as a potential aetiologic factor for cemental tears in addition to occlusal traumatism and aging.     

Salvaging a tooth with a deep palatogingival groove: an endo-perio treatment--a case report

AIM: To describe the diagnosis and management of tooth 22 with a necrotic pulp and severe periodontal destruction associated with a deep palatogingival groove extending to the root apex. SUMMARY: Palatogingival grooves are uncommon in maxillary lateral incisors, but when present may contribute to the pathogenesis of periodontal and endodontic lesions. In the present case, the prognosis was considered poor, as the patient presented with a deep probing defect, advanced bone loss and grade III mobility of tooth 22. Root canal treatment was performed, followed by periodontal surgery, during which the groove was conditioned and sealed with conventional glass-ionomer cement and the osseous defect filled with indigenously prepared hydroxyapatite. The 18 month post-operative follow up showed substantial resolution of the osseous defect with gain in attachment and decreased tooth mobility. KEY LEARNING POINTS: Teeth with deep palatogingival grooves may be significantly compromised with severe periodontal and periapical bone loss. Following thorough evaluation, the careful application of endodontic and periodontal surgical procedures may restore satisfactory function.     

Cemental tear: clinical characteristics and its predisposing factors

Introduction

Cemental tears often show characteristics mimicking a periapical or periodontal lesion. This leads to difficulty in the early diagnosis of cemental tears.

Methods

In this multicenter study, 71 teeth with cemental tears being confirmed by direct inspection or histological examination were included. For each case, demographic data, dental history, clinical and radiographic findings, and the results of exploratory surgery were recorded and analyzed.

Results

Maxillary or mandibular incisors (76.1%) were most frequently affected by cemental tears. Univariate analysis of predisposing factors found that teeth with cemental tears occurred more commonly in men (77.5%) and patients older than 60 years of age (73.2%). Analysis of clinical characteristics showed that teeth with cemental tears were prone to have abscess formation (66.2%), a deep pocket >6 mm (73.2%), positive vitality test (65.3%), healthy antagonist teeth (84.3%), and moderate to severe attrition (77.9%). About 56.3% of cemental tears could be detected on preoperative radiographs. Further analysis of radiographic findings showed that teeth with cemental tears were more likely to have periodontal bone destruction (85.9%) or periapical bone destruction (64.8%).

Conclusions

Endodontists and dentists may avoid misdiagnosis and unnecessary treatment of teeth with cemental tears if they can properly evaluate the radiographs and pulp vitality of teeth as well as know the predisposing factors and clinical characteristics of teeth with cemental tears in advance.     

Maxillary sinusitis and periapical abscess following periodontal therapy: a case report using three-dimensional evaluation

BACKGROUND: Maxillary sinusitis may develop from the extension of periodontal disease. In this case, reconstructed three-dimensional images from multidetector spiral computed tomographs were helpful in evaluating periodontal bony defects and their relationship with the maxillary sinus. METHODS: A 42-year-old woman in good general health presented with a chronic deep periodontal pocket on the palatal and interproximal aspects of tooth #14. Probing depths of the tooth ranged from 2 to 9 mm, and it exhibited a Class 1 mobility. Radiographs revealed a close relationship between the root apex and the maxillary sinus. The patient's periodontal diagnosis was localized severe chronic periodontitis. Treatment of the tooth consisted of cause-related therapy, surgical exploration, and bone grafting. A very deep circumferential bony defect at the palatal root of tooth #14 was noted during surgery. After the operation, the wound healed without incidence, but 10 days later, a maxillary sinusitis and periapical abscess developed. To control the infection, an evaluation of sinus and alveolus using computed tomographs was performed, systemic antibiotics were prescribed, and endodontic treatment was initiated. RESULTS: Two weeks after surgical treatment, the infection was relieved with the help of antibiotics and endodontic treatment. Bilateral bony communications between the maxillary sinus and periodontal bony defect of maxillary first molars were shown on three-dimensional computed tomographs. The digitally reconstructed images added valuable information for evaluating the periodontal defects. CONCLUSION: Three-dimensional images from spiral computed tomographs (CT) aided in evaluating and treating the close relationship between maxillary sinus disease and adjacent periodontal defects.     

Cemental tear on a mandibular second molar: a case report

A cemental tear is a special kind of root fracture that may cause rapid and localized periodontal destruction. Most cemental tears have been reported on bicuspids and incisors. Here we present a case of cemental tears on both the right mandibular first and second molars. The patient was a 72-year-old man who showed gingival swelling and a deep pocket over his right mandibular second molar as well as a deep periodontal pocket on the distolingual aspect of the first molar. During exploratory flap surgery, a detached root fragment on the mesial side of the second molar and a small root fragment on the lingual surface of the first molar were found and removed for biopsy. After histopathological examination, both root fragments were confirmed to be cemental tears. The periodontal defects were treated by osseous grafting and guided tissue regeneration. A postoperative probing depth of 4 mm on the second molar was recorded at 3 months and remained stable for 5 years. Where marked periapical and periodontal bony destruction are present, a cemental tear should be considered as a possible diagnosis, even in the molar teeth, for early treatment to improve prognosis.     

Management of periodontitis associated with endodontically involved teeth: a case series

The pulp and the periodontal attachment are the two components that enable a tooth to function in the oral cavity. Lesions of the periodontal ligament and adjacent alveolar bone may originate from infections of the periodontium or tissues of the dental pulp. The simultaneous existence of pulpal problems and inflammatory periodontal disease can complicate diagnosis and treatment planning. The function of the tooth is severely compromised when either one of these is involved in the disease process. Treatment of disease conditions involving both of these structures can be challenging and frequently requires combining both endodontic and periodontal treatment procedures. This article presents cases of periodontitis associated with endodontic lesions managed by both endodontic and periodontal therapy.     

Periodontosis: a case report with scanning electron microscopic observations.

A tooth and associated periodontal tissues from a patient with the diagnosis of periodontosis was subjected to scanning electron microscopic evaluation after reflection of the soft tissue portion of the lingual defect. The cemental surface of the apical portion of the lesion was found to be populated by markedly similar rod-shaped organisms. The microorganisms were observed to be continuously present in a coronal-apical direction as the transition from cementum to the attached soft tissues at the base of the defect were examined. These findings provide additional evidence that the lesion of periodontosis is characterized by a rather distinct microbial population of rod-shaped organisms located predominately at the base of the defect.     

Treatment Outcome of the Teeth with Cemental Tears

Introduction

A cemental tear is a special type of surface root fracture noted in combination with periodontal and/or periapical bony destruction. We hypothesized that clinical characteristics and treatment techniques may affect the prognosis of teeth with cemental tears.

Methods

Treatment outcome for the teeth with a cemental tear was assessed in a multicenter cemental tear study project. Of the 71 teeth with cemental tears, 38 teeth (53.5%) were extracted. The remaining 33 teeth (46.5%) were examined for a treatment outcome of healed, questionable, or failed.

Results

Outcome assessment found that 51.5% (17/33), 42.4% (14/33), and 6.1% (2/33) of teeth were classified as healed, questionable, and failed, respectively. Additive bivariate analysis indicated a significant difference between treatment outcome and the length (P = .01) and apicocoronal location (P = .02) of the separated root fragments. Logistic regression analysis found that treatment technique and apicocoronal location of cemental tears may affect the treatment outcome. The percentage of healed cemental tear cases located in the apical, middle, and cervical third of roots was 11.1%, 66.7%, and 60.0%, respectively. By surgical management, 57.7% of cemental tears were healed, whereas only 28.6% cases were healed after nonsurgical treatment.

Conclusions

Most teeth with cemental tears can be retained to function by nonsurgical and surgical periodontal and endodontic treatment. Clinical diagnosis and treatment of cemental tears should also consider the apicocoronal location and the type of treatment technique to improve outcomes.     

牙骨质撕裂的诊治进展

牙骨质撕裂被定义为牙骨质片自根面撕裂,是一类不常见的根折形式,可导致迅速的附着丧失.典型症状表现为局限性牙位的局限位点出现深牙周袋,常伴有瘘管或疼痛肿胀等症状.牙骨质撕裂的早期诊断较为困难,并且关于牙骨质撕裂的报道较少,尤其是国内鲜有关于这方面的报道,尚没有牙骨质撕裂在不同国家地区的发病率统计,但实际上,牙骨质撕裂的发病率远远高于临床上发现的数据,特别是在老年人群中.因此,本文从牙骨质撕裂病因、临床诊断和治疗等方面进行综述,为以后牙骨质撕裂的临床诊治提供一定的参考.     

Atypical localized deep pocket due to a cemental tear: case report

A 71-year old patient with a history of minimal periodontal attachment loss presented with an asymptomatic, non-bleeding, isolated deep pocket on the mesio-facial of a central incisor. Such localized, deep pockets are most frequently associated with a root fracture or an abscess, but in this case an atypical ledge-like projection determined to be a cemental tear was detected at the base of the 6 mm pocket. Periodontal flap surgery revealed a partial detachment of the cementum. Uneventful resolution of the pocket was achieved following root planing to remove the cemental fragment and placement of a bone graft and resorbable membrane. This article reviews the nature, predisposing factors, causes, clinical significance, and treatment of cemental tears.     

Combined therapy of mineral trioxide aggregate and guided tissue regeneration in the treatment of external root resorption and an associated osseous defect

BACKGROUND: The treatment of external root resorption and associated periodontal defects can be challenging to the most astute clinician. In this case report, a multidisciplinary approach was performed to treat a maxillary central incisor that presented with a sinus tract. An amalgam restoration had been placed approximately 10 years earlier to repair an area of external root resorption. METHODS: A full-thickness mucoperiosteal flap was reflected from teeth #8 to #9. Following degranulation of the area, an amalgam restoration was found on the distal root surface of tooth #8. A 2-wall osseous lesion was also associated with the distal surface of #8. The amalgam was removed and the defect was restored with mineral trioxide aggregate (MTA). The root surface was chemically conditioned with tetracycline, and the osseous defect was grafted with decalcified freeze-dried bone allograft (DFDBA) and a calcium sulfate barrier. RESULTS: An 8 mm gain in clinical attachment, as well as an increase in radiodensity, was noted on the distal surface of tooth #8 at 15 months postsurgery. The patient was also asymptomatic, with no clinical signs of inflammation present. CONCLUSIONS: A combined approach utilizing MTA for root surface repair, and DFDBA and calcium sulfate to address an associated osseous lesion, appears to be a viable modality in the treatment of chronic endodontic/periodontal lesions.     

Squamous cell carcinoma presenting as an endodontic-periodontic lesion

BACKGROUND: Regardless of advances in diagnosis and treatment during the past 40 years, the overall 5-year survival rates for oral and oropharyngeal squamous cancers have only slightly improved and remain around 50%. Thus, the early diagnosis and treatment of carcinoma by health care providers are essential in achieving a good prognosis. We report a case of invasive squamous cell carcinoma that presented as a benign endodontic-periodontic lesion with a 7-mm periodontal pocket on tooth #15 in a 40-year-old, non-smoking woman. The subsequent management of the case is also discussed. The study was conducted in accordance with the Helsinki Declaration of 1975, as revised in 2000. METHODS: Our patient was seen for a comprehensive periodontal examination including a periodontal charting, occlusal analysis, study casts, electronic pulp test for tooth #15, and complete mouth periapical radiographs. As there was a periapical radiolucency, an endodontic consultation was obtained. A periodontal flap surgical procedure was performed on teeth #13 to #15, and as there was bone erosion into the maxillary sinus, a biopsy of the soft tissue was submitted to the local hospital for histological analysis. RESULTS: The biopsied lesion was diagnosed as invasive, moderately differentiated squamous cell carcinoma with focal spindle and clear cell differentiation (grade II to III of IV). Bone invasion was also identified. The treatment of the carcinoma involved a hemimaxillectomy with the removal of the maxillary left posterior teeth. The patient remained free of tumor for 5 years after the initial presentation. CONCLUSIONS: Patient education and periodic oral cancer examinations by dental professionals are necessary to reduce diagnostic delay and improve prognosis. This case report emphasizes the important role of dental professionals, especially periodontists and endodontists, of being aware that squamous cell carcinoma may manifest itself clinically and/or radiographically as a common periodontal or endodontic lesion.     

Dental Pulp Regeneration Induced by Allogenic Mesenchymal Stromal Cell Transplantation in a Mature Tooth: A Case Report

IntroductionCellular therapy constitutes a new therapeutic alternative in regenerative endodontics. In this case report, we evaluated the capacity of allogeneic mesenchymal stromal cells (MSCs) to induce dental pulp and apical bone regeneration in a tooth previously endodontically treated.MethodsA healthy 55-year-old female patient consulting for swelling and a sinus tract associated with tooth #8 was referred for an endodontic evaluation. Previously, tooth #8 had undergone root canal treatment and apical resection and had no response to thermal or electric pulp testing. Radiographically, tooth #8 showed root canal treatment, a cut apex angle, and periapical radiolucency. The root canal was recleaned and shaped, and calcium hydroxide was used as an interappointment medication. Cryopreserved allogeneic bone marrow MSCs were thawed, expanded, incorporated into preclotted platelet-rich plasma, and implanted into the pulp cavity of tooth #8. The cervical part of the canal was sealed with bioceramic cement and a composite.ResultsAfter 14 months of MSC transplantation, tooth #8 showed sensitivity to cold and electric pulp tests. Radiographic and cone-beam computed tomographic imaging showed signs of increased periapical bone density, healing of the periapical lesion, and almost complete apical remodeling.ConclusionsThis case report shows periodontal bone formation, apex remodeling, and dental pulp regeneration induced by allogeneic MSC transplantation in a mature nonvital tooth. Allogeneic MSCs may constitute a first-line therapy in regenerative endodontics.     

Radiographic bone fill following debridement of a periodontal abscess. A case report

A periodontal abscess often develops in association with deepened periodontal pockets. Traditional management is by establishing drainage and prescribing antibiotics. This is usually followed by surgical pocket reduction. This case report discusses the remarkable healing of a periodontal abscess by establishing drainage alone without resorting to surgical pocket reduction. A 42-year-old white male presented with swollen gingivae associated with the mesiolingual of tooth #23. Increased probing depth and suppuration were evident. Radiographic bone loss on mesial #23 was present. A diagnosis of periodontal abscess was established. The abscess was drained through the orifice of the pocket. The patient failed to return for follow-up as instructed. A year later, the patient came back. Clinical evaluation showed healthy gingival tissues with probing depth of 3 mm on the mesiolingual of tooth #23. Radiographic evaluation showed bone fill of the osseous defect on the mesial of #23. The results of this case suggest that sufficient time should be allowed for healing prior to surgical pocket reduction.     

上颌侧切牙年轻恒牙牙中牙伴根尖周炎的牙髓血运重建治疗1例

牙内陷是由牙发育时期成釉器过度卷叠或局部过度增殖，深入到牙乳头中而导致的牙齿形态异常，因其复杂的解剖结构，给常规的牙髓治疗带来困难和挑战。牙中牙的牙髓治疗为牙内陷最复杂的一种情况，本文报道1例上颌侧切牙年轻恒牙牙中牙伴根尖周炎的牙髓血运重建治疗的病例，结合锥形束CT的辅助诊断，对其治疗及预后进行评估。随访2年，牙根继续发育，根尖周炎症消失。本病例为年轻恒牙牙中牙的牙髓病及根尖周病提供了新的治疗策略。