The Vertical Radiolucency – Fourteen Cemental Tear Cases: Histopathology/Radiology

Objective: Only 14 in vivo cases of cemental tear have been published since the first report in 1992; there is a possible increased risk for endodontically treated teeth and teeth in older individuals. The defect mimics endodontic or periodontal disease and may result in extraction of the affected tooth. The tear results from separation of cementum from the underlying root dentin. Our objective is to present additional new cases with associated clinical and microscopic reviews.

Method: Cases were consecutively collected from the patient panels of the authors.

Result: We report 14 new cases of cemental tear, 8 in males; 6 in females. The average age at diagnosis was 66 years, with a range of 52-90 years. All cases were associated with vertical or D-shaped, moderately well demarcated, symptomatic radiolucencies which could not be probed; 10 cases were isolated to the apical half of the affected root. All cases were associated with viable teeth and anterior maxillary incisors were most often affected (n = 7), although no alveolar site was spared. Histopathology showed fibrous scar formation around 3 cementum fragments and chronic inflammation with fibrosis (chronic fibrosing osteomyelitis) in all other cases; 3 submitted teeth all showed traumatic loss of cementum. Nine cases required extraction of the affected tooth. A total of 25 in situ tears where seen in a microscopic review of 750 extracted teeth without clinical evidence of cemental tear. Tear patterns will be reviewed, including two teeth with almost half of the cementum torn of the near-apical root.

Conclusion: Cemental tears are not resorbed in vivo and produce symptomatic, low grade chronic fibrosing osteomyelitis of the adjacent bone, characterized by a vertical radiolucency adjacent to the root. Depending on presentation, extraction of the affected tooth may not be necessary.