1
|
Kuwada C, Kikuchi T, Kato A, Naitoh M, Kise Y, Mitani A, Honda M, Ariji E. Unusual imaging appearance of cemental tear in the maxillary first molar on cone-beam computed tomography: A case report. AUST ENDOD J 2024; 50:157-162. [PMID: 37964478 DOI: 10.1111/aej.12810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/12/2023] [Accepted: 10/22/2023] [Indexed: 11/16/2023]
Abstract
A cemental tear (CeT) is a definitive clinical entity and its radiographic appearance is well known in single-rooted teeth. However, the imaging features of CeT in multi-rooted teeth have not been clarified. We report a case of CeT which arose in the maxillary first molar and exhibited an unusual appearance in cone-beam computed tomography images. The torn structure was verified as cementum by micro-computed tomography and histological analysis. The hypercementosis, most likely induced by occlusal force, might have been torn from the root by a stronger occlusal force caused by the mandibular implant. An unusual bridging structure was created between the two buccal roots. These features may occur in multi-rooted teeth with long-standing deep pockets and abscesses that are resistant to treatment.
Collapse
Affiliation(s)
- Chiaki Kuwada
- Department of Oral and Maxillofacial Radiology, Aichi Gakuin University School of Dentistry, Nagoya, Japan
| | - Takeshi Kikuchi
- Department of Periodontology, Aichi Gakuin University School of Dentistry, Nagoya, Japan
| | - Akiko Kato
- Department of Oral Anatomy, Aichi Gakuin University School of Dentistry, Nagoya, Japan
| | - Munetaka Naitoh
- Department of Oral and Maxillofacial Radiology, Aichi Gakuin University School of Dentistry, Nagoya, Japan
| | - Yoshitaka Kise
- Department of Oral and Maxillofacial Radiology, Aichi Gakuin University School of Dentistry, Nagoya, Japan
| | - Akio Mitani
- Department of Periodontology, Aichi Gakuin University School of Dentistry, Nagoya, Japan
| | - Masaki Honda
- Department of Oral Anatomy, Aichi Gakuin University School of Dentistry, Nagoya, Japan
| | - Eiichiro Ariji
- Department of Oral and Maxillofacial Radiology, Aichi Gakuin University School of Dentistry, Nagoya, Japan
| |
Collapse
|
2
|
Lee AHC, Neelakantan P, Dummer PMH, Zhang C. Cemental tear: Literature review, proposed classification and recommendations for treatment. Int Endod J 2021; 54:2044-2073. [PMID: 34403513 DOI: 10.1111/iej.13611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/16/2021] [Indexed: 11/29/2022]
Abstract
Cemental tears are an important condition of relevance to Endodontics but are often overlooked. A cemental tear is the partial or complete detachment of the cementum from the cemento-dentinal junction or along the incremental line within the body of cementum. The limited attention received is most likely due to the limited awareness amongst dental professionals and challenges in accurately diagnosing them, resulting in misdiagnosis and erroneous treatment. The aim of this review is to describe the: (i) epidemiology and predisposing factors; (ii) clinical, radiographic and histological features and (iii) the clinical management and treatment outcomes of cemental tear. The review included 37 articles published in English that comprised eight observational studies and 29 case reports. The prevalence of cemental tears was reported to be lower than 2%; whilst the incidence remains unknown. Internal factors due to the inherent structural weakness of cementum and its interface with the dentine, and external factors that are associated with stress have been proposed as the two mechanisms responsible for the development and propagation of cemental tears. Predisposing factors that have been implicated were tooth type, gender, age, previous root canal treatment, history of dental trauma, occlusal trauma and excessive occlusal force; however, evidence is limited. Common clinical and radiographic manifestations of cemental tears resemble the presentations of primary endodontic diseases, primary periodontal diseases and combined endodontic-periodontal lesions. Clinical management tended to focus on complete removal of the torn fragments and periodontal treatment, often combined with regenerative treatment. In this article, a new classification for cemental tears is developed that consists of classes 0 to 6 and stages A, B, C and D based on the: (i) location and accessibility of the torn cemental fragment; (ii) the pattern and extension of the associated bony defect in relation to the root length and (iii) the number of root surface/s affected by the cemental tear/s and the associated bony defect. Recommendations for treatment strategies are also provided and linked to the classification to aid in streamlining the process of treatment decision making.
Collapse
Affiliation(s)
- Angeline H C Lee
- Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Prasanna Neelakantan
- Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Paul M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Chengfei Zhang
- Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
3
|
The pararadicular radiolucency with vital pulp: Clinicopathologic features of 21 cemental tears. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:680-689. [DOI: 10.1016/j.oooo.2019.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 07/03/2019] [Accepted: 07/21/2019] [Indexed: 11/18/2022]
|
4
|
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; 9:64-69. [PMID: 31498568 DOI: 10.1002/cap.10053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 10/08/2018] [Indexed: 11/10/2022]
Abstract
INTRODUCTION A cemental tear (CeT) is a special type of surface root fracture that may cause periodontal and even periapical tissue destruction. Unfortunately, there is limited knowledge as to how these rare cases can effectively be treated. The present case is believed to be the first reported in the literature treating a bony defect caused by a cemental tear with hyaluronic acid (HA) and a collagen membrane. The aim of this case report is to present a regenerative surgical approach with clinical and tomographic success and stability at 2-year follow-up. CASE PRESENTATION A 61-year-old patient presented with spontaneous pain and gingival swelling over his right central maxillary incisor. Radiographically, a radiolucent area was observed in the medial third between both central incisors. The tomographic evaluation showed a buccal bone dehiscence and a bony defect. Once the differential diagnosis with an endodontic-periodontal lesion and root fracture was performed, CeT was the presumptive diagnosis. During the exploratory flap surgery, a small root fragment (CeT) on the mesial side of the tooth was founded and removed. The bony lesion was treated with hyaluronic acid (HA) and a resorbable collagen membrane. At 2-year follow-up clinical, radiographic, and tomographic success was observed. CONCLUSION A CeT-associated bony defect could be successfully treated after removing cemental fragments and performing a regenerative approach using HA and a resorbable collagen membrane.
Collapse
Affiliation(s)
- Andrea Pilloni
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Flavia Nardo
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Mariana A Rojas
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, "Sapienza" University of Rome, Rome, Italy
| |
Collapse
|
5
|
Videoscope-Assisted Minimally Invasive Surgery (VMIS) for Bone Regeneration around Teeth and Implants: A Literature Review and Technique Update. Dent J (Basel) 2018; 6:dj6030030. [PMID: 29986378 PMCID: PMC6162722 DOI: 10.3390/dj6030030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/02/2018] [Accepted: 07/03/2018] [Indexed: 11/17/2022] Open
Abstract
Background—The literature related to minimally invasive periodontal surgery is reviewed. This includes the original minimally invasive surgery (MIS) procedure for bone regeneration, the modification of MIS for the minimally invasive surgery technique (MIST) and modified MIST (M-MIST) procedures, and the introduction of the videoscope for oral surgical procedures and the ability to perform videoscope-assisted minimally invasive surgery (VMIS). The evolution from MIS through MIST to the current VMIS is reviewed. The results from studies of each of these methods are reported. Conclusion—The use of small incisions that produce minimal trauma and preserve most of the blood supply to the periodontal and peri-implant tissues results in improved regenerative outcomes, minimal to absent negative esthetic outcomes, and little or no patient discomfort. Minimally invasive procedures are a reliable method to regenerate periodontal tissues.
Collapse
|
6
|
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 2017; 117:261-267. [PMID: 28969877 DOI: 10.1016/j.jfma.2017.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022] Open
Abstract
Cemental tear is a special kind of root surface fracture, contributing to periodontal and periapical breakdown. However, it is a challenge for doctors to diagnose, resulting in delayed or improper treatment. We reviewed the predisposing factors, location, radiographic/clinical characteristics, diagnosis and treatments of cemental tears. From the literature, patients with cemental tear were mainly males, over 60 year-old. Possible predisposing factors include gender, age, tooth type, traumatic occlusal force and vital teeth. Cemental tears were common in upper and lower anterior teeth, single or multiple, and can be present in cervical, middle and apical third of roots. Morphology of cemental tears can be either piece-shaped or U-shaped. Clinically, cemental tear shows a unitary periodontal pocket and signs/symptoms mimicking localized periodontitis, apical periodontitis and vertical root fractures. Treatment of cemental tears include scaling, root planning, root canal treatment, periodontal/periapical surgery, guided tissue regeneration, bone grafting, and intentional replantation. Recurrence of cemental tear is possible especially when the fracture involves root apex. Extraction is recommended for teeth with poor prognosis. In conclusion, cemental tears can involve both periodontal and periapical area. Dentists should understand the predisposing factors and clinical features of cemental tears for early diagnosis/treatment to prevent bone loss/tooth extraction.
Collapse
Affiliation(s)
- Po-Yuan Jeng
- Department of Dentistry, Universidad CEU Cardenal Herrera, Valencia, Spain
| | - Arlinda Luzi Luzi
- Department of Dentistry, Universidad CEU Cardenal Herrera, Valencia, Spain.
| | | | - Mei-Chi Chang
- Chang Gung University of Science and Technology, Kwei-Shan, Taoyuan City, Taiwan; Department of Dentistry, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Yu-Hsueh Wu
- Department of Dentistry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jiiang-Huei Jeng
- School of Dentistry, National Taiwan University Medical College and Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.
| |
Collapse
|
7
|
Harrel SK, Nunn ME, Abraham CM, Rivera-Hidalgo F, Shulman JD, Tunnell JC. Videoscope Assisted Minimally Invasive Surgery (VMIS): 36-Month Results. J Periodontol 2017; 88:528-535. [PMID: 28183218 DOI: 10.1902/jop.2017.160705] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Clinical outcomes from videoscope assisted minimally invasive surgery (VMIS) at 36 to 58 months are reported. METHODS Fourteen patients having sites with residual probing depth (PD) of at least 5 mm and 2 mm loss of clinical attachment level (CAL) after initial non-surgical therapy were treated with VMIS. RESULTS At 36 months or greater post-surgery there was a statistically significant improvement (P <0.001) in mean PD and CAL (PD: 3.80 ± 1.18 mm, CAL: 4.16 ± 1.18 mm) in all surgical sites compared with baseline. There was a mean improvement in soft tissue height (0.36 ± 0.64 mm, P = 0.03). In most cases, patients reported no postoperative discomfort. CONCLUSIONS Improvements from VMIS appear to be favorable when compared with previously reported results of periodontal regenerative surgery. All improvements were stable over time. The lack of post-surgical recession after VMIS has not been reported with traditional regenerative surgery.
Collapse
Affiliation(s)
- Stephen K Harrel
- Department of Periodontology, Baylor College of Dentistry, Texas A&M University, Dallas, TX
| | - Martha E Nunn
- Department of Periodontology, Creighton University, Omaha, NE
| | - Celeste M Abraham
- Department of Periodontology, Baylor College of Dentistry, Texas A&M University, Dallas, TX
| | | | - Jay D Shulman
- Department of Periodontology, Baylor College of Dentistry, Texas A&M University, Dallas, TX
| | - John C Tunnell
- Department of Periodontology, Baylor College of Dentistry, Texas A&M University, Dallas, TX
| |
Collapse
|
8
|
Liu X, Ma C, Jing Y, Sun H. Hierarchical Nanofibrous Microspheres with Controlled Growth Factor Delivery for Bone Regeneration. Adv Healthc Mater 2015; 4:2699-708. [PMID: 26462137 PMCID: PMC4715540 DOI: 10.1002/adhm.201500531] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/19/2015] [Indexed: 01/19/2023]
Abstract
The integration of controlled growth factor delivery and biomimetic architecture into a microsphere is a challenging but attractive strategy for developing new injectable biomaterials. In this work, a unique hierarchical nanosphere-encapsulated-in-microsphere scaffolding system is developed. First, heparin-conjugated gelatin (HG) is synthesized, which provides binding domains for bone morphogenetic protein 2 (BMP2) to stabilize this growth factor, protect it from denaturation and proteolytic degradation, and subsequently prolong its sustained release. Next, a unique approach is developed which includes a water-in-oil-in-oil double emulsion process and a thermally induced phase separation to encapsulate BMP2-binding HG nanospheres into nanofibrous microspheres. The nanofibrous microsphere is self-assembled from synthetic nanofibers, and has superior surface area, high porosity, low density, and is an excellent carrier to support cell adhesion and tissue in-growth. BMP2 in the hierarchical microsphere is released in a multiple-controlled manner by the binding with heparin and encapsulation of the nanosphere and microsphere. An in vivo calvarial defect model confirms that this microsphere is an excellent osteoinductive scaffold for enhanced bone regeneration. By choosing different growth factors, this hierarchical microsphere system can easily be applied to other types of tissue regeneration. The work expands the ability to develop new injectable biomaterials for advanced regenerative therapies.
Collapse
Affiliation(s)
- X. Liu
- Department of Biomedical Sciences, Texas A&M University Baylor College of Dentistry, Dallas, TX 75246, USA
| | - C. Ma
- Department of Biomedical Sciences, Texas A&M University Baylor College of Dentistry, Dallas, TX 75246, USA
| | - Y. Jing
- Department of Biomedical Sciences, Texas A&M University Baylor College of Dentistry, Dallas, TX 75246, USA
| | - H. Sun
- Department of Pathology, School of Stomatology, Jilin University, Changchun 130021, P.R. China
| |
Collapse
|
9
|
Treatment Outcome of the Teeth with Cemental Tears. J Endod 2014; 40:1315-20. [DOI: 10.1016/j.joen.2014.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/27/2014] [Accepted: 05/29/2014] [Indexed: 11/18/2022]
|
10
|
Harrel SK, Abraham CM, Rivera-Hidalgo F, Shulman JD, Nunn ME. Videoscope-assisted minimally invasive periodontal surgery (V-MIS). J Clin Periodontol 2014; 41:900-7. [PMID: 25039580 DOI: 10.1111/jcpe.12294] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 11/28/2022]
Abstract
AIM Small incision surgery has become routine in many areas of medicine but has not been widely accepted in periodontal therapy. A videoscope to assist minimally invasive surgery (MIS) has been developed. The clinical outcomes from MIS performed using this videoscope (V-MIS) are reported. MATERIALS AND METHODS Patients were evaluated for residual defects following non-surgical therapy consisting of root planing with local anaesthetic. Thirty patients having 110 sites with residual pocket probing depth (PPD) of at least 5 mm, 2 mm loss of clinical attachment level (CAL), and radiographic evidence of bone loss were surgically treated. V-MIS was performed utilizing the videoscope for surgical visualization. RESULTS At re-evaluation 6 months post surgery, there was a statistically significant improvement (p < .001) in mean PPD and CAL (PPD 3.88 ± 1.02 mm, CAL 4.04 ± 1.38 mm) in 1, 2, and 3 wall defects. All PPD at re-evaluation were 3 mm or less. There was a mean post-surgical increase in soft tissue height (0.13 ± 0.61 mm, p = 0.168) with a decrease in recession. CONCLUSIONS The improvement in PPD and CAL from V-MIS, in the authors' opinion, appears to be favourable when compared to previously reported results of periodontal regenerative surgery. The lack of post-surgical recession following V-MIS has not been reported with traditional regenerative surgery.
Collapse
Affiliation(s)
- Stephen K Harrel
- Texas A&M University, Baylor College of Dentistry, Dallas, TX, USA
| | | | | | | | | |
Collapse
|
11
|
Harrel SK, Wilson TG, Rivera-Hidalgo F. A videoscope for use in minimally invasive periodontal surgery. J Clin Periodontol 2013; 40:868-74. [PMID: 23782239 DOI: 10.1111/jcpe.12125] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Minimally invasive periodontal procedures have been reported to produce excellent clinical results. Visualization during minimally invasive procedures has traditionally been obtained by the use of surgical telescopes, surgical microscopes, glass fibre endoscopes or a combination of these devices. All of these methods for visualization are less than fully satisfactory due to problems with access, magnification and blurred imaging. CLINICAL INNOVATION A videoscope for use with minimally invasive periodontal procedures has been developed to overcome some of the difficulties that exist with current visualization approaches. This videoscope incorporates a gas shielding technology that eliminates the problems of fogging and fouling of the optics of the videoscope that has previously prevented the successful application of endoscopic visualization to periodontal surgery. In addition, as part of the gas shielding technology the videoscope also includes a moveable retractor specifically adapted for minimally invasive surgery. DISCUSSION The clinical use of the videoscope during minimally invasive periodontal surgery is demonstrated and discussed. CONCLUSION The videoscope with gas shielding alleviates many of the difficulties associated with visualization during minimally invasive periodontal surgery.
Collapse
Affiliation(s)
- Stephen K Harrel
- Baylor College of Dentistry Texas A&M Health Science Center, Dallas, TX 75229, USA.
| | | | | |
Collapse
|
12
|
Simonelli A, Farina R, Rizzi A, Trombelli L. Trattamento ricostruttivo con Single Flap Approach di un difetto parodontale infraosseo associato a un’anomalia radicolare. DENTAL CADMOS 2013. [DOI: 10.1016/s0011-8524(13)70065-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
13
|
Harrel SK, Abraham CM, Rivera-Hidalgo F, Steffer MR, Rossmann JA, Kerns DG, Al-Hashimi I, Solomon ES, Cipher DJ. Comparison of Minimally Invasive and Conventional Flap Surgery for Treatment of Intrabony Periodontal Defects: A Pilot Case Controlled Study. ACTA ACUST UNITED AC 2013. [DOI: 10.5005/jp-journals-10031-1038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
The purpose of this study was to compare the clinical outcome of conventional flap surgery and minimally invasive surgery for the regenerative treatment of periodontal intrabony defects in a prospective, case-controlled study design. For this purpose, nine healthy individuals with 15 periodontal intrabony defects were included in the study. Patients were randomly assigned to undergo either minimally invasive surgery or conventional flap surgery for treatment of their intrabony periodontal defect. Each patient had preoperative and postoperative X-ray and measurement of periodontal parameters by a blinded examiner. All bony defects were treated with allograft consisting of enamel matrix derivative and demineralized freeze-dried bone. Results of this study indicated that both minimally invasive and conventional flap surgery improved pocket depth and clinical attachment levels after 6 months of surgery with no significant difference between the two surgeries. The overall result of our study suggests that minimally invasive surgery is as effective as conventional flap surgery in the treatment of intrabony periodontal defects and that both techniques appear to provide a comparable outcome.
How to cite this article
Steffer MR, Harrel SK, Rossmann JA, Kerns DG, Rivera-Hidalgo F, Abraham CM, Al-Hashimi I, Solomon ES, Cipher DJ. Comparison of Minimally Invasive and Conventional Flap Surgery for Treatment of Intrabony Periodontal Defects: A Pilot Case Controlled Study. J Contemp Dent 2013;3(2):61-67.
Collapse
|
14
|
Schmidlin PR. Regenerative Treatment of a Cemental Tear Using Enamel Matrix Derivatives: a Ten-Year Follow-up. Open Dent J 2012; 6:148-52. [PMID: 23056160 PMCID: PMC3465863 DOI: 10.2174/1874210601206010148] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Revised: 06/21/2012] [Accepted: 06/25/2012] [Indexed: 11/22/2022] Open
Abstract
A patient presented with chronic periapical periodontitis on tooth 45. The root canal was re-treated and a wide apical perforation was closed with MTA® as an apical plug. At reevaluation six month later, the tooth presented with increased mobility, bleeding on probing and probing pocket depths of 9 mm. Despite good periapical healing radio graphically, the tooth showed signs of localized marginal bone loss that was diagnosed as being due to a cemental fracture. The tooth was splinted, a muco-periostal flap was raised and the fragment of cementum was removed. The defect was treated in a regenerative approach, using enamel matrix derivatives (EMD). Six month after therapy, the probing pocket depths decreased to values of ≤ 3 mm and a defect fill was radiographically visible. The 10-year follow up showed a stable situation. It can be concluded that the occurrence of a local delamination of the root surface may contribute to the development of plaque-induced periodontal destruction. Its removal and the regenerative conditioning of the root surface with EDTA and EMD may result in a, at least partial, resolution of the problem and regeneration of bone at the affected the site.
Collapse
Affiliation(s)
- Patrick R Schmidlin
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Switzerland
| |
Collapse
|
15
|
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; 38:1058-62. [DOI: 10.1016/j.joen.2012.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 04/17/2012] [Accepted: 04/24/2012] [Indexed: 10/28/2022]
|
16
|
Watanabe C, Watanabe Y, Miyauchi M, Fujita M, Watanabe Y. Multiple cemental tears. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:365-72. [PMID: 22862978 DOI: 10.1016/j.oooo.2012.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 12/29/2011] [Accepted: 01/11/2012] [Indexed: 11/17/2022]
Abstract
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.
Collapse
Affiliation(s)
- Chie Watanabe
- Watanabe Dental Clinic, 1870-6 Kusabuka Numakuma Town, Fukuyama City, Hiroshima Prefecture, Japan.
| | | | | | | | | |
Collapse
|
17
|
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; 37:611-8. [DOI: 10.1016/j.joen.2011.02.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 01/27/2011] [Accepted: 02/03/2011] [Indexed: 10/18/2022]
|
18
|
Rethman MP, Harrel SK. Minimally Invasive Periodontal Therapy: Will Periodontal Therapy Remain a Technologic Laggard? J Periodontol 2010; 81:1390-5. [DOI: 10.1902/jop.2010.100150] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
19
|
|
20
|
Harrel SK, Wilson TG, Nunn ME. Prospective Assessment of the Use of Enamel Matrix Derivative With Minimally Invasive Surgery: 6-Year Results. J Periodontol 2010; 81:435-41. [DOI: 10.1902/jop.2009.090393] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
21
|
Tai TF, Chiang CP, Lin CP, Lin CC, Jeng JH. Persistent endodontic lesion due to complex cementodentinal tears in a maxillary central incisor—a case report. ACTA ACUST UNITED AC 2007; 103:e55-60. [PMID: 17449287 DOI: 10.1016/j.tripleo.2006.12.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Revised: 12/03/2006] [Accepted: 12/14/2006] [Indexed: 11/15/2022]
Abstract
The cementodentinal tear is rarely detected by noninvasive procedures owing to its clinical picture simulating a root fracture or a periodontal or endodontic lesion. We present a case of complex cementodentinal tears in a 79-year-old woman who presented a repeated swelling at the labial mucosa of the left maxillary central incisor for 6 months. Periapical radiographs demonstrated a vertical radiolucent fracture line extending from the root apex along the mesial aspect of the root to near the middle portion of the root of the left maxillary central incisor. Because endodontic re-treatment failed to cure the disease, periapical surgery was performed, and 2 fractured U-shaped root fragments around the apical root surface were removed. Histologic examination showed that the 2 fractured root fragments were composed mainly of the dentin covered by a thin layer of the cementum and overlying periodontal ligament tissue, suggesting cementodentinal tears. A swelling recurred 8 months after the initial operation. Therefore, a second periapical surgery was performed. Although no obvious fracture line was observed around the root surface, the second surgery did not cure the disease, either. A persistent small swelling was noted at the alveolar mucosa of the affected tooth during the follow-up. We conclude that although a cementodentinal tear can be detected by a careful radiographic examination, its clinical outcome is not predictable by surgical removal only.
Collapse
Affiliation(s)
- Tseng-Fang Tai
- Department of Endodontics, National Taiwan University Hospital and School of Dentistry, College of Medicine, Taipei, Taiwan
| | | | | | | | | |
Collapse
|
22
|
Tulkki MJ, Baisden MK, McClanahan SB. Cemental Tear: A Case Report of a Rare Root Fracture. J Endod 2006; 32:1005-7. [PMID: 16982284 DOI: 10.1016/j.joen.2006.02.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Revised: 02/26/2006] [Accepted: 02/27/2006] [Indexed: 10/24/2022]
Abstract
A 79-yr-old female presented to the clinic for endodontic evaluation of an unresolved periodontal defect. The patient's dental history included extraction of tooth #30 with subsequent placement of two dental implants. The patient presented with a localized periodontal defect on the distal of tooth #29. Radiographic evaluation revealed a thin radiopacity and associated radiolucency along the entire lateral aspect of tooth #29. Periodontal surgery and biopsy resulted in a diagnosis of cemental tear. Cemental tears have been rarely reported in the endodontic literature. Case reports of cemental tears have been associated with age, trauma, and traumatic occlusion. With the increasing age of the dental population and longer retention of teeth, clinicians should be aware of this rare entity.
Collapse
Affiliation(s)
- Michael J Tulkki
- University of Minnesota, Division of Endodontics, Minneapolis, Minnesota 55455, USA
| | | | | |
Collapse
|
23
|
Abstract
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.
Collapse
Affiliation(s)
- M L Stewart
- Endodontics Department, Naval Postgraduate Dental School, National Naval Medical Center, Bethesda, MD, USA
| | | |
Collapse
|
24
|
Harrel SK, Wilson TG, Nunn ME. Prospective Assessment of the Use of Enamel Matrix Proteins With Minimally Invasive Surgery. J Periodontol 2005; 76:380-4. [PMID: 15857071 DOI: 10.1902/jop.2005.76.3.380] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Minimally invasive surgery (MIS) is a surgical technique using very small incisions, indicated for performing regenerative therapy in periodontal defects. Enamel matrix proteins (EMP) have been shown to enhance periodontal regeneration. This study was undertaken to determine the effect of using EMP in combination with an MIS approach. METHODS Patients from two private periodontal practices with chronic periodontitis who, following non-surgical therapy, had one or more sites with probing depths (PD) of > or =6 mm were included in the study. An MIS approach was utilized for surgical access. Following surgical debridement, EMP was placed into the bony defect. The surgical sites were reevaluated after at least 11 months. RESULTS Surgical treatment was performed at 160 sites in 16 patients. No significant differences were noted in the results between the two offices and the data were combined. Mean PD reduction (P = 0.002) and attachment level improvements (P = 0.012) were significantly greater than 3 mm with mean post-surgical PD of 3.17 mm and attachment levels of 4.05 mm, based on subject means. Mean change in recession following surgery was negligible (0.01 mm). All sites were considered to be clinically successful. CONCLUSION The combination of MIS and EMP yields significant reductions in probing depths and improvements in attachment levels while producing little or no increase in recession.
Collapse
Affiliation(s)
- Stephen K Harrel
- Private practice and Baylor College of Dentistry, Dallas, TX 75229, USA.
| | | | | |
Collapse
|
25
|
Chou J, Rawal YB, O'Neil JR, Tatakis DN. Cementodentinal Tear: A Case Report With 7-Year Follow-Up. J Periodontol 2004; 75:1708-13. [PMID: 15732875 DOI: 10.1902/jop.2004.75.12.1708] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
Collapse
Affiliation(s)
- James Chou
- Section of Periodontology, College of Dentistry, The Ohio State University Health Sciences Center, Columbus, OH 43218-2357, USA
| | | | | | | |
Collapse
|