Introduction
A cemental tear, the detachment of cementum from the root surface, may cause periodontal breakdown, although its pathogenesis has not been fully elucidated (1-3). A cemental tear often mimics periapical periodontitis, vertical root fracture, or an endodontic-periodontal lesion (2, 4-8). Therefore, interpretation of the images of dental X-rays and cone-beam computed tomography (CBCT) and clinical examinations including pulp vital testing and measurement of periodontal pocket depth need to be carefully conducted to distinguish a cemental tear from the other lesions (2, 4-6, 9-12).
Our previous case involved a mandibular right central incisor affected by a perforation into a labial site and cemental tear that underwent an endodontic approach to perforation repair and periodontal treatment including periodontal regenerative therapy using recombinant human fibroblast growth factor-2 (rhFGF-2) to the labial bone defect (13). These treatments decreased pocket depth (PD), with a 5-mm gain in the clinical attachment level (CAL) and proximal bone regeneration (13). However, sufficient reconstruction of the labial bone was not observed on cone-beam computed tomography (13).
Lee et al. (2) have recently reported a new classification for cemental tears and recommendations for treatment strategies. This case report shows that removal of torn cemental fractions and granulation tissues and the application of rhFGF-2 in a mandibular right central lower incisor with a sinus tract, cemental tear, and severe localized periodontal destruction, which had been diagnosed as Class 3/Stage C based on the classification by Lee et al., led to significant clinical improvement (PD reduction, CAL gain, and bone regeneration).