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).