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Luo N, Ying X, Tong Y, Chen Y. Intentional replantation for a Class 4/Stage C cemental tear: Etiology, choice and outcomes of treatment. Clin Case Rep 2024; 12:e9088. [PMID: 38933709 PMCID: PMC11199185 DOI: 10.1002/ccr3.9088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
Cemental tears, root cracks, and associated periapical-periodontal lesions may occur simultaneously in one tooth, and can be effectively managed by intentional replantation and etiological control. A durable splint, along with occlusal and periodontal monitoring, is required as healing progresses slowly and may be insufficient.
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Affiliation(s)
- Ning Luo
- Department of Periodontology, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Research Institute of StomatologyNanjing UniversityNanjingChina
- Department of Periodontology, College of StomatologyXi’an Jiaotong UniversityXi’anChina
| | - Xuan Ying
- Department of Periodontology, College of StomatologyXi’an Jiaotong UniversityXi’anChina
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of StomatologyXi’an Jiaotong UniversityXi’anChina
| | - Yuxin Tong
- Department of Periodontology, College of StomatologyXi’an Jiaotong UniversityXi’anChina
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of StomatologyXi’an Jiaotong UniversityXi’anChina
| | - Yue Chen
- Department of Periodontology, College of StomatologyXi’an Jiaotong UniversityXi’anChina
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of StomatologyXi’an Jiaotong UniversityXi’anChina
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2
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Zhao S, Yuan Z, Zhou X, Yang X. Clinical, radiographic features and prognosis of cemental tear: A retrospective study of 63 teeth. Heliyon 2024; 10:e30999. [PMID: 38826719 PMCID: PMC11141247 DOI: 10.1016/j.heliyon.2024.e30999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/01/2024] [Accepted: 05/09/2024] [Indexed: 06/04/2024] Open
Abstract
Cemental tears are often misdiagnosed due to their scarcity. In this study, we reported the second largest cohort of cemental tears thus far. By reviewing the radiographic data and medical records of 63 cemental tear teeth, we found that periapical periodontitis was the most frequent diagnosis, followed by cracked tooth/root fracture and periodontitis. Most of the cemental tear teeth that did not have root canal treatment had vital pulp. The apical third of the root was the most prominent site of cemental tears. Cemental tears occurred more frequently in the palatal root of the maxillary molars and in the mesial root of the two-root mandibular molars. Uncontrollable bone loss and tooth mobility were the two main reasons for the extraction of teeth with cemental tears. We suggest that cemental tears should be included in the differential diagnosis of periapical periodontitis, cracked tooth, vertical root fracture and periodontitis, especially for teeth with periapical radiolucency and vital pulp. We believe our study could provide more insights into cemental tears, which will aid clinicians in the early diagnosis and proper treatment of cemental tears.
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Affiliation(s)
- SuFeng Zhao
- Nanjing Stomatological Hospital, Medical School of Nanjing University, 30 Zhongyang Road, Nanjing, 210008, China
| | - ZhengDing Yuan
- Nanjing Stomatological Hospital, Medical School of Nanjing University, 30 Zhongyang Road, Nanjing, 210008, China
| | - XinYao Zhou
- Nanjing Stomatological Hospital, Medical School of Nanjing University, 30 Zhongyang Road, Nanjing, 210008, China
| | - XuDong Yang
- Nanjing Stomatological Hospital, Medical School of Nanjing University, 30 Zhongyang Road, Nanjing, 210008, China
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3
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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.
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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
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Nagahara T, Takeda K, Inoue S, Wada K, Shiba H. Successful regenerative response of a severe bone defect in a right lower central incisor affected by a cemental tear. Clin Case Rep 2022; 10:e6472. [PMCID: PMC9637247 DOI: 10.1002/ccr3.6472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Takayoshi Nagahara
- Nippon Kokan Fukuyama Hospital Hiroshima Japan
- Department of Biological Endodontics, Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | - Katsuhiro Takeda
- Department of Biological Endodontics, Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | | | | | - Hideki Shiba
- Department of Biological Endodontics, Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
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5
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Comparison Study of Diagnosis and Treatment Planning for Dental Infections between Dental Students and Practitioners. Healthcare (Basel) 2022; 10:healthcare10081393. [PMID: 35893215 PMCID: PMC9330809 DOI: 10.3390/healthcare10081393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/18/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to access the knowledge in diagnosing dental infections and the practice in treatment planning for the affected teeth among dental practitioners (DPs) and senior (final-year) students. A survey questionnaire containing two cases (Case A; periodontal abscess and Case B; periapical abscess) with four questions per case was delivered to potential participants. Fifty-nine DPs voluntarily participated in the survey. For senior students, the case study was a part of their course requirements; one of the two cases (either Case A or B) was randomly assigned to the 126 seniors. The distribution of responses was significantly different between the DP and senior groups except for the diagnosis of Case B (Fisher’s exact test; p = 0.05). Only 31% of the participants diagnosed Case A as periodontal abscess; most of them selected periodontal surgery as the first treatment option. Despite a high agreement in diagnosing Case B, the choice of treatment was significantly different; the most frequent treatment option was extraction (51%) from the DP group and root canal retreatment (57%) from the senior group. The study revealed that the diagnosis of periodontal abscess was more challenging than that of periapical abscess among dental professionals.
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Tan VL, Hardiman R, Pilbrow V, Parashos P. Dentinal microcracks and cemental tears related to chemo-mechanical root canal instrumentation: a micro-CT Cadaver Study. Aust Dent J 2021; 67:76-82. [PMID: 34762293 DOI: 10.1111/adj.12887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/03/2021] [Accepted: 11/07/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND The prevalence of radicular defects after root canal instrumentation is unresolved. This study used micro-CT to assess the relationship between the formation of radicular defects and chemo-mechanical instrumentation in a cadaver model. METHODS Maxillary and mandibular molars (n = 24) were sectioned from cadaver specimens as a tissue block containing the teeth, alveolar bone and attached mucogingival tissues. After a baseline micro-CT scan (13.45 μm), the specimens were distributed into 3 groups (n = 8 molars): Reciproc® , ProTaper Next™ and Mtwo® . Micro-CT scans of each specimen were obtained after access, glide path and preparation with each instrument. The pre-operative and final post-operative micro-CT cross-sectional images of the roots were screened by two blinded examiners to identify any pre-existing and new radicular defects. Pre-existing and new radicular defects were examined histologically. RESULTS Overall, 16 pre-existing radicular defects were identified in 12 of the 24 molars (50%). Most of these were cemental tears (87.5%), and not true dentinal microcracks. New dentinal microcracks were observed in the post-operative micro-CT scans of only 3 canals (3.9%; 3/77). However, only one of these defects was found to be present histologically. CONCLUSIONS Within the limitations of the study, chemo-mechanical instrumentation did not routinely promote the formation of radicular defects.
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Affiliation(s)
- V L Tan
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - R Hardiman
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - V Pilbrow
- The Australian Institute of Archaeology, Department of Archaeology and History, La Trobe University, Bundoora, Victoria, Australia
| | - P Parashos
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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Zengin AZ, Sumer AP, Ozturk G, Noujeim M. Imaging characteristics of enamel pearls on CBCT and their co-relation with supernumerary tooth. Oral Radiol 2021; 38:370-377. [PMID: 34609699 DOI: 10.1007/s11282-021-00567-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 09/08/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Enamel pearl (EP) is an ectopic growth of enamel that is generally round and white and it firmly adheres to the external root surface of tooth. The aim of this study was to assess the prevalence and imaging features of enamel pearls (EPs) and to investigate the potential relationship between EP and supernumerary tooth. METHODS Cone beam computed tomography (CBCT) images of 1003 patients were evaluated for the presence of EP. Descriptive characteristics of gender and age of patients and imaging features of EPs and presence of supernumerary tooth were recorded. RESULTS In this study, 72 EPs were radiographically detected in 63 molars in 43 patients, with a person prevalence of 4.29% and tooth prevalence of 0.71%. Most of the EPs (95.83%) were detected in maxillary molars especially in third (n = 42, 58.33%) and second molars (n = 18, 25%). They were more frequently located at mesial (n: = 21; 29.16%); distal (n = 16; 22.22%) proximal surface of roots and the furcation between the disto-buccal and the palatal roots (n = 12; 16.67%) respectively. CBCT images of 109 (10.87%) patients showed supernumerary tooth/teeth and 13 of these also presented EP. A statistical significant relationship between supernumerary tooth and EP was found (p = 0.001). Additionally, CBCT images of four EPs showed corticated hypodens tracts similar to gubernaculum dentis (GD). CONCLUSIONS Clinicians and radiologists should be aware that EPs are most frequently observed in maxilla especially in third and second molars. Presence of supernumerary tooth might be associated with higher presence of EPs.
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Affiliation(s)
- Ayse Zeynep Zengin
- Oral and Maxillofacial Radiology, Faculty of Dentistry, University of Ondokuzmayis, Atakum, 55139, Samsun, Turkey.
| | - Ayse Pinar Sumer
- Oral and Maxillofacial Radiology, Faculty of Dentistry, University of Ondokuzmayis, Atakum, 55139, Samsun, Turkey
| | - Gunay Ozturk
- Oral and Maxillofacial Radiology, Faculty of Dentistry, University of Ondokuzmayis, Atakum, 55139, Samsun, Turkey
| | - Marcel Noujeim
- Advanced Imaging Diagnostics, Private Practice, San Antonio, USA
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8
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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.
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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
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Pedercini A, Weitz DF, Heyse JD, Pedercini C, Kormas I, Koutlas IG, Johnson DK, McClanahan SB. Cemental tear: An overlooked finding associated with rapid periodontal destruction. A case series. Aust Dent J 2021; 66 Suppl 1:S82-S87. [PMID: 33864270 DOI: 10.1111/adj.12844] [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: 03/23/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
Cemental tear is defined as cementum fragment completely or partially detached from the root surface, and it has been associated with localized rapid periodontal breakdown. Although history of trauma and/or attrition may be risk factors, the etiopathology of cemental tear remains unknown. This case series aims to discuss the clinical, radiographic and histopathologic features of cemental tears to aid clinicians in making differential diagnosis. Three teeth from three patients presenting a periradicular lesion underwent an exploratory surgery to determine the cause and provide treatment. Soft and hard tissue biopsies were obtained from each lesion and forwarded for histopathologic evaluation. Two patients received a guided tissue regeneration (GTR) procedure, which allowed the tooth to be retained. One patient received an extraction with simultaneous guided bone regeneration (GBR) due to a hopeless prognosis of the tooth. The results after histopathologic evaluation yielded a final diagnosis of cemental tear for all three patients. Cemental tears may be overlooked, and therefore, they should be included in the differential diagnosis of periapical periodontitis, endodontic-periodontal lesion and vertical root fracture (VRF).
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Affiliation(s)
- A Pedercini
- Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - D F Weitz
- Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - J D Heyse
- Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - C Pedercini
- School of Oral Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - I Kormas
- Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - I G Koutlas
- Oral Pathology Laboratories, Department of Diagnostic and Biological Sciences, Division of Oral and Maxillofacial Pathology, University of Minnesota, Minneapolis, MN, USA
| | - D K Johnson
- Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - S B McClanahan
- Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
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Cemental Tear on Maxillary Anterior Incisors: A Description of Clinical, Radiographic, and Histopathological Features of Two Clinical Cases. Eur Endod J 2020; 4:90-95. [PMID: 32161894 PMCID: PMC7006551 DOI: 10.14744/eej.2019.13007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/17/2019] [Accepted: 01/17/2019] [Indexed: 11/28/2022] Open
Abstract
In this case report, three teeth with complete or incomplete cemental tear in two patients were presented. Even though periapical radiograph could detect cemental tear in these three teeth, the cone-beam computed tomography scanning clearly revealed the pattern of the cemental tear, which was later confirmed by histopathological examination. Therefore, this case report shows the benefits of incorporating both cone-beam computed tomography and histopathological examination to diagnose cemental tear.
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11
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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]
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12
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Tunçer Nİ, Köseoğlu-Seçgin C, Arman-Özçırpıcı A. An unusual case of invasive cervical resorption after piezosurgery-assisted en masse retraction. Am J Orthod Dentofacial Orthop 2019; 156:137-147. [PMID: 31256827 DOI: 10.1016/j.ajodo.2019.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 11/30/2022]
Abstract
A 16-year-old patient sought orthodontic correction for profile improvement and labially inclined maxillary incisors. She had Class II malocclusion, protrusive maxillary and mandibular incisors, and increased overjet and overbite with an American Board of Orthodontics discrepancy index value of 25. She was treated with maxillary premolar extractions and miniscrew-supported en masse retraction assisted with piezoincisions. Extraction spaces (7.5 mm per side) were closed with maximum anchorage in 10 months. Total treatment time was 23 months. Twenty-seven months after debonding, a pink spot was noted at the buccocervial region of the left central incisor. Radiographic evaluation on cone-beam computed tomographic scans revealed a severe case of invasive cervical resorption on both central incisors, around which the piezosurgical cuts had been made. Treatment proceeded with a nonintervention approach and the affected teeth were reinforced with a lingual retainer.
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Affiliation(s)
- Nilüfer İrem Tunçer
- Department of Orthodontics, Faculty of Dentistry, Başkent University, Ankara, Turkey.
| | - Cansu Köseoğlu-Seçgin
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Başkent University, Ankara, Turkey
| | - Ayça Arman-Özçırpıcı
- Department of Orthodontics, Faculty of Dentistry, Başkent University, Ankara, Turkey
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Liao WC, Lee YL, Tsai YL, Lin HJ, Chang MC, Chang SF, Chang SH, Jeng JH. Outcome assessment of apical surgery: A study of 234 teeth. J Formos Med Assoc 2019; 118:1055-1061. [DOI: 10.1016/j.jfma.2018.10.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 10/24/2018] [Accepted: 10/26/2018] [Indexed: 11/29/2022] Open
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14
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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.
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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
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15
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Patel S, Mavridou AM, Lambrechts P, Saberi N. External cervical resorption-part 1: histopathology, distribution and presentation. Int Endod J 2018; 51:1205-1223. [PMID: 29704466 DOI: 10.1111/iej.12942] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 04/22/2018] [Indexed: 12/13/2022]
Abstract
External cervical resorption (ECR) is the loss of dental hard tissue as a result of odontoclastic action. It is a dynamic process that involves periodontal, dental and in later stages pulpal tissues. Over the last two decades, ECR has attracted increased interest; this is in part due to novel micro-CT and histopathological techniques for its assessment and also improved radiographic detection using CBCT. This literature review will cover the aetiology, potential predisposing factors, histopathology and diagnosis of ECR. Part 2 will cover the management of ECR.
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Affiliation(s)
- S Patel
- Department of Endodontology, King's College London Dental Institute, London, UK.,Specialist Practice, London, UK
| | - A M Mavridou
- Department of Oral Health Services, University of Leuven, Leuven, Belgium
| | - P Lambrechts
- Department of Oral Health Services, University of Leuven, Leuven, Belgium
| | - N Saberi
- Department of Endodontology, King's College London Dental Institute, London, UK
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16
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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.
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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.
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17
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Fazlyab M, Asgary S. Failure of Cone-Beam Computed Tomography in Detection of Fiber Post Perforation. IRANIAN ENDODONTIC JOURNAL 2017; 12:396-400. [PMID: 28808473 PMCID: PMC5527222 DOI: 10.22037/iej.v12i3.17690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Detection of iatrogenic root perforation during post-space preparation especially in labiolingual plane can be challenging due to the two-dimensional nature of conventional radiography; this can be even more challenging if the cemented post is radiolucent. Cone-beam computed tomography (CBCT) scans were shown to be a valuable diagnostic aid in diagnosis of such cases. However, in this case, the application of CBCT did not help in diagnosis of a labial fiber post perforation in a maxillary central incisor which was finally detected through exploratory surgery.
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Affiliation(s)
- Mahta Fazlyab
- Department of Endodontics, Dental Branch, Islamic Azad University, Tehran, Iran.,Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Asgary
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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18
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Martinez‐Canut P, Llobell A, Romero A. Predictors of long-term outcomes in patients undergoing periodontal maintenance. J Clin Periodontol 2017; 44:620-631. [PMID: 28419497 PMCID: PMC5519943 DOI: 10.1111/jcpe.12730] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2017] [Indexed: 01/03/2023]
Abstract
AIM This retrospective study aimed to characterize the baseline status of patients following periodontal maintenance, analysing the association between the long-term outcome of these patients, smoking, bruxism, and the main clinical and radiographic variables. MATERIAL AND METHODS A sample of 174 patients with moderate to severe periodontitis was refined into homogeneous subsamples according to smoking and bruxism and the rate of tooth loss due to periodontal disease (TLPD): 0, 1-2, and >2 teeth. The association and the distribution (χ² test) of the variables within the subsamples were analysed. RESULTS Smoking and bruxism were significantly associated with higher TLPD rates. Vertical and circumferential bone defects (p < .0001), and abfractions (p < .0001) were associated with bruxism and particularly with bruxism and TLPD >2. Furcation defects (p = .0002), fewer radio-opaque subgingival calculus (χ² p < .0001), a lower mean Gingival index (χ² p = .027), and increased mean recessions >1.5 mm (χ² p = .0026) were associated with smoking and higher TLPD rates. The mean baseline mobility, abfractions, and recessions characterized two basic types of TLPD. CONCLUSIONS Smoking, bruxism, and routine clinical and radiological parameters can be used to characterize the baseline status of patients with worse outcomes.
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Affiliation(s)
- Pedro Martinez‐Canut
- Division of PeriodonticsFacultad de Medicina y OdontologíaUniversidad de ValenciaValenciaSpain
- Private practiceValenciaSpain
| | - Andrés Llobell
- Private practiceValenciaSpain
- Division of PeriodonticsFacultad de Medicina y OdontologíaUniversidad de ValenciaValenciaSpain
| | - Antonio Romero
- Private practiceValenciaSpain
- Orofacial Pain. Tufts U. School of Dental MedicineBoston, MAUSA
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19
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Mavridou AM, Hauben E, Wevers M, Schepers E, Bergmans L, Lambrechts P. Understanding external cervical resorption patterns in endodontically treated teeth. Int Endod J 2017; 50:1116-1133. [DOI: 10.1111/iej.12744] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 01/11/2017] [Indexed: 01/30/2023]
Affiliation(s)
- A.-M. Mavridou
- Department of Oral Health Sciences; BIOMAT Research Cluster; KU Leuven & University Hospital Leuven; Leuven Belgium
- Private Practice; Endo Rotterdam; Rotterdam the Netherlands
| | - E. Hauben
- Department of Imaging and Pathology; KU Leuven & University Hospitals Leuven; Leuven Belgium
| | - M. Wevers
- Department of Materials Engineering (MTM); KU Leuven & University Hospitals Leuven; Leuven Belgium
| | - E. Schepers
- Department of Oral Health Sciences; BIOMAT Research Cluster; KU Leuven & University Hospital Leuven; Leuven Belgium
| | - L. Bergmans
- Department of Oral Health Sciences; BIOMAT Research Cluster; KU Leuven & University Hospital Leuven; Leuven Belgium
| | - P. Lambrechts
- Department of Oral Health Sciences; BIOMAT Research Cluster; KU Leuven & University Hospital Leuven; Leuven Belgium
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20
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Mavridou AM, Hauben E, Wevers M, Schepers E, Bergmans L, Lambrechts P. Understanding External Cervical Resorption in Vital Teeth. J Endod 2016; 42:1737-1751. [DOI: 10.1016/j.joen.2016.06.007] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/04/2016] [Accepted: 06/09/2016] [Indexed: 12/31/2022]
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21
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Nagata M, Nagata M, Kanie T, Shima K. Clinical and Histologic Aspects of Cervical Cemental Tear as a Risk for Periodontal Diseases. Clin Adv Periodontics 2016; 6:167-174. [PMID: 31535476 DOI: 10.1902/cap.2016.150075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 03/08/2016] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Cemental tear (CeT) has been classified as a specific type of root fracture. It can lead to rapid periodontal breakdown, and recently not many reports have focused on periodontal concerns. This case report presents macroscopy, light microscopy (LM), and scanning electron microscopy (SEM) observations of fragments of CeT. Progression of periodontal disease is discussed in terms of anatomic characteristics of the cementum. CASE PRESENTATION CeT was observed at a maxillary right central incisor of an 83-year-old male. After clinical examination and initial treatment, surgical periodontal therapy was performed in association with fragment extirpation, apicoectomy, replantation, and simultaneous regenerative treatment. Extirpated torn fragments and granulation tissue masses were subsequently examined by LM and SEM. Bacterial colonies were observed in and around peripheral crevices of cemental fragments. CONCLUSIONS Characteristics of cervical CeT are similar to common periodontitis features, such as rapid, periodic, sporadic, and site-specific advance, with occasional spiral pattern of pathologic pockets. In this case report, these features correspond to progression of bacterial pollution along the periphery of the overlapping scales of the cementum. In cases with such advanced periodontitis features, CeT should be discussed as a possible diagnosis. Optimum treatment should be more interventional, such as removal of degraded and torn cemental layers, when definite diagnosis is made by intrasurgical inspection.
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Affiliation(s)
- Mutsumi Nagata
- Private practice, Kagoshima, Japan.,Department of Biomaterial Science, Field of Oral and Maxillofacial Rehabilitation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Mizuki Nagata
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takahito Kanie
- Department of Biomaterial Science, Field of Oral and Maxillofacial Rehabilitation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kaori Shima
- Department of Oral Pathology, Field of Oncology, Graduate School of Medical and Dental Sciences, Kagoshima University
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22
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Tsai YL, Liao WC, Wang CY, Chang MC, Chang SH, Chang SF, Chang CW, Huang YD, Chan CP, Jeng JH. Horizontal root fractures in posterior teeth without dental trauma: tooth/root distribution and clinical characteristics. Int Endod J 2016; 50:830-835. [PMID: 27677655 DOI: 10.1111/iej.12704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 09/23/2016] [Indexed: 11/30/2022]
Abstract
AIM To describe the clinical characteristics and radiographic findings of horizontal root fractures (HRF) in posterior teeth without a history of dental trauma. METHODOLOGY A total 24 patients and 31 HRF cases in 28 posterior teeth were collected from 2006 to 2015. Clinical examinations and radiographic imaging were evaluated. Value of confidence intervals of the proportions was calculated for data presentation. RESULTS The number of males (54%) was similar to females (46%). The patients were predominantly between 50 and 70 years of age (75%). Most HRF cases were found in nonendodontically treated teeth (79%), without crown and bridge restorations (82%), and maxillary molars (54%). Many roots of maxillary molars had developed HRF, and the probability was nearly equal. Fractured teeth usually presented with periodontal and apical bone loss, and most patients (92%) were diagnosed with full mouth chronic periodontitis. Tooth wear was another common clinical feature amongst these patients. CONCLUSIONS HRF in posterior teeth without dental trauma occurred mainly in patients aged between 50 and 70, in nonendodontically treated teeth, teeth with attrition but without crown and bridge restorations, maxillary molars and with periodontal and periapical bony destruction. Periodontal condition, occlusal wear and patients' age at diagnosis were the possible related factors. HRF in posterior teeth without dental trauma is a diagnostic challenge and even misdiagnosed. A thorough clinical examination, radiographic analysis and recognition of the clinical characteristics are helpful in the early diagnosis and treatment of HRF.
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Affiliation(s)
- Y-L Tsai
- Graduate Institute of Clinical Dentistry, National Taiwan University Medical College, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - W-C Liao
- Graduate Institute of Clinical Dentistry, National Taiwan University Medical College, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - C-Y Wang
- Graduate Institute of Clinical Dentistry, National Taiwan University Medical College, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - M-C Chang
- Biomedical Science Team, Chang Gung University of Science and Technology, Taoyuan, Taiwan.,Department of Dentistry, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - S-H Chang
- Biostatistics Laboratory, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - S-F Chang
- Department of Dentistry, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - C-W Chang
- Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Y-D Huang
- Graduate Institute of Clinical Dentistry, National Taiwan University Medical College, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - C-P Chan
- Department of Dentistry, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - J-H Jeng
- Graduate Institute of Clinical Dentistry, National Taiwan University Medical College, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
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23
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Nagata M, Kanie T, Shima K. Cemental Tear in an Autotransplanted Tooth That Had Been Functioning for 15 Years. Clin Adv Periodontics 2016; 6:111-117. [PMID: 31535470 DOI: 10.1902/cap.2015.150047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 10/29/2015] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Cemental tears have been described as specific types of root surface fractures that are seen infrequently but can cause rapid collapse of the periodontal tissue. However, to the best of the authors' knowledge, cases of cemental tears in autotransplanted teeth and their recovery by autotransplantation have not been reported previously. This case report presents the clinical and histopathologic features of a rare case of a cemental tear that occurred on an autotransplanted tooth. This meant a total long-term treatment course of 20 years involving two separate treatment procedures. CASE PRESENTATION In 1995, the mandibular left second molar of a 40-year-old woman was extracted, and autogenous tooth transplantation was performed simultaneously using a third molar from the same side. Good clinical and radiologic progress was observed for >10 years after tooth transplantation. After discovery of a vertical bone defect in the distal area in 2006, conservative periodontal treatment was conducted on the diseased periodontal pocket over the course of several years. In 2010, autogenous tooth transplantation and a subsequent histopathologic examination of the extracted tooth were performed. After recovery treatment, a 5-year follow-up examination provided good results. CONCLUSIONS This case report concerns the suspected contributing factors of cemental tears and the recovery treatment. When cemental tears are suspected after radiographic and other clinical examinations, interventional surgical treatment should be performed immediately. When autogenous tooth transplantation is performed, following careful consideration of the advantages and disadvantages of appropriate treatment and proper selection, continuous monitoring should be a prerequisite because of the possible occurrence of cemental tear.
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Affiliation(s)
- Mutsumi Nagata
- Private practice, Kagoshima, Japan.,Department of Biomaterial Science, Field of Oral and Maxillofacial Rehabilitation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Takahito Kanie
- Department of Biomaterial Science, Field of Oral and Maxillofacial Rehabilitation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kaori Shima
- Department of Oral Pathology, Field of Oncology, Graduate School of Medical and Dental Sciences, Kagoshima University
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24
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Bhat A, Sirajuddin S, Prabhu SS, Chungkham S, Bilichodmath C. Iatrogenic Damage to the Periodontium Caused by Endodontic Treatment Procedures: An Overview. Open Dent J 2015; 9:214-6. [PMID: 26312090 PMCID: PMC4541319 DOI: 10.2174/1874210601509010214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 03/04/2015] [Accepted: 03/10/2015] [Indexed: 11/23/2022] Open
Abstract
The tooth, the pulp tissue within it and its supporting structures should be viewed as one biologic unit. The interrelationship of these structures influences each other during health, function and disease. The interrelationship between periodontal and endodontic diseases has aroused much speculation, confusion and controversy. The endodontium and periodontiumare closely related and disease or damage of one tissue may lead to the involvement of the other.
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Affiliation(s)
| | - Syed Sirajuddin
- Department of Periodontology, Rajarajeswari Dental College & Hospital, Bangalore-560074, Karnataka, India
| | - Sandeep S Prabhu
- Department of Periodontology, Rajarajeswari Dental College & Hospital, Bangalore-560074, Karnataka, India
| | - Sachidananda Chungkham
- Department of Periodontology, Rajarajeswari Dental College & Hospital, Bangalore-560074, Karnataka, India
| | - Chandrasekhar Bilichodmath
- Department of Periodontology, Rajarajeswari Dental College & Hospital, Bangalore-560074, Karnataka, India
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25
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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]
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26
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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]
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27
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Versiani MA, Cristescu RC, Saquy PC, Pécora JD, de Sousa-Neto MD. Enamel pearls in permanent dentition: case report and micro-CT evaluation. Dentomaxillofac Radiol 2013; 42:20120332. [PMID: 23520396 DOI: 10.1259/dmfr.20120332] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To investigate the frequency, position, number and morphology of enamel pearls (EPs) using micro-CT (µCT) and to report a case of an EP mimicking an endodontic-periodontic lesion. METHODS Cone beam CT (CBCT) was performed in a patient to evaluate a radio-opaque nodule observed on the left maxillary first molar during the radiographic examination. Additionally, 23 EPs were evaluated regarding frequency, position, number and morphology by means of µCT. The results were statistically compared using the Student's t-test for independent samples. RESULTS 1 pearl was presented in 13 specimens, while 5 specimens presented 2 pearls. The most frequent location of the EPs was the furcation between the disto-buccal and the palatal roots of the maxillary molars. Overall, the mean major diameter, volume and surface area were 1.98 ± 0.85 mm, 1.76 ± 1.36 mm³ and 11.40 ± 7.59 mm², respectively, with no statistical difference between maxillary second and third molars (p > 0.05). In the case report, CBCT revealed an EP between the disto-buccal and the palatal roots of the maxillary first left molar associated with advanced localized periodontitis. The tooth was referred for extraction. CONCLUSIONS EPs, located generally in the furcation area, were observed in 0.74% of the sample. The majority was an enamel-dentin pearl type and no difference was found in maxillary second and third molars regarding diameter, volume and surface area of the pearls. In this report, the EP mimicked an endodontic-periodontic lesion and was a secondary aetiological factor in the periodontal breakdown.
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Affiliation(s)
- M A Versiani
- Department of Restorative Dentistry, School of Dentistry, University of São Paulo, Ribeirão Preto, Brasil
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28
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Du J, Wang X, Zhang J, Yan S, Wang L, Yang P. The Possible Effect of an Accessory Root-Like Structure on Periodontitis: A Clinical and Histologic Case Report. Clin Adv Periodontics 2013. [DOI: 10.1902/cap.2012.110105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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29
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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.
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Affiliation(s)
- Patrick R Schmidlin
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Switzerland
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30
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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]
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31
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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.
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Affiliation(s)
- Chie Watanabe
- Watanabe Dental Clinic, 1870-6 Kusabuka Numakuma Town, Fukuyama City, Hiroshima Prefecture, Japan.
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