Cemental tear: a multicenter retrospective case series.

INTRODUCTION: Cemental tear (CeT) is an often-overlooked condition that may mimic endodontic and periodontal diseases, leading to misdiagnosis and inappropriate management. This multicenter study reports a series of CeT cases characterized using an integrated clinical, CBCT-based imaging, and tissue-based analytical approach. METHODS: Twenty-nine teeth from 21 patients were diagnosed with CeT based on clinical and cone-beam computed tomography (CBCT) findings. Fragment location, root third distribution, and extent of root surface and periradicular bone involvement were assessed. Extracted teeth and surgically removed fragments were subjected to micro-computed tomography (micro-CT), scanning electron microscopy (SEM), and histopathologic examination, depending on specimen availability. Demographic, clinical, and imaging variables were recorded and analyzed. RESULTS: CeT predominantly affected older adults (mean age, 66.5 years) and was most frequently observed in anterior teeth (96.6%). Cases presented with history of dental trauma (41.4%), parafunctional habits (37.9%), and occlusal interference (31%). Radiographic examination failed to identify CeT in 72.4% of cases. CBCT demonstrated fragment detachment in 28 teeth (96.6%), while one case (3.4%) was diagnosed only during surgery. CeTs most frequently involved the apical and middle thirds of the root, with fragment thickness ranging from 0.23 to 0.81 mm and surface area from 0.59 to 28.42 mm2. Histopathologic examination revealed acellular or cellular cementum associated with periodontal ligament remnants, fibrous connective tissue, chronic inflammation, and occasional cystic epithelial lining. Micro-CT demonstrated abrupt margins, crater-like defects, and microfractures, while SEM showed irregular fragment planes, exposed periodontal fibers, and biofilm-like deposits. CONCLUSIONS: CeT was commonly associated with occlusal overload, traumatic factors, and age-related structural changes. CBCT is essential for accurate diagnosis and differentiation from endodontic-periodontal lesions, although rare cases may require surgical confirmation. A clinical summary of diagnostic assessment and management considerations was developed.