Diagnostic Complexity of Cemental Tear: An Integrative Review
Yara de Souza Holanda
Federal University of Ceará, Sobral Campus, Conselheiro José Júlio Street, S/N, Center, Sobral, Ceará, Brazil.
Edileuda Oliveira dos Santos
Federal University of Ceará, Sobral Campus, Conselheiro José Júlio Street, S/N, Center, Sobral, Ceará, Brazil.
Marcelo Bonifácio da Silva Sampieri
Federal University of Ceará, Sobral Campus, Conselheiro José Júlio Street, S/N, Center, Sobral, Ceará, Brazil.
Bruno Carvalho de Vasconcelos
Federal University of Ceará, Sobral Campus, Conselheiro José Júlio Street, S/N, Center, Sobral, Ceará, Brazil.
Virgínia Régia Souza da Silveira Nunes
Federal University of Ceará, Sobral Campus, Conselheiro José Júlio Street, S/N, Center, Sobral, Ceará, Brazil.
Alrieta Henrique Teixeira *
Federal University of Ceará, Sobral Campus, Conselheiro José Júlio Street, S/N, Center, Sobral, Ceará, Brazil.
*Author to whom correspondence should be addressed.
Abstract
Background: Careful evaluation of intraoral radiographs is essential to minimize the risk of misdiagnosis and unnecessary treatment. However, two-dimensional radiographic images, among other well-known limitations, allow the detection of cementum delamination only in the proximal portion of the root.
Aims: This study aimed to understand the main clinical and imaging challenges in the diagnosis of cemental tears through an integrative review.
Methodology: The databases consulted were PubMed, Web of Science, Scopus, and LILACS, combining the English descriptors "Cemental tear," "Cemental delamination," and "Diagnosis," and using the Boolean operators "OR" and "AND." A 10-year filter (2015 to 2025) was established, and the availability of full articles in English was considered, resulting in 22 articles.
Results: Of the studies evaluated, 77.3% used periapical radiography for the detection of cemental delamination. The main clinical and imaging signs and symptoms were periodontal and periapical bone loss, mobility of varying degrees, high probing depth, pain and discomfort, presence of fistulous tracts, and tissue edema. The proposed treatments included scaling and root planing with or without antibiotics, endodontic treatment, and surgical periodontal therapy for the removal of cementum fragments. Tooth extraction was indicated in cases of progression of bone resorption. Histologically, circumferential fibrous connective tissue was observed, with infiltration of inflammatory cells around a deep periodontal pocket.
Conclusion: It is concluded that cementum delamination presents itself as a condition that is difficult to diagnose, frequently confused with severe periodontal diseases or endodontic lesions. Recognizing this condition as a differential diagnosis is fundamental to avoid inappropriate management that worsens the prognosis and results in tooth loss.
Keywords: Cemental tear, cemental delamination, diagnosis, radiology.