Cemental Tear: Systematic Review and Thematic Analysis of Clinical and Imaging Features with a Proposed Diagnostic Framework.

Abstract

Introduction: Cemental tear (CT) is a rare condition with poorly understood prevalence, etiology, and clinical presentation, often mimicking vertical root fractures or endodontic-periodontal lesions. This review aimed to synthesize current evidence on CT and propose a diagnostic framework.

Methods: A comprehensive search was conducted in Cochrane Library, Latin American and Caribbean Health Sciences Literature, PubMed, ScienceDirect, Scopus, Web of Science, and grey literature (Google Scholar, ProQuest) for case reports (2000-2024). Inclusion required full clinical and radiographic documentation. Risk of bias was assessed using the Joanna Briggs Institute checklist. Data on epidemiological, clinical, and imaging features were extracted.

Results: Twenty studies reported 24 patients and 39 teeth. Methodological quality was heterogeneous, mostly with moderate risk of bias. CT mainly affected single-rooted teeth, especially incisors (46.1%), in older patients (mean 56.2 years). Frequent clinical findings included deep periodontal pockets (75%), mobility (60%), and fistulas (40%). Radiographically, bone loss (33.3%), radiopaque fragments (28.2%), and lateral radiolucencies (23.1%) were noted. Cone-beam computed tomography proved crucial for detecting buccal/lingual fragments. Histopathology confirmed cementum detachment, often infection-related. Treatments ranged from fragment removal to extraction, with prognosis linked to early diagnosis.

Conclusions: CT is rare and challenging, best identified with high-resolution cone-beam computed tomography and integrated clinical evaluation. Early, precise diagnosis guides prognosis, with conservative fragment removal recommended when feasible.