Treatment of severe localized periodontal destruction associated with a cemental tear: a case report and review of the literature.

Cemental tears have been described as a fragment of cementum becoming detached from the root surface, which can lead to severe periodontal breakdown. A 50-year-old woman with no history of periodontal attachment loss had an asymptomatic, isolated deep pocket on the mesial aspect of tooth No. 14. The radiographic examination revealed a thin, chip-like radiopacity along the lateral aspect of tooth No. 14. Periodontal flap surgery revealed a cemental tear on the apical part of the tooth. The root fragment was removed and the intrabony lesion was treated with enamel matrix derivative. A clinical examination one year after surgery demonstrated resolution of the pocket. Radiographic examination revealed an apparent bone fill at the bottom and the mesial wall of the original defect. This case illustrates that severe attachment loss associated with a cemental tear can be treated successfully by removing the cemental fragment and applying enamel matrix derivative.