Histopathology, Diagnosis, Management and Treatment Outcomes of Cemental Tears: A Retrospective Observational Cohort Study

INTRODUCTION: Diagnosing cemental tears remains challenging, and treatment outcomes can be unpredictable; recommendations for their diagnosis and management are primarily based on case reports and anecdotal experience. Although a classification has been developed for cemental tears, its clinical applicability and importance have yet to be investigated and validated. AIMS AND OBJECTIVES: This study aims to deepen our understanding of cemental tears through a comprehensive examination of a patient cohort, focusing on: (i) evaluating the cases based on the classification for cemental tears; (ii) assessing clinical presentations, radiographic features, and histopathological characteristics; and (iii) identifying factors that influence diagnosis, treatment approaches, and clinical outcomes. MATERIALS AND METHODS: This retrospective cohort study evaluated teeth diagnosed with cemental tears at the university's endodontic clinic from September 2019 to June 2024. The review included case histories, clinical, radiographic and histopathological findings, as well as the treatments performed and their outcomes. Descriptive statistics were used. RESULTS: Thirty-seven patients with 45 teeth diagnosed with cemental tears were included. Majority of affected teeth (68.9%) had received previous treatment or undergone previously initiated therapy. Among those root treated, most (84.6%) exhibited adequate obturation. Pain, swelling and/or sinus tracts, as well as significant crestal bone loss, were detected in approximately half of the cases. Cone-beam computed tomography (CBCT) scans and direct inspection successfully identified all affected teeth, whereas periapical radiographs (PR) only detected 60.0%. Histopathological analysis revealed cementum in all 37 cases comprising 45 teeth, bone in 11 cases, and cystic lesions in 5 cases. Unfavourable treatment outcomes were observed in 78.9% of teeth classified as Class 4-6. Across all classes, regenerative approaches using enamel matrix derivatives (EMD) achieved favourable outcomes in 44.4% of teeth treated, xenografts in 38.1%, and collagen membranes in 55.6%. Notably, none of the teeth in Classes 4-6 treated with EMD or xenografts demonstrated favourable outcomes. CONCLUSION: CBCT scans, direct inspection, and histopathological examination demonstrated a higher detection rate compared to PR. Classification is a critical prognostic factor, with Classes 4-6 exhibiting poorer outcomes than others. The impacts of regenerative approaches on periradicular healing appear questionable.