Association Between Suspected Cemental Tears and Periodontal Breakdown: A Large Retrospective Study on Periapical Radiographs

AIM: To determine the radiographic detection rate of suspected cemental tear on periapical radiographs and to evaluate its association with localised radiographic periodontal breakdown and initial diagnostic pathways. MATERIALS AND METHODS: We retrospectively screened 370,061 periapical radiographs from 203,286 patients (2022-2024) for features suggestive of cemental tear. Three calibrated examiners independently assessed the radiographs and linked their findings to clinical records. Relative radiographic bone loss (rRBL%) was measured at suspected sites and compared with within-patient reference sites. RESULTS: Cemental tear was radiographically suspected in 1573 teeth (tooth-level detection rate, 0.43%) from 1509 patients (patient-level detection rate, 0.74%). The detection rate increased with age (OR 1.46 per decade; p < 0.001). The suspected sites showed greater localised radiographic periodontal breakdown than the reference sites (p < 0.001), and age and sex remained associated with ΔrRBL% after adjustment. Cemental tear was documented as the initial diagnosis in 17 of 1466 tooth-level records (1.16%). Most of the reviewed records initially documented periodontal or endodontic diagnoses. CONCLUSIONS: Radiographically suspected cemental tear is associated with greater localised radiographic periodontal breakdown, whereas an initial diagnosis of cemental tear was infrequently documented. Combined clinical-radiographic evaluation and prospective validation are warranted.