Multidisciplinary management of an endo-perio lesion complicated by a cemental tear: a case report

Endodontic-periodontal lesions (EPLs) complicated by cemental tears present a diagnostic and therapeutic challenge. This case report describes the successful management of a 66-year-old male patient with a mandibular second molar (#18) exhibiting an EPL complicated by a cemental tear. Clinical examination revealed a draining sinus tract, deep periodontal pockets, and radiographic evidence of a "J-shaped" lesion and a radiopaque cemental fragment. The tooth had previously initiated endodontic treatment. A multidisciplinary approach involving endodontic treatment and surgical removal of the cemental tear was implemented. At 24-month follow-up, clinical and radiographic examination revealed significant improvement in periodontal health, bone regeneration, and resolution of the lesion. This case highlights the importance of considering cemental tears in the differential diagnosis of EPLs and demonstrates the efficacy of a combined endodontic-periodontal approach for achieving predictable outcomes.