Labial Bone Loss With Periapical Lesions Caused By Cemental Tear

Cemental tear can be related multiple etiologies, such as trauma, endodontic and periodontal lesions. Due to the complexity of etiology, it leads to poor prognosis for affected teeth. This case showed the treatment on labial bone loss with periapical lesions caused by cemental tear. The patient’s chief complaint was gum swelling on the right upper front tooth for 2 years. At first visit, periodontal probing depth of the tooth 11 was 6-9 mm and the tooth mobility was Ⅱ°. The tooth accepted root canal treatment and initial periodontal therapy. Considering the mobility degree, occlusal adjustment and tooth fixation were performed. However, the inflammation was not controlled completely. Then, apical surgery and periodontal regenerative surgery were performed, as labial bone loss with periapical lesions and suspected cemental tear imaging were shown in radiographic views. During the surgery, the torn part was confirmed and removed, and bone powder was implanted in the defect. The re-evaluations after surgery demonstrated significant treatment efficacy. Considering labial bone loss was adverse bone defects along with patients’ willing, we took risks for poor prognosis and preserved the tooth. Reviewing the case, the possible cause for labial bone loss was cemental tear, which could be caused by occlusal trauma. The proactive pursuit of possible causes and early diagnosis will facilitate treatment. For labial bone loss caused by cemental tear, combining periodontal regenerative surgeries with apical surgeries can achieve good osteogenic effect and preservation of affected teeth.