Treatment of an intraosseous periodontal defect associated with a "cemental tear" with the Single Flap Approach

Objectives. The cemental tear (CT) is an unfrequent root fracture characterized by the separation of a cementum fragment from the underlying root surface along the cementodentinal interface. CT can affect tooth prognosis leading to a rapid and progressive attachment loss. The aim of the present study is to illustrate the treatment of an intra-osseous periodontal defect associated with a CT with a minimally invasive surgical technique (Single Flap Approach, SFA) in combination with reconstructive devices. Materials and methods. A severe and localized periodontal attachment loss associated with bleeding and suppuration upon probing was identified at tooth 1.1. Radiographic examination revealed the presence of a CT on the mesial aspect of the root surface. A buccal SFA was performed, the CT was removed and the defect was debrided with mechanical and manual instruments. Then, the defect was filled with deproteinized bovine bone mineral and covered with a resorbable collagen membrane. Results. At 6 months following surgery, a clinical attachment gain of 10 mm and 7 mm and a probing depth reduction of 12 mm and 8 mm were observed at the mesio-buccal and buccal aspect, respectively, of 1.1. Radiographic examination confirmed the absence of the CT. Conclusions. The present case report indicates that buccal SFA in combination with a hydroxyapatite-based biomaterial and resorbable membrane may be an effective strategy for the treatment of deep intraosseous defects associated with CT.