Researchers created a standardized approach to identify cemental tears, reducing misdiagnosis and improving patient outcomes

Dentists worldwide have been battling with a silent and often overlooked dental problem known as a cemental tear. This rare condition occurs when a fragment of cementum—the hard, mineralized tissue covering a tooth’s root—detaches, acting as a persistent irritant that triggers inflammation and destruction of surrounding bone and gum tissue. Because its symptoms closely mimic those of gum disease, root fractures, or abscesses, cemental tear frequently goes undetected, leading to misdiagnosis, ineffective treatments, and often, tooth loss.

To address this pressing gap, a team of experts has developed the first standardized clinical guidelines for diagnosing and treating cemental tear. The consensus was co-led by Professor Shaohua Ge, Shandong University, China; Professor Xuedong Zhou, Sichuan University, China; and Professor Chengfei Zhang, The University of Hong Kong, China . Published online in the International Journal of Oral Science on August 22, 2025, the consensus offers practical guidance to sharpen diagnosis and improve patient care.

“Cemental tear is a hidden culprit behind many puzzling dental cases,” says Prof. Ge. “Our consensus is a call to action for clinicians to consider this diagnosis when they see isolated, rapid bone loss that doesn’t respond to conventional treatment. Often, the key to saving the tooth is finding and removing that fragment.”

While cemental tear is rare, its consequences can be devastating if overlooked. Patients may present with deep gum pockets, sinus tracts, swelling, pus discharge, or pain—symptoms that closely resemble other dental diseases. This diagnostic overlap often leads to root canal treatment or even extractions that fail to address the real problem. The consensus highlights that advanced imaging tools are essential for accurate detection. Cone-beam computed tomography (CBCT), which provides a three-dimensional view, can reveal the characteristic “flake-like” or “prickle-like” fragments that standard X-rays often miss.

The researchers also identified key risk factors. Age plays a major role: Cemental tears are most often seen in people over 60, as cementum thickens and weakens with time. Excessive biting forces (occlusal trauma), a history of gum disease, and previous dental injuries can all predispose patients to this condition. Systemic factors that impair tissue integrity may also increase susceptibility.

“Even experienced clinicians can misdiagnose these cases,” notes Prof. Zhou. “That’s why raising awareness is so important. With the right tools and knowledge, we can distinguish cemental tear from other conditions and avoid unnecessary or harmful treatments.”

Treatment guidance emphasizes one critical point: All torn cemental fragments must be removed for successful healing. If any fragments remain, disease can persist or recur. For some patients, non-surgical scaling and root planing may be sufficient, but surgical interventions are often required. These may include periodontal surgery, apical surgery, or regenerative therapies that use enamel matrix derivatives or bone grafts to restore lost bone.

Encouragingly, many affected teeth can be saved when fragments are completely removed and the site is properly debrided and regenerated as needed. “Our goal is to preserve natural teeth whenever possible,” says Prof. Zhang. “With accurate diagnosis and tailored treatment, patients who might otherwise face extraction can keep their teeth and maintain better oral health.”

Overall, this study provides the first standardized roadmap for tackling cemental tear, a condition that is rare but often misdiagnosed. By clarifying risk factors, diagnostic strategies, and treatment principles, the consensus empowers clinicians to recognize and manage this hidden threat more effectively. With greater awareness and adherence to these guidelines, patients stand a much better chance of keeping their natural teeth—and avoiding unnecessary, irreversible treatments.