Review

. 2025 Aug 22;17(1):61.

doi: 10.1038/s41368-025-00381-9.

Expert consensus on the diagnosis and treatment of cemental tear

Ye Liang^#¹, Hongrui Liu^#¹, Chengjia Xie^#¹, Yang Yu¹, Jinlong Shao¹, Chunxu Lv¹, Wenyan Kang¹, Fuhua Yan², Yaping Pan³, Faming Chen⁴, Yan Xu⁵, Zuomin Wang⁶, Yao Sun⁷, Ang Li⁸, Lili Chen⁹, Qingxian Luan¹⁰, Chuanjiang Zhao¹¹, Zhengguo Cao¹², Yi Liu¹³, Jiang Sun¹⁴, Zhongchen Song¹⁵, Lei Zhao¹⁶, Li Lin³, Peihui Ding¹⁷, Weilian Sun⁹, Jun Wang¹⁶, Jiang Lin¹⁸, Guangxun Zhu¹⁹, Qi Zhang²⁰, Lijun Luo²¹, Jiayin Deng²², Yihuai Pan²³, Jin Zhao²⁴, Aimei Song¹, Hongmei Guo¹, Jin Zhang²⁵, Pingping Cui²⁵, Song Ge²⁶, Rui Zhang²⁶, Xiuyun Ren²⁷, Shengbin Huang²⁸, Xi Wei²⁹, Lihong Qiu³⁰, Jing Deng³¹, Keqing Pan³¹, Dandan Ma³², Hongyu Zhao³³, Dong Chen³³, Liangjun Zhong^{34

35}, Gang Ding³⁶, Wu Chen⁵, Quanchen Xu³¹, Xiaoyu Sun³⁷, Lingqian Du³⁸, Ling Li³⁹, Yijia Wang¹³, Xiaoyuan Li⁴⁰, Qiang Chen⁴¹, Hui Wang⁴¹, Zheng Zhang⁴², Mengmeng Liu⁴³, Chengfei Zhang⁴⁴, Xuedong Zhou⁴⁵, Shaohua Ge⁴⁶

Affiliations

¹ Department of Periodontology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China.
² Department of Periodontology, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing, China.
³ Department of Periodontics, School and Hospital of Stomatology, China Medical University, Shenyang, China.
⁴ State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Department of Periodontology, School of Stomatology, The Fourth Military Medical University, Xi'an, China.
⁵ Department of Periodontology, The Affiliated Stomatological Hospital of Nanjing Medical University, Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China.
⁶ Department of Stomatology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
⁷ Department of Implantology, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China.
⁸ Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China.
⁹ Department of Oral Medicine, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
¹⁰ Department of Periodontology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering, Beijing, China.
¹¹ Hospital of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China.
¹² State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University; Department of Periodontology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
¹³ Laboratory of Tissue Regeneration and Immunology and Department of Periodontics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China.
¹⁴ Dalian Stomatological Hospital, Dalian, China.
¹⁵ Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China.
¹⁶ State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
¹⁷ Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China.
¹⁸ Department of Stomatology, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
¹⁹ Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
²⁰ Department of Endodontics, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China.
²¹ Department of Periodontics, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China.
²² School and Hospital of Stomatology, Tianjin Medical University, Tianjin, China.
²³ Department of Endodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, China.
²⁴ Department of Endodontics, First Affiliated Hospital of Xinjiang Medical University, and College of Stomatology of Xinjiang Medical University, Urumqi, China.
²⁵ Department of Endodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Provincial Key Laboratory of Oral Tissue Regeneration & Shandong Provincial Engineering Laboratory for Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China.
²⁶ School and Hospital of Stomatology, Zunyi Medical University, Zunyi, China.
²⁷ Shanxi Medical University School and Hospital of Stomatology, Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, China.
²⁸ Department of Prosthodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, China.
²⁹ Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.
³⁰ Department of Endodontics, School and Hospital of Stomatology, China Medical University; Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China.
³¹ Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao, China.
³² Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China.
³³ Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
³⁴ Stomatology Center, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China.
³⁵ School of Stomatology, Hangzhou Normal University, Hangzhou, China.
³⁶ School of Stomatology, Shandong Second Medical University, Weifang, China.
³⁷ Key Laboratory of Oral Diseases Research of Anhui Province, College & Hospital of Stomatology, Anhui Medical University, Hefei, China.
³⁸ The Second Hospital of Shandong University, Jinan, China.
³⁹ Department of Periodontology, Linyi People's Hospital, Shandong Second Medical University, Linyi, China.
⁴⁰ Department of Stomatology, The Fifth People's Hospital of Jinan, Jinan, China.
⁴¹ Suzhou Stomatological Hospital, Suzhou, China.
⁴² Tianjin Stomatological Hospital, School of Medicine, Nankai university, Tianjin, China.
⁴³ Department of Stomatology, Qilu Hospital of Shandong University (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China.
⁴⁴ Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China. zhangcf@hku.hk.
⁴⁵ State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China. zhouxd@scu.edu.cn.
⁴⁶ Department of Periodontology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China. shaohuage@sdu.edu.cn.

^# Contributed equally.

PMID: 40846694
PMCID: PMC12373928
DOI: 10.1038/s41368-025-00381-9

Review

Expert consensus on the diagnosis and treatment of cemental tear

Ye Liang et al. Int J Oral Sci. 2025.

. 2025 Aug 22;17(1):61.

doi: 10.1038/s41368-025-00381-9.

Authors

Affiliations

¹ Department of Periodontology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China.
² Department of Periodontology, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing, China.
³ Department of Periodontics, School and Hospital of Stomatology, China Medical University, Shenyang, China.
⁴ State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Department of Periodontology, School of Stomatology, The Fourth Military Medical University, Xi'an, China.
⁵ Department of Periodontology, The Affiliated Stomatological Hospital of Nanjing Medical University, Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China.
⁶ Department of Stomatology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
⁷ Department of Implantology, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China.
⁸ Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China.
⁹ Department of Oral Medicine, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
¹⁰ Department of Periodontology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering, Beijing, China.
¹¹ Hospital of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China.
¹² State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University; Department of Periodontology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
¹³ Laboratory of Tissue Regeneration and Immunology and Department of Periodontics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China.
¹⁴ Dalian Stomatological Hospital, Dalian, China.
¹⁵ Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China.
¹⁶ State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
¹⁷ Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China.
¹⁸ Department of Stomatology, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
¹⁹ Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
²⁰ Department of Endodontics, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China.
²¹ Department of Periodontics, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China.
²² School and Hospital of Stomatology, Tianjin Medical University, Tianjin, China.
²³ Department of Endodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, China.
²⁴ Department of Endodontics, First Affiliated Hospital of Xinjiang Medical University, and College of Stomatology of Xinjiang Medical University, Urumqi, China.
²⁵ Department of Endodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Provincial Key Laboratory of Oral Tissue Regeneration & Shandong Provincial Engineering Laboratory for Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China.
²⁶ School and Hospital of Stomatology, Zunyi Medical University, Zunyi, China.
²⁷ Shanxi Medical University School and Hospital of Stomatology, Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, China.
²⁸ Department of Prosthodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, China.
²⁹ Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.
³⁰ Department of Endodontics, School and Hospital of Stomatology, China Medical University; Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China.
³¹ Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao, China.
³² Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China.
³³ Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
³⁴ Stomatology Center, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China.
³⁵ School of Stomatology, Hangzhou Normal University, Hangzhou, China.
³⁶ School of Stomatology, Shandong Second Medical University, Weifang, China.
³⁷ Key Laboratory of Oral Diseases Research of Anhui Province, College & Hospital of Stomatology, Anhui Medical University, Hefei, China.
³⁸ The Second Hospital of Shandong University, Jinan, China.
³⁹ Department of Periodontology, Linyi People's Hospital, Shandong Second Medical University, Linyi, China.
⁴⁰ Department of Stomatology, The Fifth People's Hospital of Jinan, Jinan, China.
⁴¹ Suzhou Stomatological Hospital, Suzhou, China.
⁴² Tianjin Stomatological Hospital, School of Medicine, Nankai university, Tianjin, China.
⁴³ Department of Stomatology, Qilu Hospital of Shandong University (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China.
⁴⁴ Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China. zhangcf@hku.hk.
⁴⁵ State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China. zhouxd@scu.edu.cn.
⁴⁶ Department of Periodontology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China. shaohuage@sdu.edu.cn.

^# Contributed equally.

PMID: 40846694
PMCID: PMC12373928
DOI: 10.1038/s41368-025-00381-9

Abstract

Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture, primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography (CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.

PubMed Disclaimer

Conflict of interest statement

Competing interests: The authors declare no competing interests.

Figures

**Fig. 1**
Characteristic radiographic images of teeth with cemental tear. a Periapical radiographs of 21 and 22 presented the “prickle-like” radiopaque masses detached from the root surface (black arrows). **b–d** CBCT and periapical radiographs of tooth 41 with cemental tear. Reconstructed CBCT images of 41 in b coronal and c sagittal views, the black arrow indicating the “flake-like” radiopaque mass detached from the disto-lateral aspect of the root with periapical radiolucent lesions, and the white arrow indicating normal alveolar bone. However, periapical radiograph of 41 d after RCT presented with an irregular radiopaque mass (black arrow), which was blurry and easily overlooked, near the disto-lateral aspect at the apical third of the root and periapical radiolucent lesions

**Fig. 2**
Decision tree of treatment plans for cemental tear. (*RCT* root canal treatment, *re-RCT* root canal retreatment, the asterisk (*) denotes that neither fragments nor associated bone defects involve the alveolar crestal bone and the apex of the root)

**Fig. 3**
Schematic image of cemental tear

**Fig. 4**
Summary figure of diagnosis and treatment procedure of cemental tear

See this image and copyright information in PMC

References

1. Lin, H. J. et al. Clinical fracture site, morphologic and histopathologic characteristics of cemental tear: role in endodontic lesions. J. Endod.38, 1058–1062 (2012). - PubMed
1. Watanabe, C., Watanabe, Y., Miyauchi, M., Fujita, M. & Watanabe, Y. Multiple cemental tears. Oral. Surg. Oral. Med. Oral. Pathol. Oral. Radiol.114, 365–372 (2012). - PubMed
1. Lee, A. H. C., Neelakantan, P., Dummer, P. M. H. & Zhang, C. Cemental tear: literature review, proposed classification and recommendations for treatment. Int. Endod. J.54, 2044–2073 (2021). - PubMed
1. Jeng, P. Y. et al. Cemental tear: to know what we have neglected in dental practice. J. Formos. Med. Assoc.117, 261–267 (2018). - PubMed
1. Qari, H., Dorn, S. O., Blum, G. N. & Bouquot, J. E. The pararadicular radiolucency with vital pulp: clinicopathologic features of 21 cemental tears. Oral. Surg. Oral. Med. Oral. Pathol. Oral. Radiol.128, 680–689 (2019). - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
- Nature Publishing Group
- PubMed Central

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Expert consensus on the diagnosis and treatment of cemental tear

Affiliations

Expert consensus on the diagnosis and treatment of cemental tear

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources