Periodontal regenerative treatment for maxillary anterior cemental tears: A mid-term cohort study

Background: The aim of this cohort study was to evaluate the mid-term clinical and radiographic outcomes of periodontal regenerative treatment of maxillary anterior cemental tears associated with intrabony defects using enamel matrix derivative (EMD) in combination with deproteinized porcine bone mineral (DPBM). Methods: Forty-one patients (mean age 68.8 ± 11.0 years) were followed for a mean of 48.3 ± 17.1 months after periodontal regenerative surgery. Clinical parameters, including probing pocket depth (PPD) and clinical attachment level (CAL), and radiographic parameters, including defect width (DW) and defect depth (DD), were measured using serial periapical radiographs at baseline (T0), 6 months (T1), and last follow-up (T2). In addition, a Kaplan–Meier survival analysis was performed to assess tooth loss due to cemental tears. Results: The significant clinical and radiographic improvements observed at T1 were maintained at T2. Specifically, periodontal surgery combining EMD and DPBM resulted in significant clinical improvements in PPD (6.7–4.7 mm) and CAL (7.0–5.2 mm) as well as radiographic improvements in DW (1.93–1.52 mm) and DD (6.28–4.47 mm) from T0 to T1 (p < 0.05). With only four cases of tooth loss recorded during the follow-up period, a high tooth survival rate of 90.2% was observed. Conclusions: Within the limitations of the current study, the combination of EMD and DPBM proved effective in promoting periodontal regeneration and predicting tooth survival in patients with maxillary anterior cemental tears associated with two-wall or three-wall intrabony defects. Further rigorous and well-designed bias-controlled clinical trials are needed to confirm these findings and determine their relevance to clinical practice. Plain Language Summary: Cemental tears are a rare but serious dental issue that can lead to tooth loss, especially in older adults. They occur when a small piece of the tooth's root covering (cementum) breaks away, causing inflammation and bone loss. This study followed 41 patients who received regenerative surgical treatment using enamel matrix derivative and deproteinized porcine bone mineral to repair the damage. Over an average of 4 years, patients showed significant improvements in gum health and bone healing. Pockets around the teeth were reduced in depth, gum attachment improved, and bone defects decreased. Importantly, 90.2% of the treated teeth survived, showing the procedure's mid-term effectiveness. These findings suggest that regenerative surgery using enamel matrix derivative and deproteinized porcine bone mineral can be a successful option for treating cemental tears, but further research is needed to refine treatment strategies and confirm these results in larger patient groups.