Association Between Suspected Cemental Tears and Periodontal Breakdown: A Large Retrospective Study on Periapical Radiographs

Aim To determine the radiographic detection rate of suspected cemental tear on periapical radiographs and to evaluate its association with localised radiographic periodontal breakdown and initial diagnostic pathways. Materials and Methods We retrospectively screened 370,061 periapical radiographs from 203,286 patients (2022–2024) for features suggestive of cemental tear. Three calibrated examiners independently assessed the radiographs and linked their findings to clinical records. Relative radiographic bone loss (rRBL%) was measured at suspected sites and compared with within‐patient reference sites. Results Cemental tear was radiographically suspected in 1573 teeth (tooth‐level detection rate, 0.43%) from 1509 patients (patient‐level detection rate, 0.74%). The detection rate increased with age (OR 1.46 per decade; p < 0.001). The suspected sites showed greater localised radiographic periodontal breakdown than the reference sites ( p < 0.001), and age and sex remained associated with ΔrRBL% after adjustment. Cemental tear was documented as the initial diagnosis in 17 of 1466 tooth‐level records (1.16%). Most of the reviewed records initially documented periodontal or endodontic diagnoses. Conclusions Radiographically suspected cemental tear is associated with greater localised radiographic periodontal breakdown, whereas an initial diagnosis of cemental tear was infrequently documented. Combined clinical‐radiographic evaluation and prospective validation are warranted.