Skip to content
Join Now For Patients

Cemental Tears and Clinical Discipline: Falling to Our Training in the Pursuit of Surgical Excellence – Ep. 82

March 6, 2026
Guest: Pierre Wohlgemuth, DDS

In this episode of Endo Voices, Dr. Marcus D. Johnson sits down with Dr. Pierre Wohlgemuth for a thoughtful and collegial examination of two defining challenges in contemporary endodontics: the elusive cemental tear and the disciplined art of soft tissue management in surgical care. 

Cemental tears—seldom discussed yet likely underdiagnosed—often masquerade as endodontic or periodontal pathology. With a limited but growing body of evidence, accurate identification demands clinical vigilance. Key red flags include vital teeth presenting with periapical radiolucencies and persistent disease following technically adequate root canal therapy. The discussion explores the roles of occlusal trauma, CBCT interpretation, and histologic confirmation, reinforcing the importance of expanding the differential diagnosis before defaulting to retreatment or extraction. Decisions surrounding tooth preservation versus implant placement are framed not as reflexive, but as biologically and prognostically driven. 

A central theme resonates throughout: clinicians do not rise to the level of their intentions—they fall to the level of their training.

Episode Resources

  • Harrison, J. W., & Jurosky, K. A. (1991). Wound healing in the tissues of the periodontium following periradicular surgery. I. The incisional wound. Journal of Endodontics, 17(9), 425–435. https://doi.org/10.1016/S0099-2399(07)80131-2  
  • Harrison, J. W., & Jurosky, K. A. (1991). Wound healing in the tissues of the periodontium following periradicular surgery. II. The dissectional wound. Journal of Endodontics, 17(11), 544–552. https://doi.org/10.1016/S0099-2399(06)81720-6  
  • Harrison, J. W., & Jurosky, K. A. (1992). Wound healing in the tissues of the periodontium following periradicular surgery. III. The osseous excisional wound. Journal of Endodontics, 18(2), 76–81. https://doi.org/10.1016/S0099-2399(06)81375-0  
  • Kahneman, D. (2011). Thinking, fast and slow. Farrar, Straus and Giroux.  
  • Kim, J.-S., Shin, S.-I., Herr, Y., Park, J.-B., Kwon, Y.-H., & Chung, J.-H. (2011). Tissue reactions to suture materials in the oral mucosa of beagle dogs. Journal of Periodontal & Implant Science, 41(4), 185–191. https://doi.org/10.5051/jpis.2011.41.4.185  
  • Lee, A. H. C., Neelakantan, P., Dummer, P. M. H., et al. (2021). Cemental tear: Literature review, proposed classification and recommendations for treatment. International Endodontic Journal, 54(11), 2044–2073. https://doi.org/10.1111/iej.13611  
  • Lin, H.-J., Chang, M.-C., Chang, S.-H., Wu, C.-T., Tsai, Y.-L., Huang, C.-C., Chang, S.-F., Cheng, Y.-W., Chan, C.-P., & Jeng, J.-H. (2014). Treatment outcome of the teeth with cemental tears. Journal of Endodontics, 40(9), 1315–1320. https://doi.org/10.1016/j.joen.2014.05.012  
  • Tarnow, D. P., Magner, A. W., & Fletcher, P. (1992). The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. Journal of Periodontology, 63(12), 995–996. https://doi.org/10.1902/jop.1992.63.12.995 
  • Jeng, J. H., Lin, C. P., & Chen, Y. J. (2021). Cemental tear: A literature review, proposed classification, and clinical management guidelines. International Endodontic Journal, 54(9), 1463–1476. https://doi.org/10.1111/iej.13611 


Disclaimer

Episodes of Endo Voices may include opinion, speculation and other statements not verifiable in the scientific method and do not necessarily reflect the views of AAE or the sponsor(s). Listeners should use their best judgment in evaluating the merits of any content.