|Year : 2017 | Volume
| Issue : 2 | Page : 69-71
Taurodontism in deciduous molars: A report of a rare case
Gajendra Birajee, Mamta Dali, Sneha Shrestha, Bandana Koirala
Department of Pedodontics and Preventive Dentistry, BPKIHS, Dharan, Nepal
|Date of Web Publication||9-Aug-2017|
Department of Pedodontics and Preventive Dentistry, BPKIHS, Dharan
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Taurodontism appears to have low incidence in primary dentition and very few cases are reported in the literature. An enlarged pulp chamber, apical displacement of the pulpal floor, and no constriction at the level of the cemento-enamel junction are the characteristic features. Endodontic treatment of taurodonts is often challenging and needs more time than usual treatment. This paper reports a case of four year child with taurodontic mandibular left second deciduous molars.
Keywords: Deciduous molar, endodontic treatment, taurodontism
|How to cite this article:|
Birajee G, Dali M, Shrestha S, Koirala B. Taurodontism in deciduous molars: A report of a rare case. J Interdiscip Dentistry 2017;7:69-71
| Clinical Relevance to Interdisciplinary Dentistry|| |
- Taurodontism appears to have low incidence in primary dentition and very few cases are reported in the literature
- The most important aspect of this rare dental anomaly is endodontic challenges due to increased incidence of haemorrhage during access opening which may be mistaken for perforation
- Taurodontism is frequently associated with other anomalies and syndrome but in this case, the patient was healthy and without any known diseases or a syndrome.
| Introduction|| |
The term taurodontism was first introduced by Sir Arthur Keith in 1913 and defined taurodontism as “a tendency for the body of the tooth to enlarge at the expense of the roots.”
Taurodontism has been recognized as a clinical entity for almost a century. It is a developmental disturbance of a tooth that lacks constriction at the level of the cementoenamel junction and is characterized by vertically elongated pulp chambers, apical displacement of the pulpal floor, and bifurcation or trifurcations of the roots.
The etiology of taurodontism is unclear. It is assumed to be caused by the failure of Hertwig's epithelial diaphragm to invaginate at a suitable horizontal level, resulting in a tooth with short roots, elongated body, enlarged pulp, and normal dentin.
Taurodontism can be seen unilaterally or bilaterally, in any quadrants, and in both permanent and deciduous dentition.,
Taurodontism appears most frequently as an isolated anomaly, but it has also been associated with several developmental syndromes and anomalies including amelogenesis imperfecta, Down's syndrome, ectodermal dysplasia, Klinefelter syndrome, tricho-dento-osseous syndrome, Mohr syndrome, Wolf-Hirschhorn syndrome, and Lowe syndrome.
Diagnosis is usually made by routine radiographs. The most important aspect of this rare dental anomaly is due to difficulties encountered in performing endodontic treatment.
We presented here a case of taurodontism involving maxillary and mandibular deciduous molars.
| Case Report|| |
A 4-year-old male child was brought to the Department of Pedodontics and Preventive Dentistry, BPKIHS, with the chief complaint of pain on the lower left back tooth for the last 5 days. The dental or medical history of patient was noncontributory and his developmental milestones were within normal limits.
His intraoral examination revealed normal soft tissue appearance with a deep carious lesion in the mandibular left deciduous first molar (74). The tooth was tender to vertical percussion with no observable swelling or sinus tract. Orthopantomograph (OPG) revealed that 55, 65, 74, 75, 84, 85 had enlarged pulp chambers with short roots [Figure 1], suggestive of taurodontism. 74 is considered as hypertaurodont and 55, 65, 75, 84, 85 are considered as mesotaurodont. No other anomalies were noticed on OPG. Based on clinical and radiographic findings, a diagnosis of apical periodontitis was made in relation to 74. Multivisit pulpectomy followed by placement of stainless steel crown was planned [Figure 2].
|Figure 1: Orthopantomograph revealed Taurodontism 55, 65, 74, 75, 84, 85|
Click here to view
The tooth was anesthetized and the access was opened. The pulp tissue was then extirpated which was voluminous and hyperemic in nature. To ensure complete removal, 2.5% sodium hypochlorite was initially used as an irrigant to soften the pulp, followed by further irrigation with normal saline. The pulp chamber was quite huge, and the floor of the chamber was difficult to visualize.
A working length radiograph was taken with #15 file in all the canals, and biomechanical preparation was done followed by obturation with metapex. The pulpectomy was followed by restoration of tooth with the placement of stainless steel crown.
| Discussion|| |
Taurodontism is a morpho-anatomical change in the shape of the tooth, in which the body of the tooth is enlarged and the roots are reduced in size. Taurodontism is frequentaly associated with other anomalies and syndromes. In this case, the patient was healthy and without any known diseases or a syndrome.
Although permanent mandibular molars are most commonly affected, taurodontism can be seen in both the permanent and deciduous dentition (very low), unilaterally or bilaterally, and in any combination of teeth or quadrants.
In 1928, Shaw classified this condition as hypotaurodontism, mesotaurodontism, and hypertaurodontism based on the relative displacement of the floor of the pulp chamber. This subjective, arbitrary classification led normal teeth to be misdiagnosed as taurodontism.
In 1977, Feichtinger and Rossiwall stated that the distance from the bifurcation or trifurcation of the root to the cementoenamel junction should be greater than the occlusocervical distance for a taurodontic tooth. Although there are many classification systems to determine the severity of taurodontism, Shifman and Chanannel in 1978 proposed a new classification and is the widely used system till now.
Identification of the condition can only be made by radiographic examination as the external morphology of the teeth is within normal configurations. The radiographic examination is the only way to visualize a rectangular configuration of the pulp chamber. The radiographic characteristics of taurodontic tooth are extension of the rectangular pulp chamber into the elongated body of the tooth, shortened roots and root canals, location of furcation (near the root apices), despite a normal crown size.
Endodontic treatment of taurodontic teeth presents a challenge during negotiation, instrumentation, and obturation in root canal therapy. Because of the complexity of the root canal anatomy and proximity of buccal orifices, complete filling of the root canal system in taurodontic teeth is challenging. Increase hemorrhage during access opening may be mistaken as perforation.
Because the pulp of a taurodont is usually voluminous, to ensure complete removal of the necrotic pulp, 2.5% sodium hypochlorite has been suggested initially as an irrigant to digest pulp tissue. In case of deciduous teeth, conventional obturating material such as zinc oxide eugenol in such a bulk may take longer time to resorb which may delay the natural exfoliation of the tooth.
In this case, metapex (iodoform with calcium hydroxide) was used as an obturating material because of its fast resorbable properties.
The extraction of a taurodontic tooth is usually complicated because of a dilated apical third. In contrast, it has also been hypothesized that because of its large body, little surface area of a taurodontic tooth is embedded in the alveolus, extraction is less difficult as long as the roots are not widely divergent.
For the prosthetic treatment of a taurodontic tooth, it has been recommended that postplacement be avoided for tooth reconstruction as there is less surface area of the tooth that is embedded in the alveolus; a taurodontic tooth may not have as much stability as a cynodont when used as an abutment for either prosthetic or orthodontic purpose.
| Conclusion|| |
Endodontic treatment of taurodonts is often challenging and needs more time than usual treatment. Taurodontism in primary dentition is a condition that should be taken into consideration to avoid complications such as root canal perforation and also because root canals cannot be disinfected properly during partial pulpotomy or pulpectomy.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Tyagi P, Gupta S. Bilateral taurodontism in deciduous molars: A case report. Peoples J Sci Res 2010;3:21-3.
Prakash R, Vishnu C, Suma B, Velmurugan N, Kandaswamy D. Endodontic management of taurodontic teeth. Indian J Dent Res 2005;16:177-81.
] [Full text]
Tsesis I, Shifman A, Kaufman AY. Taurodontism: An endodontic challenge. Report of a case. J Endod 2003;29:353-5.
Sert S, Bayrl G. Taurodontism in six molars: A case report. J Endod 2004;30:601-2.
Chaparro González NT, Leidenz Bermudez JS, González Molina EM, Padilla Olmedillo JR. Multiple bilateral taurodontism. A case report. J Endod 2010;36:1905-7.
Joseph M. Endodontic treatment in three taurodontic teeth associated with 48, XXXY Klinefelter syndrome: A review and case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:670-7.
Yeh SC, Hsu TY. Endodontic treatment in taurodontism with Klinefelter's syndrome: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:612-5.
Jafarzadeh H, Azarpazhooh A, Mayhall JT. Taurodontism: A review of the condition and endodontic treatment challenges. Int Endod J 2008;41:375-88.
Shaw JC. Taurodont teeth in South African races. J Anat 1928;62(Pt 4):476-98.
Feichtinger C, Rossiwall B. Taurodontism in human sex chromosome aneuploidy. Arch Oral Biol 1977;22:327-9.
Shifman A, Chanannel I. Prevalence of taurodontism found in radiographic dental examination of 1,200 young adult Israeli patients. Community Dent Oral Epidemiol 1978;6:200-3.
Terezhalmy GT, Riley CK, Moore WS. Clinical images in oral medicine and maxillofacial radiology. Taurodontism. Quintessence Int 2001;32:254-5.
Bhat SS, Sargod S, Mohammed SV. Taurodontism in deciduous molars – A case report. J Indian Soc Pedod Prev Dent 2004;22:193-6.
Durr DP, Campos CA, Ayers CS. Clinical significance of taurodontism. J Am Dent Assoc 1980;100:378-81.
[Figure 1], [Figure 2]