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Table of Contents   
CASE REPORT  
Year : 2013  |  Volume : 16  |  Issue : 5  |  Page : 477-479
Endodontic treatment of hypertaurodontism with multiple bilateral taurodontism


Department of Endodontics, Faculty of Dentistry, Inonu University, Malatya, Turkey

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Date of Submission28-Feb-2013
Date of Decision05-May-2013
Date of Acceptance05-Jul-2013
Date of Web Publication3-Sep-2013
 

   Abstract 

The term taurodontism is derived from the Latin word tauros, for "bull," and the Greek term odus, for "tooth," or "bull tooth." Taurodontism is a morpho-anatomical developmental anomaly, which is seen infrequently in teeth only. It is characterized by a deficiency in the constriction at the cement-enamel junction, with lengthened pulp chambers and apical displacement of the pulpal floor. This gives the tooth a quadrilateral or cylindrical look. This report presents a case of multiple bilateral taurodontism and the successful endodontic treatment of the tooth that had hypertaurodontism. A male patient was referred to the endodontic clinic with decayed left maxillary first molar. Hypertaurodontism was confirmed after clinical and radiographic examination. Panaromic X-rays revealed that all of the patient's molar teeth were taurodontic. Taurodontism offers challenges to the practitioner during shaping and disinfection and at the time of filling the root canals.

Keywords: Bilateral; endodontictherapy; hypertaurodontism

How to cite this article:
Simsek N, Keles A, Ocak MS. Endodontic treatment of hypertaurodontism with multiple bilateral taurodontism. J Conserv Dent 2013;16:477-9

How to cite this URL:
Simsek N, Keles A, Ocak MS. Endodontic treatment of hypertaurodontism with multiple bilateral taurodontism. J Conserv Dent [serial online] 2013 [cited 2019 Aug 25];16:477-9. Available from: http://www.jcd.org.in/text.asp?2013/16/5/477/117497

   Introduction Top


Taurodontism is a morpho-anatomical change that usually appears in the form of multi-rooted teeth. The affected teeth have proportionately shortened roots, and their pulp chambers are enlarged as a result of apical prolongation. [1] The term taurodontism was introduced by Sir Arthur Keith to describe the "bull-like" appearance of the teeth, which have high pulp chambers, with bifurcation or trifurcation displaced apically as well as short roots. He used the Latin tauro and the Greek odonto terms to describe the condition. [2] It can be seen unilaterally or bilaterally, without gender discrimination.

The etiology of taurodontism is still unknown, although it is believed to be caused by failure of the diaphragm of Hertwig's epithelial sheath to invaginate at the appropriate horizontal level, which then results in a tooth with short roots, a prolongated body, an extended pulp, but normal dentin. [2],[3]

Taurodontism can be seen either in combination with a syndrome, such as Down syndrome, ectodermal disturbance, Klinefelter syndrome, oral-facial-digital syndrome II, osteoporosis, and trichoonychodental syndrome or isolated. [4],[5] Many authors have diagnosed taurodontism subjectively, based only on the radiographs and the internal features of the teeth. Tulensalo et al., diagnosed taurodontism when the distance from the highest point of the pulp chamber floor to the cement-enamel junction was >3.5 mm. [6] In the oral cavity, a taurodont appears as a normal tooth.

In 1928, Shaw classified the types of taurodontism as hypo-, meso-, and hypertaurodontism and also included a pyramidal form of root canal. [7] Shifman and Chanannel [8] suggested an index to determine the grade of taurodontism, as it is shown radiographically. According to this index, taurodontism is present if either of the following is true: The distance from the lowest point at the occlusal end of the pulp chamber to the highest point at the apical end of the chamber (V1), divided by the distance from the occlusal end of the pulp chamber to the apex (V2), and then multiplied by 100, is ≥20 (hypotaurodontism TI 20-30, mesotaurodontism TI 30-40, and hypertaurodontism TI 40-75); or, if the distance from the highest point of the pulp chamber floor to the cemento-enamel junction is >2.5 mm. [7] This report presents the successful endodontic treatment of a hypertaurodontic maxillary left molar in a healthy patient who had multiple bilateral taurodontism, but no syndrome or anomaly.


   Case Report Top


A 31-year-old male patient applied to the endodontic clinic with decayed left maxillary first molar. Medical and family histories were non-contributory. The tooth was asymptomatic and was not sensitive to percussion or palpation. However, several times, he had experienced pain in his tooth after drinking hot liquids. Intraoral examination revealed a deep carious lesion in the maxillary left first molar (tooth 26). An intraoral periapical radiograph showed the presence of a coronal radiolucency close to the pulp chamber, confirming the diagnosis of asymptomatic irreversible pulpitis and a large pulp chamber, as well as extremely short roots, signifying hypertaurodontism. A panoramic radiograph was recommended to look for multiple taurodonts and revealed bilateral hypertaurodontism in the maxillary and mandibular molars. Root canal therapy was advised for tooth 26. The tooth was anesthetized using 2% articaine with 1:200 000 epinephrine, and the pulp chamber of tooth 26 was accessed under rubber-dam isolation. Five canals, including two mesial, two distal, and a palatal were located. Working lengths were determined with a #15 K file (Dentsply Maillefer; Ballaigues, Switzerland) and confirmed by an electronic apex locator (Root ZX; Morita, Japan). Root canals were prepared using Revo-S (Micro-Mega, Besançon, France) rotary files. An SC1 (25.06) file was used at 2/3 of the working length. SC2 (25.04) and SU (25.06) files were used at the working length. Passive ultrasonic irrigation and 2.5% sodium hypochlorite were also used between each file, and the final flush was performed with ethylenediaminetetraacetic acid (EDTA) 15%, following 2.5% sodium hypochlorite. After drying the canals, the root canals were filled with traditional lateral compaction and the elongated pulp chamber was obturated using the vertical compaction method with AH Plus (Dentsply International) and gutta-percha cones. The final radiograph confirmed a well-condensed filling of the five root canals, and the tooth was then restored with a composite resin [Figure 1].
Figure 1: (a) Panoramic film of a patient with multiple bilateral taurodontism, (b) periapical radiography before treatment, (c) determination of working lengths of five root canals, (d) obturation of root canals with lateral and vertical condensation

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   Discussion Top


Taurodontism is an anomaly that is not seen very frequently. However, it is not uncommon in the Turkish population and has been reported to appear in approximately 4.2% of the teeth among this population. No differences have been found between genders. Taurodontism can affect all molars, but is most often found in the maxillary molars. [9] However, a number of researchers have reported that the mandibular molars are those that are most affected. [10],[11] Therefore, further larger-scale studies are necessary to evaluate its prevalence in the universal population and also to compare this with other ethnic groups.

Clinically, a taurodont appears to be a normal tooth. Therefore, a diagnosis of taurodontism is usually made from radiographs. There are differences in taurodont molar teeth, such as in the width of the pulp chambers and in the canal structures. These differences make endodontic treatments more difficult. Durr et al., proposed that the morphology can affect the position of the orifices, making it more challenging to shape and fill the root canals. [5] Increased hemorrhage observed during access preparation can be mistaken for perforation. However, since the roots are short and the pulpal floor is placed apically, it is important to be careful to avoid perforation. [9] Tsesis et al., suggested that a combination of the lateral compaction technique and the warm vertical compaction technique can be used to obturate a taurodont tooth. [2] Passive ultrasonic irrigation could be an important supplement for cleaning the root canal system, since, in comparison to traditional syringe irrigation, it can remove more organic tissue, planktonic bacteria, and dentin debris from the root canal. [12] PUI is more efficient in cleaning canals than ultrasonic irrigation with simultaneous ultrasonic instrumentation. Ultrasonic files have been proved to be difficult in controlling the cutting of dentine during ultrasonic preparation, with the result that it is impossible to control the shape of the prepared root canal and apical perforations and irregular shapes were produced. [13] Therefore, after shaping the root canal, cleaning can be completed with PUI or with a final flush of syringe irrigation. [14],[15],[16] Well-shaped root canal provides better oscillation of the file and penetration of the irrigant into the apical part of the root canal system. [17],[18] Cleaning of the isthmus is more effective when PUI is used as compared with syringe irrigation. [19]

This case presents the successful conclusion of root canal treatment for a taurodont maxillary first molar, a procedure that is difficult to complete using conventional techniques. Vigorous cleaning and shaping and a good seal achieved adequate cleaning of the canals in this case; nevertheless, clinical and radiographic follow-up will be required.

As a study on taurodontism has mentioned, it is frequently associated with hereditary or genetic malformations. [20] In this case, however, the patient was a healthy male with no known diseases. This condition is, then, considered to be an anatomic difference that can occur in the normal population. [8]

This anomaly may affect more than one tooth, both unilaterally and bilaterally. [21] In this case, taurodontism was found in more than one tooth, and it was determined that it occurred both bilaterally and symmetrically.


   Conclusion Top


Although taurodontism is a rare dental anomaly, dentists should be able to diagnose it. Taurodont teeth could then be treated more carefully when the endodontic treatment is necessary.


   Acknowledgment Top


This case was presented at 18. EBDO International Scientific Congress and Exhibition, December 2012, Izmir, Turkey. The authors deny any conflict of interest.

 
   References Top

1.Constant DA, Grine FE. A review of taurodontism with new data on indigenous southern African populations. Arch Oral Biol 2001;46:1021-9.  Back to cited text no. 1
    
2.Tsesis I, Shifman A, Kaufman AY. Taurodontism: An endodontic challenge. Report of a case. J Endod 2003;29:353-5.  Back to cited text no. 2
    
3.Hamner JE, Witkop CJ, Metro PS. Taurodontism; report of a case. Oral Surg Oral Med Oral Pathol 1964;18:409-18.  Back to cited text no. 3
    
4.Cichon JC, Pack RS. Taurodontism: Review of literature and report of case. J Am Dent Assoc 1985;111:453-5.  Back to cited text no. 4
    
5.Durr DP, Campos CA, Ayers CS. Clinical significance of taurodontism. J Am Dent Assoc 1980;100:378-81.  Back to cited text no. 5
    
6.Tulensalo T, Ranta R, Kataja M. Reliability in estimating taurodontism of permanent molars from orthopantomograms. Community Dent Oral Epidemiol 1989;17:258-62.  Back to cited text no. 6
    
7.Parolia A, Khosla M, Kundabala M. Endodontic management of hypo- meso- and hypertaurodontism: Case reports. Aust Endod J 2012;38:36-41.  Back to cited text no. 7
    
8.Shifman A, Chanannel I. Prevalence of taurodontism found in radiographic dental examination of 1200 young adult Israeli patients. Community Dent Oral Epidemiol 1978;6:200-3.  Back to cited text no. 8
    
9.Topcuoglu HS, Arslan KE, Koseoglu MH, Evcil MS. The frequency of taurodontism in the Turkish population. J Clin Exp Dent 2011;3:e284-8.  Back to cited text no. 9
    
10.Sert S, Bayýrlý G. Taurodontism in six molars: A case report. J Endod 2004;30:601-2.  Back to cited text no. 10
    
11.Jafarzadeh H, Azarpazhooh A, Mayhall JT. Taurodontism: A review of the condition and endodontic treatment challenges. Int Endod J 2008;41:375-88.  Back to cited text no. 11
    
12.van der Sluis LW, Versluis M, Wu MK, Wesselink PR. Passive ultrasonic irrigation of the root canal: A review of the literature. Int Endod J 2007;40:415-26.  Back to cited text no. 12
    
13.Lumley PJ, Walmsley AD, Walton RE, Rippin JW. Effect of precurving endosonic files on the amount of debris and smear layer remaining in curved root canals. J Endod 1992;18:616-9.  Back to cited text no. 13
    
14.Lee SJ, Wu MK, Wesselink PR. The effectiveness of syringe irrigation and ultrasonics to remove debris from simulated irregularities within prepared root canal walls. Int Endod J 2004;37:672-8.  Back to cited text no. 14
    
15.Gutarts R, Nusstein J, Reader A, Beck M. In vivo debridement efficacy of ultrasonic irrigation following hand-rotary instrumentation in human mandibular molars. J Endod 2005;31:166-70.  Back to cited text no. 15
    
16.Passarinho-Neto JG, Marchesan MA, Ferreira RB, Silva RG, Silva-Sousa YT, Sousa-Neto MD. In vitro evaluation of endodontic debris removal as obtained by rotary instrumentation coupled with ultrasonic irrigation. Aust Endod J 2006;32:123-8.  Back to cited text no. 16
    
17.Krell KV, Johnson RJ, Madison S. Irrigation patterns during ultrasonic canal instrumentation. Part I. K-type files. J Endod 1988;14:65-8.  Back to cited text no. 17
    
18.Ahmad M, Pitt Ford TR, Crum LA, Walton AJ. Ultrasonic debridement of root canals: Acoustic cavitation and its relevance. J Endod 1988;14:486-93.  Back to cited text no. 18
    
19.Goodman A, Reader A, Beck M, Melfi R, Meyers W. An in vitro comparison of the efficacy of the step-back technique versus a step-back/ultrasonic technique in human mandibular molars. J Endod 1985;11:249-56.  Back to cited text no. 19
    
20.Barker BC. Taurodontism: The incidence and possible significance of the trait. Aust Dent J 1976;21:272-6.  Back to cited text no. 20
    
21.Hayashi Y. Endodontic treatment in taurodontism. J Endod 1994;20:357-8.  Back to cited text no. 21
    

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Correspondence Address:
Neslihan Simsek
Department of Endodontics, Faculty of Dentistry, Inonu University, Malatya 44280
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-0707.117497

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This article has been cited by
1 Exploring the biomechanics of taurodontism
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Journal of Anatomy. 2014; : n/a
[Pubmed] | [DOI]



 

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    Abstract
   Introduction
   Case Report
   Discussion
   Conclusion
   Acknowledgment
    References
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