|Year : 2011 | Volume
| Issue : 2 | Page : 71-73
Management of Hypertaurodontism: An Endodontic Challenge
Saritha Vallabhaneni1, Ganesh R More1, Radhakrishna Gogineni2
1 Department of Conservative Dentistry and Endodontics, P. M. Nadagouda Memorial Dental College, Bagalkot, Karnataka, India
2 Department of Orthodontics, P. M. Nadagouda Memorial Dental College, Bagalkot, Karnataka, India
|Date of Web Publication||21-Nov-2013|
Department of Conservative Dentistry and Endodontics, P. M. Nadagouda Memorial Dental College and Hospital, Bagalkot - 587 101, Karnataka
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Taurodontism is a morpho-anatomical developmental anomaly rarely seen in teeth and usually found in association with other anomalies or as a part of syndrome. It is characterised by lack of constriction at the level of cementoenamel junction with elongated pulp chambers and apical displacement of bifurcation or trifurcation of roots. This gives the tooth a rectangular or cylindrical appearance. Endodontic treatment of a taurodont tooth is challenging, because it requires special care in handling and identifying the number of root canals. A case of endodontic treatment of a maxillary first molar with hypertaurodontism not associated with any syndrome is presented.
Keywords: Bull teeth, enlarged pulp chamber, Hertwig′s epithelial root sheath (HERS), hypertaurodontism, taurodontism
|How to cite this article:|
Vallabhaneni S, More GR, Gogineni R. Management of Hypertaurodontism: An Endodontic Challenge. J Int Clin Dent Res Organ 2011;3:71-3
|How to cite this URL:|
Vallabhaneni S, More GR, Gogineni R. Management of Hypertaurodontism: An Endodontic Challenge. J Int Clin Dent Res Organ [serial online] 2011 [cited 2019 Apr 18];3:71-3. Available from: http://www.jicdro.org/text.asp?2011/3/2/71/121868
| Introduction|| |
Taurodontism is a developmental anomaly in tooth morphology characterized by the lack of constriction at the level of the cementoenamel junction, vertically elongated pulp chambers and apical displacement of the pulpal floor.  The term Taurodontism is derived from the Latin-tauros, for 'bull' and the Greek term odus, for 'tooth' or 'bull tooth', first introduced by Sir Arthur Keith in 1913.  Taurodonts have pulp chambers in which the bifurcation or trifurcation is displaced apically, so the distance from the bifurcation or trifurcation of the roots to the cementoenamel junction is greater than the occlusalcervical distance, giving it a rectangular shape. 
The etiology of taurodontism is unclear. It is thought to be caused by the failure of Hertwig's epithelial sheath diaphragm to invaginate at the proper horizontal level or changes in the mitotic activity of cells of the developing teeth that can affect root formation  or influence from external factors on the development of the teeth  , resulting in a tooth with short roots, elongated body, an enlarged pulp, and normal dentin  Previously, taurodontism was related to syndromes such as Down's and Klinefelter's syndrome.  Today, it is considered as an anatomic variance that could occur in a normal population. 
The prevalence is reported to range from 2.5% to 11.3% of the population. , Taurodontism may be unilateral or bilateral with no sex predilection and affects permanent teeth more frequently than primary teeth. Mandibular molars are found to be affected more often than maxillary molars and the mandibular second molar is the most frequently involved tooth.
In the oral cavity, a taurodont appears as a normal tooth. The diagnosis of taurodontism is usually made from diagnostic radiographs. The severity of taurodontism is classified according to degree of apical displacement of the pulpal floor;  least pronounced (hypotaurodontism), moderate (mesotaurodontism), and most severe (hypertaurodontism). Shifman and Chanannel  proposed an index to calculate the degree of taurodontism as shown radiographically. According to this index, taurodontism is present if 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, divided by the distance from the occlusal end of the pulp chamber to the apex and multiplied by 100 is 20 or above (hypotaurodontism TI 20-30, mesotaurodontism TI 30-40, and hypertaurodontism TI 40-75).
Taurodontism, although not common, is an important occurrence that may influence dental management of patients. The present case describes endodontic treatment of a maxillary first molar with rare hypertaurodontism in a healthy individual with no associated syndrome or anomaly.
| Case Report|| |
A 26-year-old patient reported to the Department of Conservative Dentistry and Endodontics, P M N M Dental College, Bagalkot, with pain for one month on biting of the upper right back tooth. The tooth had an exaggerated response to heat with lingering pain. Medical and family histories were non-contributory. On intraoral examination, there was a deep mesio-proximal carious lesion in the maxillary right first molar (tooth 16) and disto-proximal carious lesion in the second premolar (tooth 15). The tooth was sensitive to percussion suggestive of symptomatic apical periodontitis. An intraoral periapical (IOPA) radiograph of maxillary right first molar (tooth 16) revealed the presence of a coronal radiolucency involving the pulp chamber and widening of the apical periodontal ligament space confirming the diagnosis of symptomatic apical periodontitis with elongated pulp chamber which divides at the apical 3 rd , indicating hypertaurodontism according to Shifman and Chanannel  [Figure 1]. Hypertaurodontism on the contralateral side was confirmed by osteoprotegerin (OPG) [Figure 2]. Root canal therapy was advised for tooth 46. The tooth was anaesthetized. Magnification loops (STAC, A product of ACTS Medical Mississauge, Canada) were used throughout the procedure to facilitate visualization. The tooth was isolated and the access cavity prepared. The tooth was instrumented to the furcation area where three canal orifices which was in the apical 3 rd were found: A wide palatal one (P), and two narrow orifices-a mesiobuccal (MB) and a distobuccal (DB). Instrumentation was carried out using a standardized technique with Ni-Ti K-files (Dentsply Maillefer, Ballaigues, Switzerland). An electronic apex locator (Root ZX; Morita, Tokyo, Japan) was used to determine the initial working length that was confirmed with radiograph [Figure 3]. The palatal canal was instrumented to #40 file and the buccal canals to a #35 file size. Sodium hypochlorite 3% (Venson, India) and 2% chlorehexidine (V-Consept, Dentocare PVT LTD, Sarkej, Ahmedabad, Gujrat, India) were used as irrigating solutions. A modified obturation technique was used because of the complexity of the inner root canal anatomy and the proximity of the buccal orifices. This consisted of combined lateral condensation of the individual canals followed by vertical compaction of the elongated pulp chamber, using the obtura II (LPS laboratories, Tucker, GA, USA). AH Plus sealer (Densply, Konstanz, Germany) was used. The final radiograph confirmed a well-condensed filling consisting of three canals obturated to the predetermined length [Figure 4]. Postobturation filling was done with amalgam, followed by crown.
| Discussion|| |
Taurodontism is frequently associated with other anomalies and syndromes.  Clinically, the taurodont crown has normal form, structure, colour, and texture and hence can only be diagnosed by radiographs. Taurodontism is predominantly found in the molars but has also been seen in premolars, mandibular canines, and incisors. , In the present case, the patient was a healthy male with no known diseases. mandibular first and second molars have shown taurodontism. In this case, all the types of taurodontism are present; hypo (all second molars), meso (lower first molar), and hyper (upper first molar), which were diagnosed radiographically and confirmed by using taurodontism index proposed by Shifman and Chanannel.  Often taurodont form does not interfere with operative procedures; however, endodontic therapy may be more difficult because of its morphology. The long rectangular shape of pulp chamber seems to cause difficulty in locating the canal orifices and subsequent difficulties in instrumentation and obturation.
The present case describes successful completion of endodontic treatment of a taurodont maxillary first molar, which seemed impossible to perform with conventional techniques. Success was mostly attributed to the use of magnification, which easily showed the location of the three canal orifices. Unfortunately, the patient was unavailable for future follow-ups. To the best of our knowledge, no long-term follow-up studies have been published regarding taurodont endodontically treated teeth.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]