ENDODONTIC TREATMENT IN PRIMARY MOLARS WITH TAURODONTISM

- A CASE REPORT

* Venugopal Reddy. N, ** Arun Prasad Rao. V, *** Krishna Kumar. R,**** Mohan. G. ***** Sarasakavitha D.

* Professor and HOD** Professor*** Professor**** ReaderDepartment of Pedodonties & Preventive Dentistry, Rajah Muthiah Dental College & Hospital, AnnamalaiUniversity, Annamalai Nagar, Chidambaram-608 002, INDIA***** Senior Leeturer : Karpaga Vinayaga Institute of Dental Seienees, Chengalpet, India

ABSTRACTDental morphologicai traits are of particular importance in the study of phylogenetic relationships and

population affinities. One of the most important abnormalities in tooth morphology is Taurodontism.Taurodontism can be defined as a change in tooth shape caused by the failure of Hertwig's epithelial sheathdiaphragm to invaginate at the proper horizontal level. An enlarged pulp chamber, apical displacement of thepulpal floor, and no constriction at the level of the cementoenamel junction are the characteristic features.Although permanent molar teeth are most commonly afteeted, this change is very rarely seen in primarydentition. Taurodontism has a very low incidence in primary dentition and very few cases have been reported inthe literature. Endodontic treatment of a taurodont tooth is challenging, because it requires special care inhandiing and identifying the canal obliteration and configuration and the potential for additional root canalsystems. This paper highlights a case report of taurodontism in primary molars of a five year old male child withendodontic treatment.

KEY WORDS: Primary Molars, Taurodontism, Pulpeetomy.

INTRODUCTIONUnusually shaped teeth having a eyiindrieal

or prismatie form were deseribed in remnants ofprehistorie hominids in 1903 by De Terra, in 1907by Gorjanovie Kramberger and Adioft, and inmodern man in 1909 by Piekerill, who used the term"radieular dentinoma" to deseribe the eondition.These observers noted that this tooth form wasdifferent from that usually seen in modern humandentitions, but no attempt was made by any of theseauthors to name these peeuliar teeth.^

Keith defined taurodontism as "a tendeneyfor the body of the tooth to enlarge at the expenseof the roots. It is a tendeney to assume theeondition seen in the ox." The origin of the term isfrom the Greek word tauros, whieh means "bull",and odontos, whieh refers to "tooth".^ In 1913, SirArthur Keith eoined the term "Taurodontism" todeseribe this unusual tooth form.^

In 1928, Shaw elassified the types oftaurodontism as hypotaurodontism

mesotaurodontism, and hypertaurodontism andineluded a pyramidal form of root eanal as well.These classifications were based on the relativeamount of apieal displaeement of the pulp ehamberfloor.1,3. 4. 5

Taurodontism may be unilateral or bilateraland afteets permanent teeth more frequently thanprimary teeth. The prevalenee rate of taurodontismin the general population is low and is reported tovary with ethnieity. It is eommonly observed amongthe Eskimos and Natives of Australia and CentralAmeriea.^ The prevalenee of taurodontism reportedin modern-day populations have varied from 0.54%in the primary dentitions of Japanese ehildren to ashigh as 5.6% in the permanent dentitions of Israeliadults.®

Theories eoneerning the pathogenesis oftaurodontie tooth formation inelude, an unusualdevelopmental pattern, a delay in the ealeifieation ofthe pulp ehamber floor, an odontoblastic deficiency.

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an alteration in Hertwig's epithelial root sheath, withan apparent failure of the epithelial diaphragm toinvaginate at the normal horizontal level and "adelayed or incomplete union of the horizontal flapsof the epithelial diaphragm" 1,7,

Taurodontism appears most frequently asan isolated anomaly, but it has also been found tooccur along with several well known syndromes dueto alterations of sex chromosomes, such asKlinefelter's syndrome, Trisomy 21 or Down'ssyndrome, Wolf-Hirschorn syndrome and Tricho-dento-osseous syndrome.4,5

Following is a case report of taurodontisminvolving four primary molars.

CASE REPORTA five year old male child reported with a

chief complaint of painful decayed teeth in the upperand lower jaws. He complained of recurrent,spontaneous pain in multiple primary molars for aperiod of 15 days.

His medical history was not contributory.General examination and intra oral soft tissueexamination revealed no adverse defect. Intra oralhard tissue examination revealed the presence offollowing teeth.

55 54 53 52 51 61 62 63 64 6585 84 83 82 81 71 72 73 74 75

On clinieal examination there was deepearies in relation to lower left first and seeondprimary molars, lower right first primary molar andupper left seeond primary molar. Intra oralperiapieal radiographs of these teeth revealedearies involving the pulp and also an abnormality intooth anatomy (Figure. 1, 2 and 3 respeetively).

The radiographie findings were• Unusually long pulp ehamber whieh had no

eonstrietion at the cemento-enamel junction.• No distinct roots were found but large canal

openings, ending at the apex were observed.From these radiographie findings, the tooth

was diagnosed to be a taurodont. The teeth weresubjected for clinical tests and a diagnosis ofchronic irreversible pulpitis was made in relation tolower left first and second primary molars, lowerright first primary molar and upper left second

primary molar. Multi-visit pulpectomy procedureswere performed followed by semi permanentrestorations with stainless steel crowns.

DISCUSSIONTaurodontism is a condition in which the

tooth trunk is elongated and the floor of the pulpchamber is displaced apically with proportionatelyshortened roots. The term is meant to reflect thedose similarity between human teeth and those ofungulates, particularly bulls.

Widdowson defined taurodontism as thevertical deepening of the pulp cavity at the expenseof the roots. Aitchisoa described taurodontism ashuman molars with large pulp chambers extendingto the roots. Moorress described them as pulpchamber of greater height extending rootwisebeyond the level of the cemento enamel junctionand lacking a noticeable constriction at this level.Feichtinger and Rossiwal considered that to definetaurodontism the distance from the furcation to theamelocementum joint should be greater thancervico occlusal distance.^

In 1978, Shifman and Chanannel proposedthe following criteria for determining the presence orabsence of taurodontism; Taurodontism waspresent if the distance from the lowest point at theOcclusal end of the pulp chamber (A) to the highestpoint at the apical end of the chamber (B) divided bythe distance form A to the apex was 0.2 or greaterand if the distance for B to the cementoenameljunction (CEJ) was greater than 2.5mm. 3,9

Based on Shifman and Chanannel criteria,we found that all the molars were taurodonts. Lowerleft second primary molar had an index value of 0.4,lower left first primary molar had an index value of0.5, lower right first primary molar had an indexvalue of 0.37 and upper left second primary molarhad an index value of 0.2.

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C4^iJÍ/lr^JtA <^

Fig.1 - lOPA radiographs showing taurodontism oflower left first and second primary molars, pre and

post pulpectomy.

Fig.3 - lOPA radiographs showing taurodontism ofupper left second primary molar, pre and post

pulpectomy

Fig.2- lOPA radiographs showing taurodontism oflower right first primary molar, pre and post

pulpectomy.Figure.4- Orthopantomograph showing post

treatment taurodonts.

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Taurodontism is an anomaly of multi-rootedteeth, sometimes bilateral and multiple,characterized by enlargement of the apical portionof the pulp chamber. In this patient the four primarymolars exhibited taurodontism. It can occur as anisolated case or as a eomponent of specificsyndromes. In this patient, there were no systemicdiseases or syndromes. Most reports reveal thatpermanent teeth are more frequently aftected thanprimary teeth. Permanent molars and premolarscould not be evaluated with OPG (figure 4) as theywere in their developmental stage. Mandibularmolars were found to be aftected more often thanmaxillary molars. We found taurodontism aftectingboth the maxillary and mandibular molars with morenumber of involved teeth in the mandible.

Under local anesthesia and rubber damisolation, access opening was done with round bur.Precurved K-file was used for canal exploration.The working lengths were determined byradiographie interpretation with K files. Canalpreparation and enlargement was done along withcopious irrigation of sodium hypoehlorite and normalsaline solutions. Increased hemorrhage duringaccess opening may be mistaken for pertoration.Sinee the roots are short and pulpal floor is placedapically, care should be taken to preventperforation. Obturation was done with zinc oxideeugenol paste. Stainless steel crowns were placedfollowing endodontic treatment.

CONCLUSION

Pulp therapy for taurodonts is a challengingtask. As taurodont shows wide variation in the sizeand shape of the pulp chamber with varyingdegrees of obliteration and canal configuration,more care should be taken during root canaltherapy. More emphasis should be given on itsoccurrence in both dentitions of the same patient, itsoccurrence in families, and its association with otherabnormalities. Importance should be given forcareful diagnosis and treatment modalities.

REFERENCES

1. Mark T. Jaspers and Cart J. Witkop, JR.:"Taurodontism, an Isolated Trait Associatedwith Syndromes and X-Chromosomal

Aneuploidy". Am J Hum Genet 32: 396-413,1980.

2. Ashwin R., Arathi. R.: "Taurodontism ofDeciduous and Permanent Molars; Report ofTwo Cases". J Indian Soc Pedod Prev Dent24:42^4, March 2006.

3. Axel Ruprecht, Samir Batnijik, Emad El-Neweihi.: "The Incidence of Taurodontism inDental Patients". Oral Surg., Oral Medi., OralPathol 63: 743-747, 1987.

4. Darwazeh .AM.G, Hamasha.AA.H andPillai.K.: "Prevalence of Taurodontism inJordanian Dental Patients". DentomaxiltofacialRadiology 27: 163-165, 1998.

5. Gary. S., Schulman, Deborah Redford-Badwal, Andrew Poole, Gregory Matheiu,Joseph Burteson, Deborah Däuser:"Taurodontism and Learning Disabilities inpatients with Klinefelter Syndrome". PediatrDent 27: 389-394, 2005.

6. Sood, P.B., Sood, M. "Taurodontism andPyramidal Molars". Journal Indian Soc. Pedo.Prev. Dent W. 25-27, 1992.

7. Jafarzadeh. H., Azarpazhooh. A and MayhallJ.T. "Taurodontism: a review of the conditionand endodontic treatment challenges".International Endodontic Journal, 41, 375-388,2008.

8. Prakash. R, Chenduran Vishnu, Ballal Suma,Velmurugan. N, Kandaswamy. D.: "EndodonticManagement of Taurodontic Teeth". Indian JDeniRes16:177-181, 2005.

9. Bhat. S.S., Sargod.S, Mohammed S.V.,"Taurodontism in deciduous molars - A Casereport". Journal of Indian Soc Pedo Prev Dent:22:193-196,2004.

Corresponding Author:Dr. N. Venugopal Reddy, MDS,

Professor & H.O.D.Department of Pedodontics & Preventive Dentistry,

Rajah Muthiah Dental College & Hospital,Annamalai University, Annamalai Nagar,

Chidambaram-608 002, INDIAFax: 04144-238080

Email ID: drnvenugopalreddy@gmail.com

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