Endo treatment for taurodontium

Abstract
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. Although taurodontism is a dental rarity, this unusual radicular form should merit circumspect considerations in planning and treatment. Endodontic management in taurodont teeth has been described as complex and difficult. The present paper describes the successful completion of endodontic treatment in three taurodontic teeth with appropriate use of instruments and techniques and also emphasizes the need for post endodontic rehabilitation.

Introduction

Taurodontism has been recognized as a clinical entity for almost a century. It is a dental anomaly characterised by enlargement of the pulp chamber, which may approximate of the root apex, with the body of the tooth enlarged at the expense of the roots and apically displaced furcation areas. The bifurcation or bifurcation may be only a few millimeters above the apices of the roots. It was first described by Gorjanovic – Kramberger (1908) in a 70,000 year old pre-neanderthal fossil, discovered in Kaprina, Croatia. This term taurodontism was however first stated by Sir Arthur Keith in 1913. The origin of this term is from Greek “tauros” which means “Bull” and “odontos” which means “Tooth”. Witkop defined tamodontism as follows, “taurodont teeth have pulp chambers in which the bifurcation or bifurcation is displaced apically, so that the chamber has a greater apico-occlusal height than in normal teeth and lacks a constriction at the level of the cemento-enameljunction”.

Recent literature contains reports of tamodontism as an isolated oddity a family trait with high frequency in Eskimos. Taurodontism was initially thought to be absent in modern populations, at least in the extreme forms. However there are an increasing number of reports of taurodontism in present-day man in permanent dentition, deciduous dentition or both concurrently. It seems taurodontism is a great deal more prevalent than it was previously thought Scow and Lai found that 38.4% of 66 patients with hypodontia had atleast one mandibular first permanent molar that showed taurodontism compared with only 7.5% of a control group without hypodontia Shifman and Bucher reported that in one case, eight teeth were tamodonts,of which four were molar teeth. They stated that the majority of the affected teeth occurred singly and the mandibular second molar was the tooth most frequently involved. Sert and Byrili reported one patient with six taurodont molar teeth. It is more common in molars; although it occurs occasionally in premolars and incisors. A study by Axel Ruprecht in 1987 in the Saudi Arabian population found an incidence of 11.3%.

The unusual nature of this condition is best visualized on the radiograph. No involved teeth were frequently found to be rectangular in shape, rather than tapering towards the roots. Taurodontism, although not common, is an important finding that may influence the treatment of those teeth, particularly their endodontic management This paper highlights the importance of different aspects in the endodontic management of taurodontic teeth and in their final post endodonticre habilitation.

Aetiology and pathogenesis

Theories regarding the aetiology of taurodontism have been many. It has been suggested that the anomaly represents a primitive pattern, a mutation, a specialized or retrograde character, an atavistic feature, an X-linked trait, familial or an autosomal dominant trait

Taurodontism appears most frequently as an isolated anomaly, but it has also been found to occur as apart of several well known syndromes due to alterations of sex chromosomes, such as Khnefelter’s syndrome­, Trisomy 21 or Down’s syndrome and certain diseases like hypophosphatasia.

The other less common entities, where taurodontic trait was observed and reported were Tricho-dento-osseous syndrome, Oto-dental syndrome, X­chromosome aneuploidy syndrome, XXX ­chromosome syndrome, XYY syndrome, Hereditary ectodermal dysplasia, Tricho-onchyo­dental syndrome orofacial digital It syndrome or Mohr syndrome, Amelo-onchyo-hypohidrotic syndrome, Hypohidrotic ectodermal dysplasia linked to the X-chromosome and a trait associated with systemic disturbances such as microcephalic dwarfism and certain dental anomalies such as agenesis or fusions, amelogenesis imperfecta and in dermatologic diseases.

Theories concerning the pathogenesis of taurodontic root formation are also varied: an unusual developmental pattern, a delay in the calcification of pulpal chamber, an odontoblastic deficiency, an alteration in Hertwig’s epithelial root sheath.

Classification

In 1928 Shaw classified sub-types of 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, Feichfnger and Rossiwall stated that the distance from the bifurcation or bifurcation of the root to the cemento-enamel junction should be greater than the occluso-cervical distance for a taurodontic tooth. In 1978 Shifman and Chanannel proposed the following criteria for determining the presence or absence of tamodontism. Taurodontism is present, if the distance (a) from the lowest point (A) at the occlusal end ofthe pulp chamber to the highest point at the apical end of the chamber (B), divided by the distance (b) from the occlusal end of the pulp chamber to the apex (C) is 0.2mm or greater i.e. [A/b=0.2mm] and if the distance from the highest point of the pulp chamber floor to cemento-enamel junction is more than 2.5 mm. Though there are many classification systems to determine the severity of tamodontism, the one above proposed by Shifman and Chanannel is the widely used system till now.