Endo treatment for taurodontium

[drsushant]

CASE REPORT

A 11 year old boy was referred for opinion and management of the first molars of maxillary arch. The patient complained of recurrent pain over the bilateral maxillary first molars for a period of 2 months. His medical history was not contributory. Radiographic examination revealed caries involving the pulp and also an abnormality in tooth anatomy was observed and hence the radiograph was repeated in two different angulations.

The findings were:

Unusually long pulp chamber which had no constriction at the cemento-enamel junction.
No distinct roots were found but large canal openings, ending at the apex were observed.

From these radiographic findings, the tooth was diagnosed to be a taurodont. The teeth were subjected to routine clinical tests and a diagnosis of acute irreversible pulpitis was made.

Endodontic Management of right upper first molar

The tooth was anaesthetized, the access opening was done under rubber dam isolation and the pulp tissues were extirpated using ‘H’ files of size 80. The pulp was voluminous and to ensure complete removal, 2.5% sodium hypochlorite was initially used as an irrigant to soften the pulp. Once the pulp was extirpated, further irrigation was done with normal saline and 0.2% chlorhexidine. The pulp chamber was huge and the floor of the chamber could not be visualised, which on further exploration revealed two divisions in the buccal and one in the palatal side with wide apical foramina [Figure – 1]. The huge pulp chamber walls were planed circumferentially using ‘K’ files of standard ISO taper. Sterile saline was used as the final irrigant and ultrasonic irrigation was done. A calcium hydroxide was dressing was placed, which was removed after a week and the canals were prepared for obturation. Custom made gutta-percha was prepared using glass slab and stainless steel spatula (Roll cone technique). Gutta-percha cone was trial fitted and the obturation done. The remaining canal was obturated using cold lateral completion technique [Figure – 2].

Endodontic Management of left upper first molar

The tooth was anaesthetised, the access opening was done under rubber dam isolation and the pulp tissues were extirpated using ‘H’ files of size 80. The walls were circumferentially planed using ‘K’ files, sterile saline and chlorhexidine irrigation was done. Ultrasonic irrigation was finally performed with saline. Intra canal medicament of calcium hydroxide was placed, as in right upper first molar and the patient was recalled after a week. The calcium hydroxide dressing was removed and the canal was dried. Obturation using the custom roll cone technique was performed, like in the previous instance [Figure – 3]. The patient was recalled after a week for review.

Post endodontic management

The patient after the completion of endodontic management was asymptomatic and comfortable during review. It was decided to use resin post to rehabilitate the root dentine, as the teeth were badly damaged. Gutta­percha was removed using heat and mechanical methods upto the middle third of the length of the root canal. Smear layer removal was done with sodium hypochlorite and EDTA solution. 37% phosphoric acid (Etchant) was syringed into the pulpal chamber and left for 15 seconds, rinsed off and bonding agent was applied and cured with two light transmitting posts inside the canal. Composite resin root rehabilitation was done using layered adhesion technique. Composite resin (3M – flowable) was injected into the canal and a clear light transmitting post (Dentatus, Transluminex) was placed in the centre of the canal and cured using conventional halogen (Heraeus – Kulzer) curing lamp for 120 seconds [Figure – 4]. The clear post was retrieved using artery forceps [Figure – 5] and a corresponding fibre reinforced composite post was bonded into the post space with dual cure resin luting cement (Rely – k) and cured for 40 seconds. The excess post was sheared off using a high speed handpiece and core build up was done with posterior composite resin (3M).