|Year : 2014 | Volume
| Issue : 1 | Page : 49-52
Bilateral taurodontism in primary and permanent molars associated with hypodontia
P Poornima1, Shashikant Katkade2, IE Neena1, KM Sangeeta1
1 Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere, India
2 Department of Pedodontics and Preventive Dentistry, ACPM Dental College, Dhule, Maharashtra, India
|Date of Web Publication||18-Feb-2015|
Professor and Head of Department, Department of Pedodontics and Preventive Dentistry, Room No. 08, College of Dental Sciences, Pavillion Road, Davangere - 577 004, Karnataka
Source of Support: None, Conflict of Interest: None
The aim of this article is to present a case of bilateral taurodontism in the primary and permanent molars associated with hypodontia and to discuss the endodontic aspects. Taurodontism in the permanent molars are most commonly affected, and it has a very low incidence and very few cases are reported in the literature in deciduous dentition. A 12-year-old boy presented with irregularly placed tooth in the upper right back region of his jaw. Orthopantamogram revealed taurodontism in seven teeth, including both primary and permanent teeth, associated with congenitally missing three premolars and permanent mandibular central incisors. Taurodontism is more frequent in non-syndromic familial tooth agenesis. Individuals in families with second premolar and molar oligodontia are more likely to have taurodontism. Because there is a wide variation in size and shape of pulp chamber with a varying degree of obliteration and canal configuration, root canal therapy becomes a challenge and, therefore, it is essential to recognize and render preventive care for these teeth.
Keywords: Bilateral, deciduous molars, permanent molars, taurodontism, tooth agenesis
|How to cite this article:|
Poornima P, Katkade S, Neena I E, Sangeeta K M. Bilateral taurodontism in primary and permanent molars associated with hypodontia. Int J Oral Health Sci 2014;4:49-52
|How to cite this URL:|
Poornima P, Katkade S, Neena I E, Sangeeta K M. Bilateral taurodontism in primary and permanent molars associated with hypodontia. Int J Oral Health Sci [serial online] 2014 [cited 2017 Apr 29];4:49-52. Available from: http://www.ijohsjournal.org/text.asp?2014/4/1/49/151631
| Introduction|| |
It is very important for a general dental clinician to be familiar with taurodontism not only due to its clinical implications but also due to its probable association with related syndromes and its management. The case presented here has non-syndromic familial tooth agenesis associated with taurodontism in multiple teeth.
Taurodontism is a developmental disturbance of a tooth that lacks constriction at the level of the cement-enamel junction (CEJ). It is characterized by vertically elongated pulp chamber, apical displacement of the pulpal floor and bifurcation or trifurcations of the roots.  The term "taurodontism" ("bull tooth") was coined from the Latin term "tauros," which means "bull" and the Greek term "odus," which means "tooth." 
Shaw (1928) further classified taurodont teeth according to their severity into mild, moderate and severe (hypo-, meso- and hypertaurodont) forms, based on the apical displacement of pulpal floor [Figure 1]. Hypotaurodontism is the least pronounced form, mesotaurodontism is the moderate form and hyper-taurodontism is the most severe form in which the bifurcation or trifurcation occurs near the root apices.  A most widely accepted and used criterion for diagnosis of taurodontism, on the basis of the distance from the lowest point of the roof of the pulp chamber "a" to the highest point of pulp floor "b," when divided by the distance from "a" to root apex "c," should be equal to or greater than 0.2 mm and/or distance from "b" to the CEJ "d" should be greater than 2.5 mm  [Figure 2].
|Figure 1: Diagrammatic representation of the normal (cynodontic) tooth and three subtypes of taurodontic teeth|
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The etiology of taurodontism is unclear. The possible causes of taurodontism have been enumerated by Mangion  as follows: (1) A specialized or retrograde character, (2) a primitive pattern, (3) a Mendelian recessive trait, (4) an atavistic feature and (5) a mutation resulting from odontoblastic deficiency during dentinogenesis of the roots. According to Hamner et al., taurodontism is caused by the failure of Hertwig's epithelial root sheath diaphragm to invaginate at the proper horizontal level.  In addition, it has been reported that many patients with the Klinefelter syndrome exhibit taurodontism, but it is not a constant feature of this syndrome.  Today, it is considered as an anatomic variant that could occur in a normal population.  The prevalence of taurodontism is reported to range from 2.5% to 11.3% of the human population. This range is accounted for by variations in race and differences in diagnostic criteria.  Taurodontism is more frequent in non-syndromic familial tooth agenesis. Individuals in families with second premolar and molar oligodontia are more likely to have taurodontism. This association could define a subphenotype for future genetic studies of dental development. The case presented here has non-syndromic familial tooth agenesis associated with taurodontism in multiple teeth.
| Case Report|| |
A 12-year-old male child was brought to the College of Dental Sciences, Davangere with a complaint of malposition of tooth in the right posterior tooth region of the maxilla. There was no significant medical complaint in the past. The patient had a history of dental trauma and had undergone treatment for the same . His intraoral examination revealed normal soft tissue appearance. Maxillary arch showed buccally erupting right maxillary first premolar, peg-shaped right maxillary lateral incisor and clinically missing left maxillary lateral incisor. Mandibular arch showed retained primary central incisor in the midline and clinically missing left first and second premolars and right second premolar and moderate caries on the distal surface of the primary left first molar.
OPG revealed all four permanent first molars and primary second molars to be taurodontic [Figure 3]. All first permanent molars and primary mandibular left second molar were hypertaurodont, whereas the maxillary primary second molars were mesotaurodont [Figure 4]. All permanent second molars were in the developing stage and suggestive of taurodontism in the future after root formation is completed. Other features include congenitally missing mandibular central incisors, right and left second premolars and maxillary right second premolar.
|Figure 4: Intra oral periapical radiograph of the teeth showing taurodontism|
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| Discussion|| |
Taurodontism most frequently appears as an isolated anomaly. However, its association with several syndromes has also been detected (Downs, Klinefelter, Lowe, Tricho-dento-osseous, Tricho-onchyo-dental, Williams, Wolf-Hirschhorn, Seckel, Smith-Maginus and Mohr syndrome).  Many of these disorders have oral manifestations, which can be detected on dental radiographs as alterations in the morphology or chemical composition of the teeth; thus, dentists may be the first to detect them.  Sankar  reported the association of amelogenesis imperfect with dental anomalies, including taurodontism, congenitally missing teeth, delayed eruption, crown resorption, pulpal calcifications and odontogenic fibromas. Shokri  reported the prevalence of taurodont teeth as 9.29% by observation in a panoramic radiograph. The author found that taurodonts were significantly more common in the maxilla (65.6%) than in the mandible (34.4%). The maxillary second molar (34.4%) was the most commonly involved tooth. Only four premolars were involved (12.4%). According to the morphology, hypotaurodonts were found in 24 teeth (75%), but there was no significant difference in males and females. Mesotaurodonts were found in six teeth and two teeth were hypertaurodont in morphology.
Many explanations for the pathogenesis of taurodont formation have been put forward from time to time, which include (a) an unusual developmental pattern, (b) a delay in calcification of the pulp chamber floor, (c) an odontoblastic deficiency, (d) an alteration in Hertwig's epithelial root sheath with an apparent failure of the epithelial diaphragm to invaginate at the normal horizontal levels and (e) a delayed or incomplete union of the horizontal flaps of the epithelial diaphragm. 
Individuals in families with second premolar and molar oligodontia are more likely to have taurodontism. In our case, four permanent first molars and three primary second molars exhibited taurodontism and hypodontia involving missing three second premolars and two mandibular central incisors.
Most reports reveal that permanent teeth were most frequently affected than primary teeth.  In our case, both deciduos and permanent molars were involved. The teeth that were diagnosed as taurodont were of both the meso and the hyper variety.
Ronald,  in his cases, demonstrated short, conical and misshapen roots with pulp stone in the taurodontic tooth. In the presented case also, the pulp stone was obliterating the pulp chamber of the taurodontic teeth.
Endodontic treatment in taurodontic primary teeth has been described as a complex and difficult procedure. Pulp therapy for the taurodont is a challenging treatment, with an increased incidence of hemorrhage during access opening, which may be mistaken for perforation. Because the roots are short and the pulpal floor is placed apically, care should be taken to prevent perforation. Conventional obturating materials like zinc oxide eugenol in bulk may take a longer time to resorb, which may delay the natural exfoliation of the tooth. In such cases, a combination of calcium hydroxide (such as endoflas, vitapex) can act as wonderful materials; these materials have the added advantage of faster rate of resorption due to the presence of calcium hydroxide and iodoform. 
Endodontic treatment in permanent teeth with taurodontism presents a challenge during negotiation, instrumentation and obturation in root canal therapy.  A modified filling technique, which consists of combined lateral compaction in the apical region with vertical compaction of the elongated pulp chamber, has been proposed. 
| Conclusion|| |
As taurodont shows a wide variation in the size and shape of the pulp chamber, with a varying degree of obliteration and canal configuration, root canal therapy becomes a challenge. Hence, we would like to stress on the importance of diagnostic radiograph for early identification of taurodont and rendering preventive care for these teeth.
Taurodontism requires special attention during cavity preparation, root canal therapy and tooth extraction. Taurodontism may complicate endodontic, orthodontic and/or prosthetic treatment planning. It presents a challenge for the endodontist during negotiation, instrumentation and obturation during the root canal therapy. The extraction of a taurodont tooth is also difficult and complicated as the furcation is shifted to the apical area. However, it offers favorable prognosis from a periodontal point of view because these teeth have to demonstrate significant periodontal destruction before the furcation involvement. In case of the prosthetic treatment of such a tooth, the placement of post for tooth reconstruction may be avoided. When used as an abutment, this tooth may not offer much stability and strength, as the surface area is smaller inside the alveolus.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]