Abstract
Taurodontism can be defined as a change in tooth shape caused by the failure of Hertwig’s epithelial root sheath diaphragm to invaginate at the proper horizontal level.1 Taurodontism appears most commonly as an isolated anomaly, though its association with several syndromes and abnormality has also been reported. A case of a 25 year old female with taurodontism in a tooth is reported here. Endodontic treatment was indicated due to irreversible pulpitis. This article describes the procedure of root canal treatment of mandibular right second molar with taurodontism.
Introduction
In taurodontism, the body of the tooth is enlarged at the expense of root (also called as ‘bull-like’ tooth). Pulp chamber is extremely large with greater height apico-occlusally. Bifurcation or trifurcation may be present only few millimetres above the root apex and pulp usually lacks constriction at cervical level of tooth.2 Although permanent molars are more commonly affected, this change can be seen in both permanent and deciduous dentition, unilaterally or bilaterally , and in any combination of teeth and quadrant.1
Etiology: Theories regarding the etiology of taurodontism have been many. It’s been suggested that the anomaly represents a primitive pattern , a mutation, a specialized odd retrograde character , an atavistic feature, an X-linked trait, familial or an autosomal dominant trait. 1 Taurodontism can represent itself as a single entity or as a part of a syndrome . This condition is commonly seen in association with certain syndromes like Klinefelter syndrome and Down’s syndrome. 2
Classification : Shaw (1928) classified taurodont teeth according to their severity into -
- hypo- taurodont
- meso- taurodont and
- hyper-taurodont forms.
Hypotaurodontism is the least pronounced form, mesotaurodontism is the moderate form and hypertaurodontism being the most severe form in which the bifurcation or trifurcation occurs near the root apices.3
Review of literature shows a wide range in different population. Usually radiographic examination can reveal taurodontism because of its unique appearance with greater apico-occlusal height of pulp chamber and short roots.
Case Report
A 25 year old female who had non contributory medical history, was referred with the chief complaint of spontaneous, severe pain and food lodgement in right mandibular region. Intraoral clinical examination revealed normal shaped crown with deep carious lesion in mandibular right second molar. Tooth was tender on percussion . On performing the vitality test , complete pulpal necrosis was confirmed.
Radiographic examination revealed an abnormal tooth anatomy.
The radiographic findings were:
- Large occlusal carious lesion reaching distal pulp horn.
- The large pulp chamber with pulp stone was extended beyond cemento-enamel junction with greater apico-occlusal height.
- Two short roots were seen.
From radiographic findings , the tooth was diagnosed to be taurodont. Taurodontism on the contralateral side was confirmed by radiograph. All clinical and radiographic findings were suggestive of irreversible pulpitis.
Endodontic Management of Mandibular Right Second Molar:
The tooth was anaesthetised with 2% lidocaine, the access was opened and modified. The pulp stone was removed with the help of an ultrasonic scaler tip and spoon excavator, and remaining pulp tissue was extirpated. The pulp was large and voluminous so to ensure complete removal , 3% sodium hypochlorite was initially used as an irrigant to soften and dissolve the necrotic pulp .
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