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Term taurodontism originated by Sir Arthur Keith in 1993 to describe a peculiar dental anomaly in which the body of the

e tooth is enlarged at the expense of the roots.


bull-like

teeth its usage derived from the similarity of these teeth to those of ungulated or cud-chewing animals.

Hypotaurodont mildest form Mesotaurodont Hypertaurodont extreme form in which the bifurcation or trifurcation occurs near the apices of the roots.

A specialised or retrograde character A primitive pattern A mendelian recessive trait An avastic feature A mutation resulting from odontoblastic deficiency during dentinogenesis of the roots

Hammer and his associates believe that it is caused by failre of Hertwigs epithelial sheath to invaginate at the proper horizontal level. Goldstein and Gottleib have stated that the condition appears to be genetically controlled and familial in nature.

A case of taurodontism occur in concomitantly with amelogenesis imperfecta has been reported by Crawford. It has been reported that many patients with the Klinefelter syndrome exhibit taurodontism,but it is not a constant feature of this syndrome. For this reason,Gardner and Girgis have recommended that male patients exhibiting taurodontism should have chromosomal studies performed,esp,if there is any nonspecific diagnosis of mental retardation and if the patient has a tall,thin appearance with long arms and a prognathic jaw.

It may affect either the deciduous or permanent dentition,although permanent tooth involvement is more common. Teeth involved are almost invariably molars. Single tooth/several molars in the same quandrant/unilateral/bilateral involvement. The teeth themselves have no remarkable or unusual morphologic clinical characteristics.

Involved teeth rectangular in shape rather than taper towards the roots. Large pulp chamber with a much greater apico-occlusal height than normal. Pulp lacks usual constiction at the cervical of the tooth and the roots are exceedingly short. The bifurcation or trifurcation may be only a few millimeters above the apices of the roots.

No specific treatment is required for the anomaly.

CLINICAL CONSIDERATION
The clinical implication of taurodontism has potentially increased risk of pulp exposure because of decay and dental procedures. Taurodontism may complicate orthodontic and/or prosthetic treatment planning. Taurodontism, although not very common has to be emphasized due to its influence on various dental treatments.

Endodontic considerations:
A taurodont tooth shows wide variation in the size and shape of
the pulp chamber, varying degrees of obliteration and canal configuration, apically positioned canal orifices, and the potential for additional root canal systems

From an Endodontists view, taurodontism presents a challenge during negotiation, instrumentation and obturation in root canal therapy. Because of the complexity of the root canal anatomy and proximity of buccal orifices, complete filling of the root canal system in taurodont teeth is challenging. 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. In addition to the difficulty of the endodontic procedure, a recent case report suggests the possibility of taurodont teeth having an extraordinary root canal system which is challenging for endodontists.

Recently, a case report highlights the use of high-end diagnostic imaging modalities such as spiral computerized tomography in making a confirmatory diagnosis of the multiple morphologic abnormalities such as taurodontism, dens invaginatus, pyramidal cusps of the premolars, dens evaginatus.

The endodontic therapy of choice in these situations will be conservative. Therefore, root canal treatment becomes a challenge.

Though taurodontism is of rare occurrence, the clinician should be aware of the complex canal system for its successful endodontic management.

Pre-operative radiograph of maxillary right first molar.

Radiograph of contra lateral maxillary left first molar.

Radiograph upon completion of root canal filling.

Surgical considerations: The extraction of a


taurodont
tooth is usually complicated because of shift in the furcation to apical third . In contrast, it has also been hypothesized that the large body with little surface area of a taurodont tooth is embedded in the alveolus. This feature would make extraction less difficult as long as the roots are not widely divergent. It is reported that extraction of such teeth may not be a problem unless the roots are not widely divergent. However, some authors believe that hypertaurodonts may pose some problem syndrome .

From a periodontal standpoint,

taurodont teeth may, in specific cases, offer favorable prognosis. Where periodontal pocketing or gingival recession occurs, the chances of furcation involvement are considerably less than those in normal teeth because taurodont teeth have to demonstrate significant periodontal destruction before furcation involvement occurs. It is very important for a general dental practitioner to be familiar with taurodontism not only with regards to clinical complications but also its management. Taurodontism also provides a valuable clue in detecting its association with many syndromes and other systemic conditions.

For the prosthetic treatment of a taurodont tooth, it


has been recommended that postplacement be avoided for tooth reconstruction .

Because less surface area of the tooth is embedded in the alveolus, a taurodont tooth may not have as much stability as a cynodont when used as an abutment for either prosthetic or orthodontic purposes. The lack of a cervical constriction would deprive the tooth of the buttressing effect against excessive loading of the crown.

Variable dimensions for establishing the taurodontism index: vertical height of the pulp chamber (V1), distance between the lowest point of the roof of the pulp chamber to the apex of the longest root (V2), and distance between the baseline connecting the two CEJ and the highest point in the floor of the pulp chamber (V3). Establishing a condition of taurodontism is made when V1 is divided by V2 and multiplied by 100 if above 20, and V3 exceeds 2.5 mm: (V1/V2) * 100 20 and V3 2.5 mm. Taurodontic index (TI) V1/V2 100. Degrees of taurodontism were determined as: hypotaurodontism: TI 2030, mesotaurodontism: TI 3040, and hypertaurodontism: TI 4075 (5). In this case,

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