|Year : 2021 | Volume
| Issue : 1 | Page : 43-46
Implication of taurodontism in orthodontic diagnosis and treatment planning: A review and case report
Sanjeev Datana, Shiv Shankar Agarwal, SK Bhandari, Dhruv Jain
Department of Dental Surgery and Oral Health Sciences, Armed Forces Medical College, Pune, Maharashtra, India
|Date of Submission||16-Feb-2020|
|Date of Decision||21-Aug-2020|
|Date of Acceptance||02-Dec-2020|
|Date of Web Publication||09-Mar-2021|
Department of Dental Surgery and Oral Health Sciences, Armed Forces Medical College, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
Taurodontism is defined as lack of usual constriction at the cement-enamel junction, elongated pulp chambers with apical displacement of pulp floor. Affected tooth may not exhibit any characteristic morphologic trait for clinical recognition and require radiologic diagnosis. A special attention is required while planning any treatment for affected tooth. Present article highlights the important of early diagnosis of taurodntism in orthodontic treatment planning. A case report is presented with diagnosis of taurodontism affecting multiple teeth in both maxillary and mandibular arch.
Keywords: Bull teeth, orthodontic treatment, taurodontism
|How to cite this article:|
Datana S, Agarwal SS, Bhandari S K, Jain D. Implication of taurodontism in orthodontic diagnosis and treatment planning: A review and case report. J Dent Def Sect. 2021;15:43-6
|How to cite this URL:|
Datana S, Agarwal SS, Bhandari S K, Jain D. Implication of taurodontism in orthodontic diagnosis and treatment planning: A review and case report. J Dent Def Sect. [serial online] 2021 [cited 2021 Apr 18];15:43-6. Available from: http://www.journaldds.org/text.asp?2021/15/1/43/310974
| Introduction|| |
Taurodontism is a morphoanatomical disturbance in the development of tooth defined by the lack of usual constriction at the cementoenamel junction. The characteristic features of this condition include vertically elongated pulp chambers, apical displacement of the floor of the pulp chamber as well as the furcation of the roots resulting in shortened roots with greater apico-occlusal height of the pulp chamber. This condition is commonly missed on the routine diagnostic radiographs used by an orthodontist, in spite of numerous case reports highlighting its association with hypodontia/oligodontia.,
The etiology of taurodontism is not clearly understood, considered to be an atavistic feature. Various authors attempted to explain the cause of this condition. 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. Mangion enumerated possible causes of taurodontism as a specialized or retrograde character, primitive pattern, Mendelian recessive trait, an atavistic feature, or mutation resulting from odontoblastic deficiency during dentinogenesis of the roots. Taurodontism may occur as an isolated nonsyndromic anomaly like cleft lip and palate or hypodontia or in combination with various syndromes such as Down's syndrome, Klinefelter syndrome, tricho-dento-osseous syndrome, Mohr syndrome, ectodermal dysplasia, Maroteaux–Lamy syndrome, Williams syndrome, Lowe syndrome, and amelogenesis imperfecta. Various theories relating to development of taurodontism include delayed calcification of pulp chamber, altered Hertwig's epithelial root sheath, or disturbed developmental homeostasis.
Genetic transmission, of taurodontism has been suggested by some investigators, associated with an increased number of X chromosomes. However, other investigators noticed a trend for X chromosomal aneuploidy and no simple genetic association among these patients. Although a specific genetic abnormality could not be attributed, an autosomal transmission has been observed. Biometric studies by Blumberg et al. described this trait as a polygenic system with a continuous trait without discrete modes of expression. Cementum agenesis during root development associated with late gene expression (ALPL and DLX3) has been associated with hypophosphatasia and taurodontism.
The prevalence of taurodontism ranges from 5.6% to 60% among different populations., This wide difference in prevalence can be attributed to different ethnicities or because of different criteria used for diagnosing taurodontism. The prevalence of taurodontism in the North Indian population is reported to be 0.4%, more common in the maxilla (65.5%) and maxillary second molar (34.4%) being the most common tooth involved. Taurodontism accounts for 18% of all the dental anomalies reported in the Indian population.
This review article addresses the anticipated problems associated with taurodontism with orthodontic therapy and a case report diagnosed with the condition in routine orthodontic diagnosis.
| Literature Search|| |
Gorjanovic-Kramberger was the first who described taurodontism in 1908 on a 70,000-year-old pre-Neanderthal fossil discovered in Kaprina Croatia. The first case in humans was described by Pickerill in 1909 and he used the term “radicular dentinoma” to describe the condition. However, the term “taurodontism” was introduced by Sir Arthur Keith who described the teeth of prehistoric people, the Neanderthals and Heidelberg. The molars of modern man were described as “cynodont” (dog-like teeth), with small pulp chamber and constriction in outline form of chamber at the cementoenamel junction (CEJ). The term taurodontism has been derived from the Latin word “tauro” (bull) and Greek term “odus” (tooth) because the affected tooth bears morphological resemblance to the tooth of ungulates, especially bulls.
Taurodontism was first categorized by Shaw in 1928, based on the relative displacement of the floor of the pulp chamber as “cynodont,” “hypotaurodont,” “mesotaurodont,” and “hypertaurodont.” Hypotaurodontism manifests as moderate enlargement of the pulp chamber at the expense of the roots. Mesotaurodontism is characterized by quite large pulp chamber with shortened roots, but roots are still separate. Hypertaurodontism is characterized by clindrical/ prismatic forms of the teeth with the pulp chambers nearly reaching the apex. Cuneiform is a single or pyramidal root with pulp extending throughout the length of root without cervical constriction resulting in a single-wide apical foramen. However, this classification is more subjective and arbitrary resulting in misdiagnosis of normal tooth to be taurodontism. As it was noticed that degree of taurodontism increased from first molar to third molar, second molar was used as a standard tooth for the purpose of classification of taurodontism.
Keene in 1966 gave “Taurodont Index:” The height of pulp chamber was related to the length of the root. The index value for cynodont was 0%–24.9%, hypo-T with an index value of 25%–49.9%, meso-T with an index value of 50%–74.9%, and hyper-T with an index value of 75%–100%. Although this method was more objective as compared to the index developed by Shaw, it used a relative method. The landmarks used for calculation are biologic structures which may change with time and also the grading of index into four groups is arbitrary and unrealistic.
Blumberg et al. in 1971 described taurodontism as a continuous trait which cannot be grouped into strict categories. The authors used five variables in their biometric study and recommended that these variables cannot be generalized because of the variation of race and type of molars.
Feichtinger and Rossiwall gave a quantitative method to define taurodontism and suggested that if the distance from the furcation of the root to the CEJ is greater than the cervico-occlusal distance, then a tooth can be diagnosed as taurodontism. Taurodont index (TI) introduced by Shiffman and Chanannel in 1978 is the most widely used classification system. The authors used two anatomical landmarks on tooth, i.e., Point A (lowest point at the occlusal end of the pulp chamber) and Point B (highest point at the apical end of the chamber). Biometric calculations were derived for the distances using these landmarks and ratios were developed to categorize the severity of taurodontism. The value for hypo-T is derived to be 20%- 29.9%, meso-T is 30%–39.9%, and hyper-T is 40%–75%. The authors with this biometric system have overcome the disadvantage of Keene's index using radiographs (no reparative dentin or roots with varied morphology). However, the measurement of distance between Point B to CEJ is very small and may result in error.
| Report of Case|| |
A 14-year-old male patient reported to the Division of Orthodontics and Dentofacial Orthopedics of this tertiary care hospital for orthodontic treatment of forwardly placed upper front teeth. Pretreatment orthopantomograph (OPG) [Figure 1] revealed that the permanent first and second molars of all the four quadrants presented with enlarged pulp chambers with unusual cervical constriction and shortened roots suggestive of taurodontism. To confirm the findings, intraoral periapical (IOPA) radiographs [Figure 2] were recorded.
| Diagnosis of Taurodontism|| |
To confirm the diagnosis of taurodontism, TI described by Shiffman and Chanannel was used:
- The distance from the lowest point of the roof of the pulp chamber to the highest point of the floor of the pulp chamber was measured
- The distance from the highest point of the floor of the pulp chamber to the root apex was measured
- TI = a/b × 100.
TI values for all affected teeth were calculated and tabulated [Table 1]. The diagnosis of taurodont was made if the calculated value of TI was >20%.
In the present case, multiple teeth in both maxillary and mandibular arches were involved (both first molar and second molars in all the four quadrants). The TI index ranged from 27% to 29%. Although it is documented in the literature that the severity of taurodontism increases from first molar to third molar, the same was not noticed in this case.
| Orthodontic Implications|| |
A taurodont tooth does not exhibit any characteristic clinical morphologic trait which may aid in its clinical recognition. Therefore, the diagnosis of taurodontism is usually made from diagnostic radiographs (OPG and IOPA), which may be an incidental finding. Radiographic records (OPG and lateral cephalogram) are standard orthodontic records which are obtained before any treatment planning for orthodontic patients. The frequency of taurodontism for posterior teeth (except third molars) among orthodontic patients has been reported as 4.5%.
Taurodontism is an important radiological finding which demands special attention during treatment planning for any specialty, which includes: restoration of tooth, endodontic therapy, extraction of tooth, orthodontic tooth movement, or prosthodontic tooth preparation.
The “anchorage value” of any tooth, i.e., its resistance to movement, is a function of its root surface area which is equivalent to its periodontal ligament area. The larger the root, the greater is its surface area over which an orthodontic force can be distributed. In case of taurodontism, the anchorage value of the affected tooth is reduced, as there is reduction in the surface area of the root. Anchorage preparation is the first step in treatment planning for orthodontic patients. The anchorage value of a taurodont molar tooth may be enhanced by adding more number of teeth in the anchored unit or with indirect anchorage using orthodontic implants. Because of reduced root support, the use of headgear is contraindicated on taurodont molars.
Prolonged duration of orthodontic treatment may result in some undesirable effects; apical blunting or root resorption is one of the most commonly encountered problems with prolonged treatment. Literature has revealed a strong connection between taurodontism and an increased tendency to root resorption during orthodontic treatment. Hence, the taurodont tooth with shorter and thinner roots becomes more susceptible to resorption. It is advised to avoid any orthodontic movement of tooth with taurodontism.
The potential risks and benefits of orthodontic treatment should be discussed with the patient and/or parents and informed consent should be obtained.
| Conclusion|| |
Taurodontism is a relatively uncommon clinical entity usually affecting the multirooted teeth.Taurodontism may present a clinical challenge to the Orthodontist especially during anchorage preparation. Therefore, the orthodontist should be familiar with this dental anomaly for its early detection and appropriate management to achieve optimum treatment outcome and patient satisfaction with no deleterious side effects.
The orthodontist should be proverbial with this condition because of its clinical importance during orthodontic therapy and a likely association with numerous syndrome associated.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]