471

Journal of Oral Science, Vol. 51, No. 3, 471-474, 2009

Case Report

“Taurodontism” an endodontic challenge: a case report

Ramesh Bharti, Anil Chandra, Aseem P. Tikku and Kulvindar K. Wadhwani
Department of Conservative Dentistry and Endodontics, CSM Medical University, Lucknow, India
(Received 5 November 2008 and accepted 1 May 2009)

Abstract: Taurodontism can be defined as a change to their severity into hypo-, meso- and hypertaurodont
in tooth shape caused by the failure of the Hertwig’s forms, hypotaurodontism being the least pronounced form,
epithelial sheath diaphragm to invaginate at the proper mesotaurodontism the moderate form and hyper-
horizontal level. An enlarged pulp chamber, apical taurodontism being the most severe form in which the
displacement of the pulpal floor, and no constriction bifurcation or trifurcation occurs near the root apices (3).
at the level of the cementoenamel junction are the The etiology of taurodontism is unclear. The possible
characteristic features. Permanent molars are most causes of taurodontism have been enumerated by Mangion
commonly affected. Endodontic treatment of a (4) as follows: 1) A specialized or retrograde character,
taurodont tooth is challenging and requires special 2) A primitive pattern, 3) A Mendelian recessive trait, 4)
handling because of the proximity and apical An atavistic feature, and 5) A mutation resulting from
displacement of the roots. Here, we report a case in odontoblastic deficiency during dentinogenesis of the
which endodontic treatment of the maxillary right first roots.
molar with taurodontism was performed. In this case, According to Hamner et al., taurodontism is caused by
the maxillary right second molar and maxillary left first the failure of Hertwig’s epithelial sheath diaphragm to
and second molars were also taurodont teeth. (J Oral invaginate at the proper horizontal level (5). In addition,
Sci 51, 471-474, 2009) it has been reported that many patients with the Klinefelter
syndrome exhibit taurodontism, but it is not a constant
Keywords: taurodontism; pulp chamber; endodontic feature of this syndrome (6). Today, it is considered as an
treatment; maxillary molar. anatomic variant that could occur in a normal population
(7). The prevalence of taurodontism is reported to range
from 2.5% to 11.3% of the human population. This range
Introduction is accounted for by variations in race and differences in
Taurodontism is a developmental disturbance of a tooth diagnostic criteria (8). The present article describes the
that lacks constriction at the level of the cementoenamel review of literature of taurodontism (Table 1) and
junction (CEJ) and is characterized by vertically elongated management of hypertaurodontism by endodontic treatment
pulp chambers, apical displacement of the pulpal floor and in a right maxillary first molar.
bifurcation or trifurcations of the roots (1).
The term “taurodontism” (‘bull tooth’) was coined from Case Report
the Latin term “tauros”, which means ‘bull’ and the Greek A 22-year-old male patient was referred to the post-
term “odus”, which means ‘tooth’(2). graduate clinic of the Department of Conservative Dentistry
Shaw (1928) further classified taurodont teeth according and Endodontics, C.S.M. Medical University Lucknow,
India for treatment of the maxillary right first molar. The
Correspondence to Dr. Ramesh Bharti, Flat no. 805, Doctors Flats, tooth had been subjected to emergency pulpotomy by a
TG Hostel Campus, Khadra, Sitapur Road, Lucknow 226003, general dentist because of irreversible pulpitis. The patient’s
India
Tel: +91-9935724723
medical history was noncontributory. At the time of
Fax: +91-522-2254555 examination, the tooth was asymptomatic. Intraoral
E-mail: r_bharti14@yahoo.com examination revealed a normal shaped crown with a
472

Table 1 Review of literature

temporary occlusal restoration. The tooth was not sensitive Endodontic management of the maxillary right
to percussion. Radiographic examination of the affected first molar
tooth revealed an abnormal tooth anatomy. The tooth was anaesthetized, the access was opened under
The radiographic findings were: rubber dam isolation and the access cavity was modified.
• The pulp chamber extended beyond the cervical area The remaining pulp tissue was extirpated. The pulp was
reaching the furcation. voluminous and to ensure complete removal, 2.5% sodium
• Three short roots were seen at the furcation area in the hypochlorite was initially used as an irrigant to soften the
apical third. pulp. Once the pulp was extirpated, further irrigation was
From these radiographic findings, the tooth was done with normal saline. The pulp chamber was huge and
diagnosed to be a hypertaurodont (Fig. 1). Hypertauro- the floor of the chamber could not be visualized. At the
dontism on the contralateral side was confirmed by furcation area, three canal orifices were found: palatal,
radiograph (Fig. 2). mesiobuccal and distobuccal. A working length radiograph
was taken with a #15 file in the canal and it was confirmed
by an electronic apex locator (Root ZX; Morita, Japan) (9).
 473

After working length determination, the palatal canal was

instrumented up to # 40 file and the buccal canals up to
#30 file size. After completion of instrumentation, a
modified obturation technique was used because of the
proximity of the orifices. After drying the canals, AH plus
(Dentsply International) sealer was applied onto the root
canal walls with a lentulospiral (Dentsply /maillefer; Tulsa,
OK, USA). The premeasured master cone was coated
with sealer and slowly moved to full working length.
Then, the premeasured #30 spreader was introduced into
the canal along side the master cone gutta percha and
with a rotary vertical motion was slowly moved apically
to full penetration. After a minute, the spreader was
removed with the same reciprocating motion and
Fig. 1 Pre-operative radiograph of maxillary right first molar.
immediately followed by the first #30 accessory cone
inserted to the full depth of the space left by the spreader
then #25 and #20 accessory cones were inserted after the
use of spreader. Thus, the canals were obturated with
lateral condensation. After that, the elongated pulp chamber
was obturated with vertical compaction of warm gutta
percha. The final radiograph confirmed a well condensed
filling of the canals (Fig. 3).

Discussion
A taurodont tooth shows wide variation in the size of
the pulp chamber, varying degrees of obliteration and
canal configuration, apically positioned canal orifices.
Therefore, root canal treatment becomes a challenge
(10,11).
Taurodontism is a dental anomaly characterized by large
pulp chambers and short roots. Roots often bifurcate or
trifurcate at a low level. They are thought to result from
Fig. 2 Radiograph of contra lateral maxillary left first molar.
failure of the Hertwig’s epithelial root sheath to invaginate
at the proper time (12). The most frequently affected teeth
are the molars (7). The distance between the baseline
connecting the two CEJ and the highest point in the floor
of the pulp chamber are used in determining taurodont teeth.
Taurodontism is diagnosed in molars when this distance
exceeds 2.5 mm (7).
Taurodontism is associated with several developmental
syndromes and anomalies including amelogenesis
imperfecta, Down’s syndrome, ectodermal disturbance,
Klinefelter syndrome, tricho-dento-osseous syndrome,
Mohr syndrome, Wolf-Hirschhorn syndrome and Lowe
syndrome (8).
From an endodontist’s view, taurodontism presents a
challenge during negotiation, instrumentation and
obturation in root canal therapy. The mesiobuccal and
distobuccal canal orifices were very narrow and close to
each other, due to which negotiation of these orifices was
very difficult. During instrumentation, as the canals were Fig. 3 Radiograph upon completion of root canal filling.
474

very short, they were instrumented with only the apical 2. Keith A (1913) Problems relating to the teeth of the
third of the file. Therefore, instrumentation was time- earlier forms of prehistoric man. J R Soc Med 6, 103-
consuming. Similarly, due to the typical internal anatomy, 124.
where buccal canals were narrow and orifices were close, 3. Shaw JC (1928) Taurodont teeth in South African
the canal orifices were also deeply placed in the tooth. races. J Anat 62, 476-498.
Therefore, the obturation procedure was also different 4. Mangion JJ (1962) Two cases of taurodontism in
from the conventional one. The proximity of the orifices modern human jaws. Br Dent J 113, 309-312.
and deeply situated opening of the canals made it difficult 5. Hamner JE III, Witkop CJ Jr, Metro PS (1964)
to obturate the canals with any single method of obturation. Taurodontism: report of a case. Oral Surg Oral Med
Therefore, a combination of lateral condensation technique Oral Pathol 18, 409-418.
and warm vertical condensation technique was performed 6. Shafer WG, Hine MK, Levy MB (1999) A textbook
to achieve the best results and it can be seen in the post of oral pathology. 4th ed, W. B. Saunders,
operative radiograph (Fig. 3). Philadelphia, 43.
Because of the complexity of the root canal anatomy and 7. Shifman A, Chanannel I (1978) Prevalence of
proximity of buccal orifices, complete filling of the root taurodontism found in radiographic dental
canal system in taurodont teeth is challenging. A modified examination of 1,200 young adult Israeli patients.
filling technique, which consists of combined lateral Community Dent Oral Epidemiol 6, 200-203.
compaction in the apical region with vertical compaction 8. Joseph M (2008) Endodontic treatment in three
of the elongated pulp chamber, has been proposed (10). taurodontic teeth associated with 48, XXXY
Another endodontic challenge related to taurodont teeth Klinefilter syndrome: a review and case report. Oral
is intentional replantation. The extraction of a taurodont Surg Oral Med Oral Pathol Oral Radiol Endod 105,
tooth is usually complicated because of the dilation of the 670-677.
roots in the apical third (13). In contrast, it is also believed 9. Lucena-Martin C, Robles-Gijon V, Ferrer-Luque
that because of its large body, little surface area of a CM, Navajas-Rodriguez de Mondelo JM (2004) In
taurodont tooth is embedded in the alveolus. This feature vitro evaluation of the accuracy of three electronic
would make extraction less difficult as long as the roots apex locators. J Endod 30, 231-233.
are not widely divergent (14). 10. Tsesis I, Shifman A, Kaufman AY (2003)
In addition to the difficulty of the endodontic procedure, Taurodontism: an endodontic challenge: report of
the present case might suggest the possibility that taurodont a case. J Endod 29, 353-355.
teeth have an extraordinary root canal system which is 11. Rao A, Arathi R (2006) Taurodontism of deciduous
challenging for endodontists. and permanent molars: report of two cases. J Indian
Soc Pedod Prev Dent 24, 42-44.
Acknowledgments 12. Bhaskar SN (2001) Orban’s oral histology and
The authors would like to thank Dr. Mala Kamboj, embryology. 11th ed, CV Mosby, St Louis, 41-44.
Reader (Career Institute of Dental Sciences, Lucknow) for 13. Yeh SC, Hsu TY (1999) Endodontic treatment of
her critical review and valuable suggestions. taurodontism with Klinefelter’s syndrome: a case
report. Oral Surg Oral Med Oral Pathol Oral Radiol
References Endod 88, 612-615.
1. Jafarzadeh H, Azarpazhooh A, Mayhall JT (2008) 14. Durr DP, Campos CA, Ayers CS (1980) Clinical
Taurodontism: a review of the condition and significance of taurodontism. J Am Dent Assoc
endodontic treatment challenges. Int Endod J 41, 100, 378-381.
375-388.