Saudi Endodontic Journal

REVIEW ARTICLE
Year
: 2021  |  Volume : 11  |  Issue : 1  |  Page : 7--13

Diagnostic criteria and treatment modalities of taurodont teeth undergoing root canal treatment: A literature review of case reports and case series


Deepti Sreen, Alpa Gupta, Dax Abraham, Arundeep Singh, Namrata Mehta, Jaiprin Sethi 
 Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Faridabad, Haryana, India

Correspondence Address:
Dr. Deepti Sreen
Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Faridabad, Haryana
India

Abstract

Introduction: The objective of this article was to review the diagnostic tools and treatment modalities used in root canal treatment of taurodont teeth in published case reports and case series. Materials and Methods: An electronic search of the literature was performed in PubMed (Medline), EBSCOhost databases, and the reference lists of articles that had been published from 1990 to 2019. Data of the articles that had been included were extracted. Results: The initial search led to the retrieval of 558 articles. After removing duplicates, 121 articles were left, the titles of these articles along with abstracts were read which resulted in the selection of 48 articles for full-text reading. Thirty-six articles were later selected for data extraction and qualitative analysis. In all these articles, treatment was discussed for taurodontism. Conclusion: Treating a taurodont tooth can be quite a challenge and careful evaluation and treatment planning is important for a successful outcome.



How to cite this article:
Sreen D, Gupta A, Abraham D, Singh A, Mehta N, Sethi J. Diagnostic criteria and treatment modalities of taurodont teeth undergoing root canal treatment: A literature review of case reports and case series.Saudi Endod J 2021;11:7-13


How to cite this URL:
Sreen D, Gupta A, Abraham D, Singh A, Mehta N, Sethi J. Diagnostic criteria and treatment modalities of taurodont teeth undergoing root canal treatment: A literature review of case reports and case series. Saudi Endod J [serial online] 2021 [cited 2021 Jan 27 ];11:7-13
Available from: https://www.saudiendodj.com/text.asp?2021/11/1/7/306615


Full Text



 Introduction



Tauradontism was first described by Gorjanovic'- Kramberger in 1908 in a 70,000-year-old preneanderthal fossil in Kaprina, Croatia.[1] It is derived from the Latin word tauros, meaning “bull” and a Greek word odus, meaning “tooth” or “bull tooth.” The distinguishing feature of taurodontism is large (vertically elongated) pulp chambers, apically displaced pulpal floor, and bi/trifurcation of the roots. The first case in humans was reported by Pickerell in 1909 and he used the term radicular dentinoma to describe this condition.[2] Taurodontism is prevalent in 2.5%–11.3% of the population.[3]Taurodontism occurs due to the failure of Hertwig's epithelial root sheath diaphragm to infold at the level of the cementoenamel junction.

Normally, taurodontism manifests as an isolated abnormality though it is also associated with some developmental defects and syndromes such as amelogenesis imperfecta,[4] Down syndrome,[5] tricho–dento–osseus syndrome,[6] Klinefelter's syndrome,[7] and McCune-Albright syndrome.[8]

In a taurodont tooth, the roots, as well as the body, lie under the alveolar margin; hence, it cannot be distinguished clinically.[9] The diagnosis is generally made using radiographs. Although a tauradontic index is available, it is a biometric method. Hence, it is advisable to use cone-beam computed tomographic (CBCT) as a diagnostic aid to gauge the root canal system.[10]

The objective of this article was to review the diagnostic tools and treatment modalities used in root canal treatment of taurodont teeth in published case reports and case series.

 Materials and Methods



Study design, sampling, and setting

This was a literature review conducted in Manav Rachna Dental College, Faridabad, India, between June 2018 and July 2018. Thirty-six case reports were included in this study.

Eligibility criteria

The literature review included only case reports or case series of patients with taurodontism because it is an accidental finding, and case series and clinical studies related to our topic are none to the best of our knowledge. The titles and abstracts of all the articles were screened in the electronic and manual search. The following inclusion criteria were applied in the research: Case reports performed on humans, articles published in English language, permanent teeth in individuals > 15 years of age, articles published after 1990 because of advances in diagnostic methods, and articles in which taurodontism was endodontically treated. The following exclusion criteria were applied: Review articles, in vitro studies, animal studies, prevalence studies, articles in foreign languages, and deciduous teeth. Of the total database search, the relevant articles were hand searched. Bibliography of all the relevant papers and review articles were screened so that exact relevant data could be evaluated. All these data were framed in the PRISMA flowchart.

Source of information

The search strategy included an electronic database and reference list of articles which were published from 1990 to 2019. PubMed (National Library of Medicine) and Ebscohost were searched. References of the articles selected in the search were also screened and included if they did not appear in the database search.

Literature search strategy

The following search strategy was used for PubMed (Medline) and Ebscohost. The terms used were “Taurodontism,” ”Bull teeth,” “Hypertaurodontism,” “Hypotaurodontism,” “Mesotaurodontism,” “CBCT,” “Review,” “Treatment,” “Maxillary molars,” “Mandibular molars,” and “Premolars”. Additional keywords related to the theme of the review were used through Boolean operators (OR and AND) to combine these words [Table 1].{Table 1}

Study selection

The articles were selected in two stages. In the first stage, the titles/abstracts of all the articles that were retrieved during the search were read. References that did not meet the eligibility? criteria were excluded from the study. When the title/abstract was either not available or did not give sufficient information for a decision on inclusion or exclusion, the full text was retrieved. In the second stage, full text of the articles was read and eligibility criteria were applied. Articles meeting the criteria were included in the study. [Figure 1] depicts the flowchart of the study.{Figure 1}

Data extraction and data items

Two reviewers independently evaluated titles and abstracts of publications that were related to taurodontism. Data were extracted and analyzed. For each study, the parameters recorded were the author's name, age and sex of the patient, diagnostic modality, file system, magnification used if any, percentage of sodium hypochlorite used, treatment modality, and follow-up if any.

 Results



The initial search retrieved 558 articles. After removing duplicates, 121 articles were left. The titles and abstracts of these articles were read, leading to the selection of 48 articles for full-text analysis. After eligibility criteria were applied, 36 articles were selected for data extraction and qualitative analysis. The study involved patients in the age group of 16–53 years with taurodontism. The follow-up period of the studies ranged from 1 month to 24 months.

Characteristics of the studies

Thirty-three of the 36 articles were case reports and three were case series. The entire information on the characteristics of the included studies is presented in [Table 2]. The study showed that endodontic treatment done before 2012 used hand files (K- and H-files)[11],[13],[17],[18],[23],[28],[29], and after 2011, several case reports were found to have used nicle-titinum (NiTi) rotary instruments including ProTaper,[14],[21],[25],[27],[32],[33],[37],[39],[41],[45] Heroshaper,[35] Profile,[3],[22] K3,[36] and M2.[15] Four case reports had used CBCT as a diagnostic modality.[22],[31],[34],[41],[43] A taurodont tooth has pulp tissue which is quite voluminous, so for complete removal of the pulp tissue, a copious amount of sodium hypochlorite is needed. Wilderman and Serene[46] suggested 2.5%. Joseph et al., Krishamoorthy et al., Ghargozloo et al., and Silva et al. suggested using 5.25%.[3],[19],[36],[38] Venigalla et al., Tsesis et al., and Saranesha et al. suggested using 3% concentration of sodium hypochlorite[13],[20],[41] and Radwan used 6%.[34]{Table 2}

 Discussion



Although taurodontism is quite frequently prevalent in molars, it has also been reported in premolars. Venigalla et al. and Mokhtari et al. treated a taurodont mandibular premolar with three canals[31],[41] and Demiryurek et al. successfully treated a taurodontic premolar with five canals.[30] In addition, Brito-Junior et al. reported a rare case of taurodontism in an upper central incisor with two canals.[28]

Diagnostic tools

Conventionally, radiographs were used to diagnose taurodontic teeth. The use of conventional radiographs in studying the morphology of teeth has a limitation of showing the subject in two-dimensional views instead of three, which results in the superimposition of structures. The introduction of CBCT leads to a greater frequency of three-dimensional diagnosis in dentistry, including morphological analyses.[47] Mokhtari et al. evaluated axial images of the CBCT which revealed the presence of a third canal in the taurodontic premolar.[31] Similarly, CBCT evaluation by Lim and Le Clerc revealed a square-shaped root having a C-shaped configuration of the canal with pulp calcification in the pulp chamber, thereby making it easier to plan the treatment.[43] In addition, the use of magnification, such as magnification loupe or dental operating microscope, helps in locating the canal orifice of additional root canals. When compared with magnifying loupes, the microscope gave either comparable or superior results. Various case reports used a dental operating microscope which helped in detecting canal orifices.[3],[16],[24],[26],[32],[34],[36],[38],[39],[43] Tsesis et al. recommended exploring the grooves meticulously between all the orifices under magnification which helped in revealing additional orifices and canals.[13]

Biomechanical preparation

Most hand preparation techniques are time consuming and cause iatrogenic errors. Hayashi in 1994 reported a case of mandibular taurodontic molar with five canals, of which only three could be instrumented till the apex using K-files.[11] Attention nowadays is directed toward root canal preparation techniques using NiTi rotary instruments. Various studies show that NiTi rotary instruments create smooth, predetermined funnel-form shapes, with minimal risk of ledging and transportation; further reducing operator fatigue as well as time required to complete the preparation.[48] Protaper universal rotary file system is used in the majority of the studies with satisfactory results.[14],[21],[25],[27],[32],[33],[37],[39],[41],[45] Another important aspect of biomechanical preparation is root canal irrigation. Proper irrigation of the canal depends on various factors including type, volume, and concentration of irrigant used. A taurodont tooth has pulp tissue which is quite voluminous, so for complete removal of the pulp tissue, a copious amount of irrigant is needed. In the majority of the studies, irrigant used was sodium hypochlorite in a concentration ranging from 1.2%–6%. However, the concentration of 2.5% was most commonly used.[21],[35],[39],[45] Simsenk et al. in their case report exhibited better results with the use of passive ultrasonic irrigation in comparison to traditional syringe irrigation, as it removes the increased amount of organic tissue, planktonic bacteria, and dentinal debris.[44]

Obturation

Due to the complex root canal space in a taurodont tooth, obturation can be a challenge. Studies have suggested the use of a modified filling technique which involves cold lateral compaction in the apical region along with the vertical compaction technique of the elongated pulp chamber to achieve a three-dimensional void-free seal.[13],[15],[19],[24]

Follow-up

Several case reports on taurodontism have been reported, but no compilation has been made on the endodontic treatment and follow-up of these cases. The central focus of the current literature review was on the diagnosis of taurodontism and its endodontic treatment with follow-up of these cases to check the healing of the periapical region. However, the limitation is that some? studies did not present with a proper follow-up of their cases and some mentioned an inadequate recall period of 1–3 months,[25],[34] which is not enough to judge healing of the periradicular area.

 Conclusion



Taurodontism requires a thorough understanding of the etiology, anatomy, and radiographic features of the affected tooth, and special consideration is required in the treatment planning of such cases. The complexity of the root canal system needs to be appreciated while performing endodontic treatment for such teeth. The success can be attributed to accurate diagnosis, proper chemomechanical debridement, and thorough obturation of the entire root canal system.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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