Enlarged Pulp Chamber Research Articles

Endodontic Management of Mesotaurodontic Maxillary First Molar – A Case Report

1 HOD, Professor and Guide, Department of Conservative dentistry and Endodontics, Vasantdada Patil Dental College and Hospital, Sangli 2 Professor, Department of Conservative dentistry and Endodontics, Vasantdada Patil Dental College and Hospital, Sangli 3 PG student, Department of Conservative dentistry and Endodontics, Vasantdada Patil Dental College and Hospital, Sangli ABSTRACT Taurodontism can be defined as a change in tooth shape caused by the failure of the Hertwig’s epithelial sheath diaphragm to invaginate at the proper horizontal level. An enlarged pulp chamber, apical displacement of the pulpal floor, and no constriction at the level of the cementoenamel junction are the characteristic features. Permanent molars are most commonly affected. Endodontic treatment of a taurodont tooth is challenging and requires special handling because of the proximity and apical displacement of the roots. Here, we report a case in which endodontic treatment of the maxillary right first molar with taurodontism was performed. In this case, the maxillary right second molar was also taurodont teeth.

The effects of idiopathic hypoparathyroidism on dental development

Hypoparathyroidism cases without etiology diagnosed in the first 10 years of life are called as idiopathic hypoparathyroidism (IHP). IHP is a rare endocrinological disorder among hypoparathyroidism cases, and the anomalies accompanying it are infrequently observed. Ca ++ metabolism disorders occurring during the formation of tooth germs may cause enamel defects in teeth, enamel hypoplasia, enlarged pulp chambers, short roots, late eruptions, and missing teeth. The case presented in this article is a good example in terms of demonstrating how tooth damage ends with the commencement of treatment. Within this article, the results of a 9-year-old male IHP patient are discussed based on the literature. The said patient could not be diagnosed until the age of 18 months so developed enamel hypoplasia as well as enamel defects in this period due to abnormal mineralization, and no problems were observed in his dental tissue that formed after the ionic equilibrium was ensured following the diagnosis.

Endodontic treatment of a mandibular hypertaurodontic second molar

Taurodontism is the consequence of a developmental disorder in which the invagination of Hertwig's epithelial root sheath doesn't occur at a proper level. As a result, the pulp body and the chamber of a multi-root tooth, usually permanent molar teeth, are enlarged by the apical displacement of the pulp floor. Despite its clinically normal appearance, the morphological variation of this tooth can be diagnosed by a routine radiographic exam that shows enlarged apico-occlusal pulp chamber and short roots. Due to these anatomical variations, endodontic treatment of a taurodontic element is a clinical challenge given the complexity of localization and instrumentation of the root canal system. According to the degree of displacement of the pulp floor, taurodontism can be classified as: hypotaurodontism, mesotaurodontism and hypertaurodontism. This study objective is to report a clinical case of a patient who was submitted to endodontic treatment of the second inferior molar affected by hypertaurodontism.

The Prevalence of Taurodontism in a North Anatolian Dental Patient Subpopulation

Objective: The aim of this study was to determine the prevalence of taurodontism in a north Anatolian dental patient subpopulation, considering factors such as dental localization. Methods: We designed a descriptive study evaluated of panoramic radiography of 1044 patients who presented to our Endodontic Services of Dentistry Faculty, Ordu University, in the city of Ordu in the north of Turkey. All the data (age and sex) were obtained from Turcasoft software (Samsun, Turkey). Patients who were less than 15 years at the time of the radiographic examination, records with poor quality radiographs and records with radiographs of only primary teeth were excluded. To minimize the variability in the present study, the examinations were carried out jointly by the first two authors of the article over approximately one month. The taurodontism classification of Shifman was used. At the end of the study, the data were assessed statistically using SPSS 16.0 software (SPSS Inc., Chicago, IL). Results: In this study, 3813 molar teeth of 936 patients were assessed. Taurodontism was present in 622 (16%) of these teeth. In 410 (66%) cases, the taurodontism affected the maxilla, and it affected the mandibles in 212 (34%) cases. Taurodontism occurred in 75 (12%) first molar teeth, 266 (43%) second molar teeth and 281 (45%) third molar teeth. Conclusion: Taurodontism was a frequent anomaly in a north Anatolian dental patient subpopulation. The frequency of this anomaly may vary in different ethnic groups. Key words: Taurodontism, epidemiology, enlarged pulp chamber

Restoration of an endodontically treated molar taurodont: A 3-year follow-up case

Taurodontism is an anomaly or variation of the anatomy of the tooth basic shape, characterized by an enlarged pulp chamber, apical displacement of the pulpal floor, and no constriction at the level of the cement-enamel junction. Due to these characteristics, endodontic treatment and restoration of these teeth is extremely challenging. In this paper, a review of the phenomenon and prevalence of taurodontism is carried out, and interesting clinical case is described in terms of endodontic notification and final crown restoration. In order to achieve longevity, by preventing microleakage, the final restoration is considered provocative, concerning the selection and combination of restorative materials to be used in such cases. Special care should always be given in occlusion and cuspal protection.

Nfic regulates tooth root patterning and growth.

Molecular interactions between epithelium and mesenchyme are important for root formation. Nuclear factor I-C (Nfic) has been identified as a key regulator of root formation. However, the mechanisms of root formation and their interactions between Hertwig's epithelial root sheath (HERS) and mesenchyme remain unclear. In this study, we investigated the role of Nfic in root patterning and growth during molar root development. The molars of Nfic knockout mice exhibited an enlarged pulp chamber and apical displacement of the pulpal floor, characteristic features of taurodontism, due to delayed furcation formation. In developing molar roots of mutant mice at P14, BrdU positive cells decreased in the apical mesenchyme of the elongation region whereas those cells increased in the dental papilla of the furcation region. Whereas cytokeratin 14 and laminin were localized in HERS cells of mutant molars, Smoothened (Smo) and Gli1 were downregulated in preodontoblasts. In contrast, cytokeratin 14 and Smo were localized in the cells of the furcation region of mutant molars. These results indicate that Nfic regulates cell proliferation in the dental mesenchyme and affects the fate of HERS cells in a site-specific manner. From the results, it is suggested that Nfic is required for root patterning and growth during root morphogenesis.

Exploring the biomechanics of taurodontism.

Taurodontism (i.e. enlarged pulp chamber with concomitant apical displacement of the root bi/trifurcation) is considered a dental anomaly with relatively low incidence in contemporary societies, but it represents a typical trait frequently found in Neandertal teeth. Four hypotheses can be envisioned to explain the high frequency in Neandertals: adaptation to a specific occlusal loading regime (biomechanical advantage), adaptation to a high attrition diet, pleiotropic or genetic drift effects. In this contribution we used finite element analysis (FEA) and advanced loading concepts based on macrowear information to evaluate whether taurodontism supplies some dental biomechanical advantages. Loads were applied to the digital model of the lower right first molar (RM1 ) of the Neandertal specimen Le Moustier 1, as well as to the digital models of both a shortened and a hyper-taurodontic version of Le Moustier RM1 . Moreover, we simulated a scenario where an object is held between teeth and pulled in different directions to investigate whether taurodontism might be useful for para-masticatory activities. Our results do not show any meaningful difference among all the simulations, pointing out that taurodontism does not improve the functional biomechanics of the tooth and does not favour para-masticatory pulling activities. Therefore, taurodontism should be considered either an adaptation to a high attrition diet or most likely the result of pleiotropic or genetic drift effects. Finally, our results have important implications for modern dentistry during endodontic treatments, as we observed that filling the pulp chamber with dentine-like material increases tooth stiffness, and ultimately tensile stresses in the crown, thus favouring tooth failure.

Clinical aspects, imaging features, and considerations on bisphosphonate-related osteonecrosis risk in a pediatric patient with osteogenesis imperfecta.

Osteogenesis imperfecta (OI) is a rare hereditary condition caused by changes in collagen metabolism. It is classified into four types according to clinical, genetic, and radiological criteria. Clinically, bone fragility, short stature, blue sclerae, and locomotion difficulties may be observed in this disease. OI is often associated to severe dental problems, such as dentinogenesis imperfecta (DI) and malocclusions. Radiographically, affected teeth may have crowns with bulbous appearance, accentuated constriction in the cementoenamel junction, narrowed roots, large root canals due to defective dentin formation, and taurodontism (enlarged pulp chambers). There is no definitive cure, but bisphosphonate therapy is reported to improve bone quality; however, there is a potential risk of bisphosphonate-related osteonecrosis of the jaw. In this study we report a case of OI in a male pediatric patient with no family history of OI who was receiving ongoing treatment with intravenous perfusion of bisphosphonate and who required dental surgery. In addition, we discussed the clinical and imaging findings and briefly reviewed the literature.

Taurodontism.

Taurodontism can be defined as a change in tooth shape caused by the failure of Hertwig's epithelial sheath diaphragm to invaginate at the proper horizontal level. An enlarged pulp chamber, apical displacement of the pulpal floor, and no constriction at the level of the cemento-enamel junction are the characteristic features. Although permanent molar teeth are most commonly affected, this change can also be seen in both the permanent and deciduous dentition, unilaterally or bilaterally, and in any combination of teeth or quadrants. Whilst it appears most frequently as an isolated anomaly, its association with several syndromes and abnormalities has also been reported. Despite the clinical challenges, taurodontism has received little attention from clinicians. Due to the prevalence of taurodontism in modern dentitions and the critical need for its true diagnosis and management, this review addresses the etiology, clinical and radiographic features of taurodontism, its association with various syndromes and anomalies, as well as important considerations in various areas of expertise dental treatments of such teeth.

"Management of taurodont right mandibular second molar tooth": A case report

Taurodontism is a rare dental anomaly in which the involved tooth has an enlarged and elongated body and pulp chamber with apical displacement of the pulpal floor. Endodontic treatment of a taurodont tooth is challenge to a clinician and requires special handling because of the proximity and apical displacement of the roots. In this case report, a 60-year-old male patient was referred for root canal treatment of his right mandibular second molar and on clinical examination, there was deep caries in the right mandibular second molar. Intraoral peri-apical radiographic examination of this tooth revealed a long crown containing large pulp chamber and two short roots with an apically located furcation, indicating hypertaurodontism. Endodontic treatment was completed with a combination of thermoplasticized gutta-percha technique and lateral condensation technique to achieve a successful obturation.

Treatment of a Hypertaurodontic Maxillary Second Molar in a Patient with 10 Taurodonts: A Case Report

IntroductionTaurodontism is an aberration in tooth morphology characterized by vertically enlarged pulp chambers, apical displacement of pulp floors, and short roots. So far in the literature, no more than 8 taurodonts have been reported in 1 patient. The aim of this case report was to describe the endodontic management of a hypertaurodont maxillary second molar and to present a rare case with 10 taurodonts in a black man with a biometric analysis using cone-beam computed tomographic imaging. MethodsAn 18 year-old black man was referred to the postgraduate endodontic clinic for emergency treatment. The patient's medical history was noncontributory. Tooth #2 had lingering pain in response to the cold test and was positive to both percussion and palpation. Radiographic examination showed the characteristics of taurodontism and periapical radiolucency around the root apices of tooth #2. Tooth #2 was diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis. The tooth was endodontically treated in 2 appointments. A panoramic radiograph showed multiple taurodontism. At the follow-up, a cone-beam computed tomographic scan was taken to further evaluate and diagnose taurodontism. Ten molars showed taurodontism including 7 hypertaurodonts, 2 mesotaurodonts, and a hypotaurodont. High variations of root canal anatomy were observed among taurodonts including maxillary and mandibular hypertaurodonts with C-shape canals. ConclusionsThe present case describes 10 taurodonts in a patient with no specific syndromes and endodontic treatment of a hypertaurodont maxillary second molar. Cone-beam computed tomographic imaging may be useful in the evaluation and management of the anatomic complexity of roots and root canals of taurodonts.

Taurodontism: A dental rarity

Taurodontism is a developmental disturbance of a tooth in which body is enlarged at the expense of the roots. An enlarged pulp chamber, apical displacement of the pulpal floor and lack of constriction at the cementoenamel junction are the characteristic features. It appears most frequently as an isolated anomaly. But its association with several syndromes and abnormalities has also been reported. Endodontic treatment of taurodont teeth is stated to be complex and difficult due to the complexity in the tooth morphology. This case report presents a case of taurodontism in permanent maxillary molars and their successful endodontic treatment.

Regional odontodysplasia: Orthodontic treatment and transplantation of premolars

Regional odontodysplasia is a rare and unique dental anomaly involving both dentitions, but mostly the teeth of 1 quadrant. This report describes the combined surgical and orthodontic treatment of a boy with regional odontodysplasia. The mandibular right central and lateral incisors and the canine (as well as the deciduous predecessors) were affected. In a 2-step procedure, the maxillary right and left second premolars were autotransplanted to the affected area. The extraction sites in the maxilla were closed, and a good functional occlusion was established.

Non Syndromic Generalised Taurodontism in Primary and Permanent teeth -A Case Report

Abstract Taurodontism is a rare dental anomaly defined as a change in shape of the tooth caused by the failure of Hertwig's epithelial sheath to invaginate at the proper horizontal level. The characteristic features of this anomaly are an enlarged pulp chamber with apical displacement of the pulpal floor, and no constriction at the level of the Cemento-enamel junction. They occur most frequently as an isolated anomaly or it may be associated with certain syndromes. Permanent dentition is more commonly affected than deciduous dentition, seen unilaterally or bilaterally, and in any combination of teeth or quadrants. This case report describes a case of generalised taurodontism involving all the deciduous molars and permanent molars in a 7 years old male patient. How to cite this article: Bharath .KP, Priya, Poornima .P, Neena I.E. Non Syndromic Generalised Taurodontism in Primary and Permanent teeth -A Case Report. CODS J Dent 2015;7: 90-92

Neural Crest Deletion of Dlx3 Leads to Major Dentin Defects through Down-regulation of Dspp

During development, Dlx3 is expressed in ectodermal appendages such as hair and teeth. Thus far, the evidence that Dlx3 plays a crucial role in tooth development comes from reports showing that autosomal dominant mutations in DLX3 result in severe enamel and dentin defects leading to abscesses and infections. However, the normal function of DLX3 in odontogenesis remains unknown. Here, we use a mouse model to demonstrate that the absence of Dlx3 in the neural crest results in major impairment of odontoblast differentiation and dentin production. Mutant mice develop brittle teeth with hypoplastic dentin and molars with an enlarged pulp chamber and underdeveloped roots. Using this mouse model, we found that dentin sialophosphoprotein (Dspp), a major component of the dentin matrix, is strongly down-regulated in odontoblasts lacking Dlx3. Using ChIP-seq, we further demonstrate the direct binding of Dlx3 to the Dspp promoter in vivo. Luciferase reporter assays determined that Dlx3 positively regulates Dspp expression. This establishes a regulatory pathway where the transcription factor Dlx3 is essential in dentin formation by directly regulating a crucial matrix protein.

Endodontic Management in a Patient with Vitamin D–resistant Rickets

Introduction Hypophosphatemic vitamin D–resistant rickets (VDRRs) is a metabolic bone disease caused by abnormalities in the vitamin D receptive system or in phosphate and calcium metabolism. This condition occurs in growing skeleton affecting bone and dentin mineralization, resulting in systemic and oral manifestations. Methods A 15-year-old boy was referred to the private clinic for endodontic treatment in #9. His medical history revealed VDRR disease. The dental findings were multiple periapical lesions in several teeth without obvious reason such as caries or trauma. The radiographic examination showed short roots, enlarged pulp chambers with longer pulp horns, thin dentin and enamel, missing or poorly defined lamina dura, and abnormalities in the cementoenamel junction, all pathognomonic features of the disorder. Conservative endodontic treatment was completed in all teeth with pulp necrosis and rarefactions. Results A 6-month, 1-year, and 2-year follow-up radiographic examination revealed progressive improvement with bone reconstruction without any clinical symptoms. Conclusions Early diagnosis, conventional treatment, and continuous radiographic examination are important factors in improving dental alterations in patients with VDRRs.

ORTHODONTIC PROBLEMS IN PATIENTS WITH HYPODONTIA AND TAURODONTISM OF PERMANENT MOLARS

Taurodontism is a morphological abnormality of the tooth shape with the following characteristic features: vertically enlarged pulp chamber, apical displacement of the bifurcation and trifurcation, shortened roots and no constriction at the level of the cementoenamel junction. This anomaly is still neglected by orthodontists when it comes to making treatment plans in spite of the reports in the literature of a close association of this condition with hypodontia and oligodontia. Aim: The article discusses the orthodontic problems arising in treating patients with hypodontia and taurodontism and suggests approaches to reducing the risk of complications during orthodontic tooth movement. Discussion: Failure to identify taurodont teeth in hypodontic patients can cause serious complications in their orthodontic management because of the greater susceptibility of these types of teeth to root resorption in orthodontic tooth movement. Besides, these types of teeth are less anchorage. Conclusion: The high incidence of taurodontism in hypodontic patients presents a clinical challenge for general dental practitioners and orthodonists alike. Furthermore, successful management of hypodontia rests on the orthodontist’s ability to identify taurodont teeth and correctly include them in treatment plan.

Endodontic treatment of a taurodontic premolar with five canals

Taurodontism is a morpho-anatomical abnormality in the shape of a tooth. An enlarged pulp chamber, apical displacement of the pulpal floor and no constriction at the level of the cemento-enamel junction are the characteristic features. Special care is required in all aspects of endodontic treatment of a taurodontal tooth, including identifying the orifice, canal exploration, cleaning, shaping and obturation of the root canal. This case report describes the successful endodontic treatment of a taurodontic mandibular second premolar with five root canals.

New roles and mechanism of action of BMP4 in postnatal tooth cytodifferentiation

During the phase of overt tooth cytodifferentiation that occurs after birth in the mouse and using the 3.6Collagen1a-Cre and the BMP4 floxed and BMP4 knockout mice, the BMP4 gene was deleted in early collagen producing odontoblasts around postnatal day 1. BMP4 expression was reduced over 90% in alveolar osteoblasts and odontoblasts. There was decreased rate of predentin to dentin formation and decreased mature odontoblast differentiation reflected in reduced DMP1 expression and proper dentinal tubule formation, as well as reduced Collagen type I and Osteocalcin expression. We observed mutant dysmorphogenic odontoblasts that failed to properly elongate and differentiate. The consequence of this failed differentiation process leads to permanent loss of dentin thickness, apparent enlarged pulp chambers in the molars and reduced bone supporting the tooth structures in mice as old as 10–12 months. Deletion of the BMP4 gene in odontoblasts also indirectly disrupted the process of enamel formation that persisted throughout life. The mechanism for this altered differentiation program in the absence of the BMP4 gene in odontoblasts is from decreased BMP signaling, and decreased expression of three key transcription factors, Dlx3, Dlx5, and Osterix. BMP signaling, as well as Dlx3 and Amelogenin expression, is also indirectly reduced in the ameloblasts of the odontoblast BMP4 cKO mice. This supports a key paracrine or endocrine postnatal role of odontoblast derived BMP4 on the proper amelogenesis and formation of the enamel.

Hymenopterengiftallergie

The tricho-dento-osseous syndrome is a rare genetic disorder due to a mutation in the DLX3 gene on chromosome 17q21. It can affect hair, teeth, bone and nails, causing phenotypic variability. We report on an 8-year-old girl with tricho-dento-osseous syndrome, who presented in our allergy center with severe atopic dermatitis. Additional clinical findings included light, kinky hair reminiscent of pili trianguli et canaliculi (uncombable hair), enamel hypoplasia and enlarged pulp chambers of the molar teeth (taurodontism). A genetic investigation revealed a de-novo mutation in the DLX3 gene on chromosome 17q21. Electron microscopic examination of the curly hair showed a flattened hair shaft with longitudinal grooves.