Taurodontism with oligodontia in a young female patient: A case report with a brief literature review

Santosh R Patil; Aileni Kaladhar Reddy

doi:10.4103/2348-2915.154647

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CASE REPORT

Year : 2015 | Volume : 2 | Issue : 1 | Page : 34-36

Taurodontism with oligodontia in a young female patient: A case report with a brief literature review

Santosh R Patil¹, Aileni Kaladhar Reddy²
¹ Department of Oral Medicine and Radiology, College of Dentistry, Al Jouf University, Sakaka, Al-Jouf, Saudi Arabia
² Department of Orthodontics, College of Dentistry, Al Jouf University, Sakaka, Al-Jouf, Saudi Arabia

Date of Web Publication

8-Apr-2015

Correspondence Address:
Santosh R Patil
Department of Oral Medicine and Radiology, College of Dentistry, Al Jouf University, Sakaka, Al-Jouf
Saudi Arabia

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/2348-2915.154647

Abstract

Human dentition is affected by a wide variety of abnormalities, which include variation in the number, morphology and eruption sequence. Absence of tooth development manifests as anodontia, hypodontia, and oligodontia. Taurodontism is a developmental anomaly affecting the teeth leading to minimal or no constriction cement enamel junction level manifesting as long pulp spaces and also the trunk of the roots is displaced toward apex giving a rectangular shape to the involved tooth. Its commonly seen in permanent teeth is common and rarely in the deciduous dentition. Oligodontia is an uncommon genetic condition representing the congenital missing of six teeth or more in primary or permanent dentitions. This case report describes concomitant occurrence of tooth agenesis and taurodontism in a young Saudi girl and a brief review regarding the etiology, clinical features, and therapeutic aspects of have been mentioned.

Keywords: Clinical features, management, oligodontia, taurodontism

How to cite this article:
Patil SR, Reddy AK. Taurodontism with oligodontia in a young female patient: A case report with a brief literature review. J Dent Res Rev 2015;2:34-6

How to cite this URL:
Patil SR, Reddy AK. Taurodontism with oligodontia in a young female patient: A case report with a brief literature review. J Dent Res Rev [serial online] 2015 [cited 2023 Mar 27];2:34-6. Available from: https://www.jdrr.org/text.asp?2015/2/1/34/154647

Introduction

Taurodontism is considered as altered intrinsic pulp chamber morphology which results in the extension of the pulp chamber apically toward the root area in a multi-rooted tooth. ^[1] The term is derived from the Latin "tauros," which refers to "bull" and the Greek "odus" meaning "tooth". ^[2] In 1909 Pickerill reported first case of taurodontism in modern man; he used the term "radicular dentinoma" to describe the condition. ^[3] Taurodontic teeth usually have short roots and enlarged pulp chamber. Prevalence of taurodontism varies from 2.5% to 11.3%, with no significant difference between genders. ^[4] Molar and premolar teeth in both primary and permanent dentitions may be affected by taurodontism. Tarurodontism may be seen as affecting a single tooth or multiple teeth, it may be seen either unilaterally or bilaterally, localized or generalized. ^[5] Third molars are reported to be most commonly missing teeth affecting 10-25% of the general population. Apart from third molars, maxillary lateral incisors and mandibular premolars found to be absent in 3.4% and 10.1% of the population respectively. ^[6] Females have been reported to be affected more by tooth agenesis in comparison with males. ^[7] On the basis of number of missing teeth, tooth agenesis may be classified as hypodontia, oligodontia, or anodontia. When one to six teeth are absent, the condition is called as hypodontia, the term oligodontia represents absence of six teeth or more with the exception of third molars. The term "severe hypodontia" is occasionally used to describe whenever four or more teeth are absent. ^[8] The absence of all teeth is termed anodontia and is a rare condition associated with syndromes. Tooth agenesis was reported to be found along with other anomalies such as taurodontism, microdontia, peg-shaped lateral incisors, rotation, and malpositioning. ^[9] The causative factor of congenital missing teeth is known to lie in heredity or developmental disorders MSX1 and PAX9 genes are proposed as responsible for nonsyndromic oligodontia. ^[10]

Case Report

A 17-year-old girl reported to the outpatient department with a desire of closing the excessive space between the teeth since birth. Past medical history of the patient was noncontributory, and there was no history of consanguineous marriage of her parents. Delivery of the patient was normal, and other family members were not having any such complaints. No history of trauma or extractions was given by the patient. Extraoral examination revealed a symmetrical face with mesomorphic appearance and profile of the face was appeared to be normal with no changes in a relationship of skeletal and dental base. Intra-oral examination revealed missing permanent maxillary and mandibular lateral incisors and canines. Deciduous canines of both the arches and maxillary second molars are over retained. Generalized interdental spacing was noted. Orthopantomogram revealed absence of tooth buds of permanent maxillary and mandibular lateral incisors and canines, erupting maxillary second premolars. Pulp chamber of 36 was elongated, and the roots were short suggesting taurodontism [Figure 1]. Based upon history of the patient, clinical and X-ray features, a clinical diagnosis of nonsyndromic taurodontism with oligodontia was considered. The treatment plan considered preprosthetic space opening orthodontically to aid in accurate positioning of the missing teeth, correcting the intra and intermaxillary relationship, as an obligation for proper prosthetic therapy. Followed by prosthetic restoration of the missing teeth and occlusal rehabilitation with bridges and prosthetic crowns for the teeth.

Figure 1: Orthopantomogram showing multiple missing deciduous teeth and taurodont 36

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Discussion

Developmental anomalies affecting the dentition are commonly noticed in the dental hospitals. Taurodontism is one of the significant anomalies affecting the human dentition. De Terra in 1903, Kramberger and Adloff in 1907 described unusually shaped teeth having a cylindrical or prismatic form in the remnants of prehistoric hominids. Arthur Keith in 1913 was the first person to introduce the term "taurodontism" and defined this condition as an enlargement of the tooth body compromising the length of roots. It is a tendency to assume the condition seen in the ox. ^[11],[12] The taurodontic teeth are characterized with increase in size of pulp chambers along with a downward shift of the root trunk. The pulp chamber has a greater apicoocclusal height than usual and appears rectangular due to lack of the narrowing at cement enamel junction level. The cause for taurodontism is not established. Theories have proposed that lack of Hertwig's epithelial sheath diaphragm to invaginate at the exact horizontal position, which results in the roots of shorter length, increased in the size of body of the tooth and pulp along with unaffected dentine. The probable etiological factors of taurodontism were proposed as increase in number of X chromosomes, positive correlation of number of trait and X chromosome expression, a unique or nonprograde character, a primordial pattern, mendelian recessive trait, atavistic character, drastic change resulting due to deficiency of odontoblast during the dentinogenesis of the roots. ^[13] On the basis of the rate of apical positioning of the floor of pulpal chamber, taurodontism is categorized as mild form, moderate form and severe form. Taurodontism is usually seen as an isolated trait, sometimes it is associated with syndromes such as, Apert's syndrome, Mohr's syndrome, Down's syndrome, Tricho-dentoosseous syndrome, and Klinefelter's syndrome, Rapp-Hodgkin syndrome and trichoonycho-dental syndrome. ^[14] While doing endodontic therapy on the taurodont teeth, the clinician should understand the alteration and complexity of the morphology involving the root canals. Exact identification of the grooves between the canal orifices, with magnification to reveal additional orifices and canals, advanced irrigation systems and filling techniques have to be considered. Intentional replantation is another endodontic challenge related to a taurodont tooth. As the taurodont tooth is dilated in the apical third, extraction will be complicated. Because of the need for significant periodontal destruction before the involvement of furcation, taurodont teeth offers favorable prognosis from periodontal viewpoint. ^[15] In the permanent dentition, hypodontia was observed ranging from 1.6% to 9.6%. Oligodontia is a developmental condition representing missing of six teeth or more except the third molars, which affecting <0.5% of the population. ^[16] The association between root abnormalities and tooth agenesis hints the existence of a common primary defect. It may exert its effect independently on different processes or root abnormalities may follow secondarily from an earlier defective event. The occurrence of taurodontism is considered as an indicator of developmental instability, and tooth agenesis is suggested as an expression of a general abnormality of dental development. Treating the oligodontia usually needs multidisciplinary team approach, which consists an orthodontist and a maxillofacial prosthodontist. The number and status of existing teeth, number of absent teeth, presence of decayed teeth, and condition of underlying tissues and nearby structures, occlusal factors, and inter-occlusion space are the other factors that have to be taken into consideration. The objective of treating a patient with oligodontia is to improve patient's esthetics, phonetics, masticatory efficiency, and psychological feeling by replacing the missing teeth with a multidisciplinary approach. Developing malocclusion can be prevented if this condition is recognized and intervened in the earlier phase. Age of the patient plays a significant role in the management of the patient. Rehabilitation with removable and fixed prosthodontic appliances, implant supported prosthetic replacement, or a unification of these available modalities are the choice for treatment. ^[17] Orthodontic therapy should be considered for teeth alignment to achieve better structural equity, functional adaptability, and esthetic amicability before initiation of prosthodontic management. Closing the space left by missing lateral incisors by orthodontic appliances is controversial and same as to opening and maintenance of the spaces for prosthodontic therapy. Height and quality of the alveolar bone will be compromised in patients with congenitally missing permanent teeth. Dental implants may be challenging in these patients due to time consumption for implant osseointegration and bone maturation. Retained primary teeth should be persevered to maintain the height of alveolar bone during orthodontic therapy. ^[18] This case report describes congenital absence of tooth and taurodontism in a young Saudi girl. The dental practitioner should be aware of this condition not only due to its clinical significance but its most likely confederation with allied syndromes and the management of the condition.

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