Buckle in, ‘cause here we go. It’s time for a tooth story all about taurodont treatment. The taurodont is one of those rare, dental anomalies that can make your life more difficult, especially when performing a root canal.
Just to be clear, Taurodontism is a condition that we see in molars that creates a vertically enlarged pulp chamber at the expense of the roots.
This happens during tooth formation and is a result of either a late invagination, or a lack of invagination of Hertwig’s epithelial root sheath, which is primarily responsible for root formation.
The end result is you have a chamber floor that’s more apical than normal.
A Tricky Tooth Story Featuring Taurodontism
Today’s case is a perfect example of a taurodont treatment. In fact, this patient has two taurodonts (and even more on the opposing arch)! Teeth #14 and 15 both have this internal configuration, but luckily I only had to treat tooth #14. Tooth #15 just doesn’t look fun with that deep apical split.
Isn’t it neat how variable teeth can be? Just look at the difference between the two teeth and how much more apical the chamber floor is on #15 than it is on #14 (shown below). I wonder what #16 is going to look like when it grows up!
Tooth #14 started to trouble this young boy as he began having some pain while chewing. Understandably, he was a bit nervous about the procedure, so it was important for me to talk with him, listen to him, and understand his whole tooth story.
To Treat or Not to Treat?
If you’ve been reading my blogs for a while, you know I talk a lot about risk assessment.
You should really only take on cases that bring you joy and that you feel confident you can tackle. Good risk assessment will decrease your anxiety while doing root canals.
Plus, it will make your procedures far more productive, AND you’ll also make some seriously happy patients. We all want to have happy patients!
Approaching Taurodont Treatment
Let’s get back to our case. What kind of clinical implications could anatomy like this have?
Well, since the chamber floor is a bit more apical (or way more apical in the case of tooth #15), locating your canals will prove more challenging because they’ll be further away from your eyes. The deeper you go in the tooth, the darker it gets in there, right? It’s like looking into a big pit!
So what do we do? We magnify!
That’s right, these cases (especially #15) will require higher magnification to be able to properly see and locate those canal orifices.
When I teach my students and they use loupes, I always suggest going up higher in magnification. Most people are using 2.5x or 3.5x, but the reality in endo is that you’ll need something stronger, especially if you want to start decreasing your stress and anxiety while doing your procedures and increase your speed to reduce chairtime.
From one professional to another, my minimum recommendation is 5.0x when you’re doing endo. And once you get used to them—because I know it’s a huge shift—you may even see that you want to use them for your restorative cases as well.
The reality is that, with these teeth, you may need an even higher magnification than 5.0x to find the orifices. So ask yourself, is this a case you can confidently perform to the desired outcome you want for your patients? Do you have the equipment on hand, and are you comfortable with it? Or is it something better referred out so you can spend your time doing something that brings you more joy and productivity? It’s all about risk assessment.
Tackling this Tooth Story with Magnification
Here’s how the rest of the case went for me.
With higher magnification on my microscope, I was able to find all of the canals. Here they’re displayed in my cone fit radiograph…
I’ll admit, this is not my most beautiful root canal, since I have some voids in my final obturation. You can see it in the palatal root and the disto-buccal root. I tried to fix it, but the anatomy prevented me from really getting my gutta percha gun as apical as I wanted, and the behavior of this patient (he was quite anxious) hindered me from getting my desired results for this taurodont treatment. Sometimes you just have to go with what you have.
And since I was confident that I sufficiently disinfected the tooth, I felt good leaving it as is.
A year later, this boy returned for his recall. He was less anxious now, and he also got all of his bone back!
The best news is #15 still doesn’t need a root canal! I always love a good success story.
I want to hear from you. Let me know in the comments if you’d feel comfortable tackling a case like this. If not, what would you need to feel more confident with it?
You could answer with higher magnification, more practice, or even nothing! It’s okay to say, “I know my limits, and I prefer to refer these cases out.”