JOURNAL OF ENDODONTICS
Copyright © 2003 by The American Association of Endodontists
Taurodontism: an Endodontic Challenge.
Report of a Case
Igor Tsesis, DMD, Arie Shifman, DMD, and Arieh Y. Kaufman, DMD
Taurodontism is a morphoanatomical change in
the shape of a tooth, which usually occurs in mul-
tirooted teeth. An enlarged body and pulp cham-
ber, as well as apical displacement of the pulpal
floor, are characteristic features. Endodontic treat-
ment of a taurodont tooth is challenging, because
it requires special care in handling and identifying
the number of root canals. A case of endodontic
treatment of a maxillary first molar with taurodon-
tism is presented.
Taurodontism is a morphologic variation in which the body of the
tooth is enlarged and the roots are reduced in size. Taurodont teeth
have large pulp chambers and apically positioned furcation (1).
The term taurodontism was coined by Sir Arthur Keith to describe
the “bull-like” condition in teeth (from Latin tauro: “bull” and
dont: “tooth” from Greek) in which the tall root trunk encloses a
high pulp chamber and short roots (2).
The etiology of taurodontism is unclear. It is thought to be
caused by the failure of Hertwig’s epithelial sheath diaphragm to
invaginate at the proper horizontal level, resulting in a tooth with
short roots, elongated body, an enlarged pulp, and normal dentin
(3). Previously, taurodontism was related to syndromes such as
Down’s and Klinefelter’s (4). Today, it is considered as an ana-
tomic variance that could occur in a normal population (5).
Taurodontism has been graded according to its severity (6): least
pronounced (hypotaurodontism), moderate (mesotaurodontism),
and most severe (hypertaurodontism). Shifman and Chanannel (5)
also included an index to calculate the degree of taurodontism as
shown radiographically (Fig. 1).
Taurodontism, although not common, is an important occur-
rence that may influence dental management of patients. The
present case describes endodontic treatment of a maxillary first
molar with taurodontism.
CASE REPORT
A 21-year-old male patient presented at the clinic for endodontic
treatment of the maxillary left first molar, which underwent emer-
gency treatment (pulpotomy) because of irreversible pulpitis. The
353
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VOL. 29, NO. 5, MAY 2003
patient’s medical history was noncontributory. At this time, the
tooth was asymptomatic. Intraoral examination revealed a normal
shaped crown with an occlusal temporary filling and a mesiopalatal
amalgam filling. The tooth was not sensitive to percussion or
palpation. Periodontal probing was within normal range (2–3 mm).
A periapical radiograph of the affected tooth showed the pulp
chamber extending beyond the cervical area reaching the furcation.
Three short roots were seen at the furcation area in the apical third
(Fig. 2), indicating hypertaurodontism according to Shifman and
Chanannel (5).
Hypertaurodontism on the contralateral side was confirmed by
radiograph (Fig. 3). The patient reported that both first mandibular
molars were extracted because of unsuccessful complicated root
canal treatment.
Lidocaine 2%, with epinephrine 1:100,000, was used for
anesthesia (Lidocadren; Teva, Jerusalem, Israel). Magnification
loops (Orascoptic, Madison, WI, U.S.A.) were used throughout
the procedure to facilitate visualization. The tooth was isolated
and the access cavity improved. The pulp was exposed and
extirpated followed by massive bleeding, which was controlled
by instrumentation. The tooth was instrumented to the furcation
area where three canal orifices were found: a wide palatal one
(P), and two narrow orifices—a mesiobuccal (MB) and a dis-
tobuccal (DB). Instrumentation was carried out using a balanced
force technique with K-files. An electronic apex locator (Root
ZX; Morita, Tokyo, Japan) was used to determine the initial
working length. During root canal preparation, a tiny fourth
canal orifice (MB2) was suspected between the mesiobuccal
and palatal canals. A working length determination radiograph,
which was taken with a file in the suspected root canal, verified
its presence (Fig. 4). The palatal canal was instrumented to #50
file and the buccal canals to a #30 file size. Sodium hypochlorite
3% and sterile saline were used as irrigating solutions. A
modified obturation technique was used because of the com-
plexity of the inner root canal anatomy and the proximity of the
buccal orifices. This consisted of combined lateral condensation
in the apical part with vertical compaction of the elongated pulp
chamber, using the System B device (Analytic Technology,
Redmond, WA, U.S.A.). The final radiograph confirmed a
well-condensed filling consisting of four canals obturated to the
predetermined length (Fig. 5). It was recommended to avoid
post placement and to use other techniques if needed for tooth
reconstruction.
354 Tsesis et al. Journal of Endodontics

FIG 3. Radiograph of contralateral maxillary right first molar.

FIG 1. Variable dimensions for establishing the taurodontism index:

vertical height of the pulp chamber (V1), distance between the lowest
point of the roof of the pulp chamber to the apex of the longest root
(V2), and distance between the baseline connecting the two CEJ and
the highest point in the floor of the pulp chamber (V3). Establishing a
condition of taurodontism is made when V1 is divided by V2 and
multiplied by 100 if above 20, and V3 exceeds 2.5 mm: (V1/V2) * 100 ⬎
20 and V3 ⬎ 2.5 mm. Taurodontic index (TI) ⫽ V1/V2 ⫻ 100. Taur-
odontism is diagnosed in molars in which TI is above 20 and variable
3 exceeds 2.5 mm. Degrees of taurodontism were determined as:
hypotaurodontism: TI 20 –30, mesotaurodontism: TI 30 – 40, and hy-
pertaurodontism: TI 40 –75 (5). In this case, TI equaled 56 and variable
3 equaled 10 mm, clearly indicating hypertaurodontism.
FIG 4. Working length radiograph.

FIG 2. Preoperative radiograph of maxillary left first molar. FIG 5. Radiograph upon completion of root canal filling.
Vol. 29, No. 5, May 2003
DISCUSSION
Taurodontism is frequently associated with other anomalies and
syndromes (4). In this case, the patient was a healthy male with no
known diseases.
Endodontic treatment in taurodont teeth has been described as
complex and difficult. Durr et al. (7) suggested that morphology
could hamper the location of the orifices, thus creating difficulty in
instrumentation and obturation. Two of five cases presented by
Cohen and Taintor (8) required endodontic therapy, in which
treatment was difficult to complete. The number of root canals
varied in each case. Hayashi (9) reported complicated endodontic
treatment of a mandibular molar with taurodontism, where five
canals were found, but only three could be instrumented to the
apex.
The present case describes successful completion of end-
odontic treatment of a taurodont maxillary first molar, which
seemed impossible to perform with conventional techniques.
Success was mostly attributed to the use of magnification,
which easily showed the location of the four canal orifices.
Unfortunately, the patient was unavailable for future follow-
ups. To the best of our knowledge, no long-term follow up
studies have been published regarding taurodont endodontically
treated teeth.
Taurodontism 355
The authors thank Ms. Rita Lazar for editorial assistance.
Drs. Tsesis and Kaufman are affiliated with the Department of Endodon-
tology and Dr. Shifman is affiliated with the Department of Oral Rehabilitation,
The Maurice and Gabriela Goldshleger School or Dental Medicine, Tel Aviv
University, Israel. Address requests for reprints to Prof. Arieh Y. Kaufman,
Department of Endodontology, The Maurice and Gabriela Goldshleger,
School of Dental Medicine, Tel Aviv University, Israel.
References
1. Contemporary terminology for endodontics. Glossary. American Asso-
ciation of Endodontists, 1998.
2. Keith A. The early history of the Gibralter cranium. Nature 1911;87:
313– 4.
3. Hamner JE, Witkop CJ, Metro PS. Taurodontism. Report of a case. Oral
Surg Oral Med Oral Pathol 1964;18:409 –18.
4. Regezi JA, Scuibba JJ. Oral pathology: clinical pathologic correlations.
WB Saunders Company, 1999:458.
5. Shifman A, Chanannel I. Prevalence of taurodontism found in radio-
graphic dental examination of 1200 young adult Israeli patients. Community
Dent Oral Epidemiol 1978;6:200 –3.
6. Shaw JC. Taurodont teeth in South African races. J Anat 1928;62:476 –
98.
7. Durr DP, Campos CA, Ayers CS. Clinical significance of taurodontism.
J Am Dent Assoc 1980;100:378 – 81.
8. Cohen DM, Taintor JF. Bilateral taurodontism. Quintessence Int 1980;
9:9 –16.
9. Hayashi Y. Endodontic treatment in taurodontism. J Endodon 1994;20:
357– 8.