Taurodontism is characterized by teeth with enlarged and elongated pulp chambers and apical displacement of the bifurcation or trifurcation of roots. This anomaly occurs either as an isolated, singular trait or in association with syndromes and with some ectodermal anomalies. The aim of this review is to address the etiology, radiographic features and clinical considerations in the treatment of such teeth. It can be seen that taurodontism has until now received insufficient attention from clinicians.
Smear layer is a controversial topic in the field of operative dentistry and endodontics. This presentation includes composition, concepts, structure, advantages, disadvantages, and removal methods of smear layer.
Remineralization is defined as the process whereby calcium and phosphate ions are supplied from an external source to the tooth thereby, causing ion deposition into crystal voids in demineralized enamel, thus producing net mineral gain.
Remineralization Agents - Biomimetic approaches to stabilization of bioavailable calcium, phosphate, and fluoride ions and the localization of these ions to non-cavitated caries lesions for controlled remineralization.
Fermentable carbohydrates provide plaque bacteria with substrate for acid production.
This causes a rapid drop in plaque pH and when pH becomes less than 5.5, hydroxyapatite in enamel breaks down and calcium and phosphate ions diffuse out from the enamel.
5.5 is the “critical pH”, the point where equilibrium exists. There is no mineral dissolution and no mineral precipitation.
The plaque remains acidic for about 30-60 minutes after which normal pH is restored gradually.
The calcium and phosphate ions re-enter enamel when normal pH is restored and thus remineralization occurs.
After reading this chapter, the student should be able to:
1. Understand the microbial etiology of apical
periodontitis.
2. Describe the routes of entry of microorganisms to the
pulp and periradicular tissues.
3. Recognize the different types of endodontic infections
and the main microbial species involved in each one.
4. Understand the bacterial diversity within infected root
canals.
5. Describe the factors involved with symptomatic
endodontic infections.
6. Understand the ecology of the endodontic microbiota
and the features of the endodontic ecosystem.
7. Discuss the role of microorganisms in the outcome of
endodontic treatment.
8. Understand the development and implications of
extraradicular infections.
Smear layer is a controversial topic in the field of operative dentistry and endodontics. This presentation includes composition, concepts, structure, advantages, disadvantages, and removal methods of smear layer.
Remineralization is defined as the process whereby calcium and phosphate ions are supplied from an external source to the tooth thereby, causing ion deposition into crystal voids in demineralized enamel, thus producing net mineral gain.
Remineralization Agents - Biomimetic approaches to stabilization of bioavailable calcium, phosphate, and fluoride ions and the localization of these ions to non-cavitated caries lesions for controlled remineralization.
Fermentable carbohydrates provide plaque bacteria with substrate for acid production.
This causes a rapid drop in plaque pH and when pH becomes less than 5.5, hydroxyapatite in enamel breaks down and calcium and phosphate ions diffuse out from the enamel.
5.5 is the “critical pH”, the point where equilibrium exists. There is no mineral dissolution and no mineral precipitation.
The plaque remains acidic for about 30-60 minutes after which normal pH is restored gradually.
The calcium and phosphate ions re-enter enamel when normal pH is restored and thus remineralization occurs.
After reading this chapter, the student should be able to:
1. Understand the microbial etiology of apical
periodontitis.
2. Describe the routes of entry of microorganisms to the
pulp and periradicular tissues.
3. Recognize the different types of endodontic infections
and the main microbial species involved in each one.
4. Understand the bacterial diversity within infected root
canals.
5. Describe the factors involved with symptomatic
endodontic infections.
6. Understand the ecology of the endodontic microbiota
and the features of the endodontic ecosystem.
7. Discuss the role of microorganisms in the outcome of
endodontic treatment.
8. Understand the development and implications of
extraradicular infections.
Taurodontism, a dental anomaly is defined as a change in tooth shape caused by the failure of
Hertwig’s epithelial root sheath to invaginate at the proper horizontal level. Enlarged and elongated
pulp chamber, apically shifted pulpal floor, and lack of constriction at the level of the cementoenamel
junction are the characteristic features. In performing root canal t
appreciate the complexity of the root canal system, canal obliteration, configuration, and the potential
for additional root canal systems. Careful exploration of the all orifices with the help of magnification,
ultrasonics and a modified filling technique are useful for its better management.
Tooth agenesis is the most prevalent craniofacial congenital anomaly in humans. The term refers to an isolated disorder in the absence of non-dental phenotypes but is also used to describe the manifestation of missing teeth in syndromes. The affected individuals suffer from compromised masticatory functions and have decreased quality of life. Discerning the genetic etiology of tooth agenesis not only improves our understanding of normal tooth development but also provides a fundamental basis for developing potential therapeutic strategies for this anomaly. To date, MSX1, Pax9, Axin2, Eda, And Wnt10a have been established as candidate genes associated with non-syndromic tooth agenesis.This article reviews the recently discovered genes involved in dental agenesis , and provides an update on the aetiological factors underlying this common malformation.
Tooth Agenesis in Orthodontic Patients at Arab Population in IsraelAbu-Hussein Muhamad
Non-syndromic tooth agenesis has been occasionally described in literature and data available for its prevalence is rare in Arabs population in Israel. The purpose of the present retrospective radiographic study was to provide data concerning the prevalence of non-syndromic hypodontia in patients reporting to the Center for Dentistry,Research & Aesthetics, Jatt, Almothalat, Israel
Nonsyndromic Oligodontia in Permanent Dentition: Three Rare CasesAbu-Hussein Muhamad
Oligodontia is the congenital absence of six or more than six teeth in either permanent or primary dentition. Because of the missing teeth in these patients esthetic, functional and psychological problems may arise. This article reports a three rare cases of non-syndromic oligodontia. Key words: oligodontia, hypodontia, severe partial anodontia
Similar to Taurodontism; clinical considerations (20)
Congenital absence of maxillary lateral incisors is a frequent clinical challenge which must be solved by a multidisciplinary approach in order to obtain an
esthetic and functional restorative treatment. . Fixed prosthodontic and removable prostheses, resin bonded retainers, orthodontic movement of maxillary
canine to the lateral incisor site and single tooth implants represent the available treatment modalities to replace congenitally missing teeth. This case report
demonstrates the team approach in prosthetic and surgical considerations and techniques for managing the lack of lateral incisors. The aims of this case
report of replacement of bilaterally congenitally missing maxillary lateral incisors with dental implants.
Aesthetic Management of Fractured Anteriors: A Case ReportAbu-Hussein Muhamad
Introduction: Coronal fracture of anterior teeth is an important topic for esthetic dentistry. Such fractures may jeopardize esthetics, function, tissue biology
and occlusal physiology, thus endangering tooth vitality and integrity. Coronal fractures resulting from dental trauma most frequently occur to the maxillary
anterior teeth of adolescents and less frequently to mandibular teeth. Adult teeth may also suffer traumatic fracture, although less frequently than for
adolescents.
Case Report: In our case, an economical and time-saving novel technique has been described for direct composite restoration in a young patient with
uncomplicated fractured maxillary anterior tooth.
Conclusion: As restoring a fractured tooth is a complex procedure, this technique can prove as a simple, effective and appropriate technique that will fulfill all
the requirements of dental personnel. This technique can also prove to be easy for inexperienced beginner clinicians without requiring special skills in
providing the patients with direct composite restorations.
Impacted Maxillary Central Incisors: Surgical Exposure and Orthodontic Treat...Abu-Hussein Muhamad
The maxillary permanent central incisor develops early in life and forms part of an aesthetic smile. Disruption of the formation or eruption of the permanent
central incisor has multiple etiological factors. Treatment options depend to some extent on the cause of failure of eruption of the central incisor. Generally,
the earlier treatment is provided, the higher the likelihood of success and the less the complexity. Our results suggest that close monitoring and interdisciplinary
cooperation during the treatment phases led to a successful esthetic result, with good periodontal health and functional occlusion.
Excess of space in the dental arch is diagnosed as a
generalised spacing or a local divergence, often
observed in the maxillary anterior region, as a median
diastema, traumatic loss of central incisors, or
congenital absence of lateral incisors. Furthermore,
spacing is observed in aging individuals, due to
pathological migration of teeth caused by
periodontitis. Finally, adult individuals with partial
edentulous jaws demand pre-prosthetic orthodontic
treatment from functional aspects. Thus, indication for
orthodontic treatment in subjects with spacing of teeth
exists for aesthetic reasons, but also for facilitating
prosthetic restorations with optimal occlusalstability.
Dental implants represent one of the most successful treatment modalities in dentistry.
However, failures do occur in the range from 5 to 8% for routine procedures and up to 20% in major grafting
cases after at least 5 years of function . The majority of implant losses may be explained as biomechanically
induced failures, since low primary implant stability, low bone density, short implants and overload have been
identified as risk factors . Hence, achievement and maintenance of implant stability are pre-conditions for a
successful clinical outcome with dental implants.
The review focuses on different methods used to assess implant stability and recent advances in this field.
Aesthetic Management of Fractured Anteriors: A Case ReportAbu-Hussein Muhamad
Introduction: Coronal fracture of anterior teeth is an important topic for esthetic dentistry. Such fractures may jeopardize esthetics, function, tissue biology
and occlusal physiology, thus endangering tooth vitality and integrity. Coronal fractures resulting from dental trauma most frequently occur to the maxillary
anterior teeth of adolescents and less frequently to mandibular teeth. Adult teeth may also suffer traumatic fracture, although less frequently than for
adolescents.
Case Report: In our case, an economical and time-saving novel technique has been described for direct composite restoration in a young patient with
uncomplicated fractured maxillary anterior tooth.
Conclusion: As restoring a fractured tooth is a complex procedure, this technique can prove as a simple, effective and appropriate technique that will fulfill all
the requirements of dental personnel. This technique can also prove to be easy for inexperienced beginner clinicians without requiring special skills in
providing the patients with direct composite restorations
Orthodontic tooth movement is basically a biologic response towards a mechanical force. Osteoclast and osteoblast cells mediate bone resorption and apposition, which eventually produces tooth movement. Researches showed that the rate of orthodontic tooth movement can be altered by certain drugs locally or systemically. The Objective of this article is to discuss the current data concerning the effect of drugs on orthodontic tooth movement.
Multidisciplinary Approach in the Rehabilitation of Congenitally Maxillary C...Abu-Hussein Muhamad
Objective: This case report describes the multidisciplinary
approach to treat a congenitally missed maxillary canine, how to
improve patient’s smile using orthodontic fixed appliance, endosseous
dental implant, and porcelain veneer to achieve the treatment results of
function and esthetic.
Materials and procedures: Unilateral agenesis of the permanent
maxillary canines in healthy individuals is extremely rare. This
paper presents the case of a female patient diagnosed with congenital
unilateral agenesis of the permanent maxillary canines as well as
occlusal abnormalities in the form of left-side crossbite. To restore the
proper aesthetics and function, interdisciplinary therapeutic treatment
was implemented. In the case presented in this paper, the aim of
oral rehabilitation was to restore a functional balance by obtaining
proper skeletal relationships, creating optimal occlusal conditions and
obtaining arch continuity.
Conclusion: Interdisciplinary treatment combined of orthodontics,
implant surgery, and prosthodontics was useful to treat a nonsyndromic
oligodontia patient. Especially, with the new strategy, implantanchored
orthodontics, which can facilitate the treatmentand make it
more simply with greater predictability.
The multifactorial factors influenc cleft Lip-literature review Abu-Hussein Muhamad
Congenital cleft-Lip and cleft palate have been the subject of many genetic
studies, but until recently there has been no consensus as to their modes of
inheritance. In fact, claims have been made for just about every genetic
mechanism one can think of. Recently, however, evidence has been
accumulating that favors a multifactorial basis for these malformations. The
purpose of the present paper is to present the etiology of cleft lip and cleft palate
both the genetic and the environmental factors. It is suggested that the genetic
basis for diverse kinds of common or uncommon congenital malformations may
very well be homogeneous, whilst, at the same, the environmental basis is
heterogeneous.
Dental implants represent one of the most successful treatment modalities in dentistry.
However, failures do occur in the range from 5 to 8% for routine procedures and up to 20% in major grafting cases after at least 5 years of function . The majority of implant losses may be explained as biomechanically induced failures, since low primary implant stability, low bone density, short implants and overload have been identified as risk factors . Hence, achievement and maintenance of implant stability are pre-conditions for a successful clinical outcome with dental implants.
The review focuses on different methods used to assess implant stability and recent advances in this field
Over time, progressively shorter implants have been placed such that short implants are now available that are less than 6 mm in length. The viability and high success rates seen with short implants can be explained by osseointegration, the macro geometric design of the implant, as well as physics and the distribution of forces. This paper was aimed to review the stability and survival rate of short implants under functional loads. Numerical and clinical studies were reviewed. Keywords: Short dental implants, sinus augmentation, factors affecting bone regeneration in dental implantology
Porcelain laminate veneers are among the most esthetic means of creating a more pleasing and beautiful smile. Porcelain veneers within reason allow for the alteration of tooth position, shape, size and color. They require a minimal amount of tooth preparation, approximately 0.5 mm to 0.7mm of surface enamel reduction. This study describes the use of ceramic veneers without tooth wear, reinforcing the concept that minimally invasive porcelain laminate veneers could become versatile and conservative allies in the fi eld of esthetic dentistry. Keywords: Ceramics, dentin-bonding agents, esthetics
Immediate Restoration of Single Implants Replacing Lateral Incisor Compromis...Abu-Hussein Muhamad
Today, the diagnosis of internal root resorption is significantly improved by the three-dimensional imaging. Furthermore, the CBCT’s superior diagnosis accuracy resulted in an improved management of the resorptive defects and a better outcome of Implant therapy of teeth with internal resorption.Implant has become a wide option to maintain periodontal architecture. Diagnosis and treatment planning is the key factors in achieving the successful outcomes after placing and restoring implants placed immediately after tooth extraction. The purpose of this clinical update is to report on the success and survival of Immediate restoration of single implants replacing right lateral incisor compromised by internal resorption.
Immediate Implant Placement And Restoration With Natural Tooth In The Maxilla...Abu-Hussein Muhamad
Anterior tooth loss and restoration in the esthetic zone is a common challenge in dentistry today. The prominent visibility of the area can be especially distressing to the patient and requires a timely and esthetically pleasing solution. Immediate single-tooth implantation followed by immediate provisionalization is becoming an increasingly desirable treatment that offers numerous benefits over conventional delayed loading. Provisionalization for immediately-placed implants using the patient’s existing tooth can enhance the final aesthetic outcome if certain steps are
followed. If the natural tooth is intact and can be used as a provisional, the emergence profile can be very similar to the preoperative condition. This article outlines a technique to use the patient’s natural tooth after extraction to provisionalize an implant.
Clinical Management of Bilateral Impacted Maxillary CaninesAbu-Hussein Muhamad
Introduction: Impaction of maxillary canines is a frequently encountered clinical problem in orthodontic therapy. When a preventive
approach fails, treatment involves surgical exposure of the impacted tooth, followed by orthodontic traction to guide and align it into the
dental arch. The aim of the present report was to demonstrate by case reports of an adult patient with bilateral impacted maxillary canines
treated with surgical exposure and orthodontic treatment.
Material and Methods: A 15year-old female with various degrees of bilateral palatal impaction of maxillary canines were managed
by the described technique.
Results and Discussion: Autonomous eruption of the impacted canines after surgical uncovering was witnessed in all patients
without the need for application of a vertical orthodontic force for their extrusion.
Conclusion: The described method of surgical uncovering and autonomous eruption created conditions for biological eruption of the
palatally impacted canines into the oral cavity and facilitated considerably the subsequent orthodontic treatment for their proper alignment
in the dental arch.
Keywords: Impacted canines; Surgical; Tooth exposure; Orthodontic treatment
“One-Piece” Immediate-Load Post-Extraction Implant In Maxillary Central IncisorAbu-Hussein Muhamad
Abstract: This case report describes extraction of a fractured left maxillary central incisor tooth, followed by immediate placement of an one-piece implant in the prepared socket and temporization by a bonded restoration.
Materials And Methods: The tooth was extracted with minimal hard and soft tissue trauma and without flap reflection. The socket was prepared to the required depth and a Implant was inserted.
Results: The atraumatic operating technique and the immediate insertion of the one-piece Implant resulted in the preservation of the hard and soft tissues at the extraction site.
Conclusion: The “One-piece” dental implant and provisional restoration provided the patient with immediate esthetics, function, comfort and most importantly preservation of tissues. The one-piece implant design resulted in a high cumulative implant survival rate and beneficial marginal bone levels.
Single Visit Replacement of Central Maxillary Using Fiber-Reinforced Composi...Abu-Hussein Muhamad
Fiber reinforced composites are high strength filling materials composed of conventional composites and glass fibres. They exhibit extensive applications in different fields of dentistry. This clinical report present a case where FRC technology was successfully used to restore central maxillary incisor edentulous area in terms of esthetic-cosmetic values and functionality.
Zirconium Dental Implants And Crown for Congenitally Missing Maxillary Latera...Abu-Hussein Muhamad
Zirconia implants were familiarized into dental implantology. Zirconia appears
to be an appropriate implant material due to its low plaque affinity, tooth like color, biocompatibility and mechanical properties. The following a case presentations will show how the acid-etched zirconia Implant can be used to functionally and aesthetically replace congenitally missing left lateral incisor tooth germ in the maxilla, and achieve optimal soft tissues and health.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Taurodontism; clinical considerations
1. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)
e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 15, Issue 12 Ver. VIII (December. 2016), PP 61-67
www.iosrjournals.org
DOI: 10.9790/0853-1512086167 www.iosrjournals.org 61 | Page
Taurodontism; Clinical Considerations
Abdulgani Azzaldeen , Abdulgani Mai , Watted Nezar,Abu-Hussein Muhamad
Abstract: Taurodontism is characterized by teeth with enlarged and elongated pulp chambers and apical
displacement of the bifurcation or trifurcation of roots. This anomaly occurs either as an isolated, singular trait
or in association with syndromes and with some ectodermal anomalies. The aim of this review is to address the
etiology, radiographic features and clinical considerations in the treatment of such teeth. It can be seen that
taurodontism has until now received insufficient attention from clinicians.
Keywords: Taurodontism, taurodont, Hertiwig’s epithelial root sheath (HERS), bull teeth
I. Introduction
Taurodontism is one of the anomalies of tooth morphology encountered in the dentition. This anomaly
is a developmental disorder of a tooth that shows a lack of constriction at the cement-enamel junction (CEJ) and
is characterized by vertically elongated pulp chambers, apical displacement of the pulpal floor and bifurcation or
trifurcation of the roots .[1]The origin of the name taurodontism is a combination of the two words “tauros”,
meaning “bull” in Latin and “odus” which is of Greek origin meaning “tooth" and the initial use of the term,
taurodontism, was to describe molar teeth resembling those of ungulates, particularly bulls .[2] Taurodontism is
currently defined as tooth morphologic alterations with the absence of the usual constriction at the cemento-
enamel junction; apical shift of the pulp chamber floor and furcation area at the expense of the roots and the root
canal length .[3]The etiology of taurodontism is still unclear. Some studies suggested that it results from the
invagination failure of Hertwig`s sheath at the proper horizontal level.[4] Llamas and Jimenez-Planas suggested
that the interference in epithelialmesenchymal induction can be considered a possible cause of taurodontism.[5]
Other theories that have been postulated include: a primitive pattern, a mutation, a retrograde or specialized
character, an X-linked trait, familial or an autosomal dominant trait ,[6] while some authors suggest that
Taurodontism is due to an ectodermal abnormality . [7]
Numerous theories have been proposed that the condition is related to genetic factors or mutations .
[2]Taurodontism seems essentially an isolated anomaly, but has been implicated to occur in association with
certain syndromes and genetic disorders that affect tooth morphogenesis, namely: Ectodermal dysplasia;
Down’s syndrome; McCune-Albright syndrome; Williams's syndrome; Amelogenesis imperfecta; Klinefelter
syndrome; Lowe syndrome; Wolf-Hirschhorn syndrome; and Mohr syndrome.[8] Taurodontism was first
described in 1908 by Gorjanovic – Kramberger a 70,000 year old pre-Neanderthal fossil, discovered in
Kaprina, Croatia . [9]Taurodontism was a frequent finding in early humans and is most common today in
Eskimos, possibly as a selective adaptation for cutting hide . The term ‘taurodontism’ was however first stated
by Sir Arthur Keith in 1913.[10]
Figure 1 : Witkop's criteria for diagnoses of taurodontism
Theories regarding the etiology of taurodontism have been many. It has been suggested that the
anomaly represents a primitive pattern, a mutation, a specialized or retrograde character, an atavistic feature, an
X-linked trait, familial or an autosomal dominant trait. Although taurodontism has been reported in association
with certain syndromes and some genetic defects its true significance is still obscure [2] . Taurodontism appears
most frequently as an isolated anomaly, but it has also been associated with several developmental syndromes
and anomalies including amelogenesis imperfecta, Down’s syndrome, ectodermal dysplasia, Klinefelter
syndrome, tricho-dento-osseous syndrome, Mohr syndrome, Wolf-Hirschhorn syndrome and Lowe syndrome
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[1]. Taurodontism has also been reported to present with other rare syndromes such as Smith-Magenis syndrome
, Williams syndrome , McCune-Albright syndrome and Van der Woude syndrome .[11]
Theories concerning the pathogenesis of taurodontic root formation are also varied: an unusual
developmental pattern, a delay in the calcification of pulpal chamber, an odontoblastic deficiency, an alteration
in Hertwig’s epithelial root sheath . According to some authors, taurodontism is most likely the result of
disrupted developmental homeostasis.[2,3,12]
Review of the literature reveals a wide discrepancy in the prevalence of taurodontism in different
populations. Its prevalence has been reported to range between 5.67% and 60% of subjects . [12]In a recent
study, it has been accounted for 18% of all of the anomalies . [13]The prevalence of taurodontism in children
was found in 0.3% .[14] A study on a group of Jordanian dental patients has shown an overall prevalence of 8%
for individuals . [15]Ruprecht et al [16]found a prevalence of 11.3% for individuals in Saudi dental patients,
whilst the results of Shifman and Channanel [17] were 5.6% in Israeli dental patients, compared with 46.4% in
young adult Chinese . [18]These variations in prevalence between different populations may be due to ethnic
variations, but may also be influenced by differences in criteria used for interpretation of taurodontism and also
the specific teeth examined .[19] Some studies have included premolars, while others believe that premolar
teeth may not be affected by taurodontism. It is commonly observed among the Eskimos and Natives of
Australia and Central America.[16]
In 1928 Shaw classified this condition as hypotaurodontism, mesotaurodontism and
hypertaurodontism based on the relative displacement of the floor of the pulp chamber.[20] This subjective,
arbitrary classification led normal teeth to be misdiagnosed as taurodontism. In 1977, Feichfnger and Rossiwall
stated that the distance from the bifurcation or trifurcation of the root to the cemento-enamel junction should be
greater than the occluso-cervical distance for a taurodontic tooth.[19] Though there are many classification
systems to determine the severity of taurodontism, Shifman and Chanannel in 1978 proposed a new
classification and is the widely used system till now.[17]
Figure 2: Measurements for taurodontic teeth
Cesar in 1971, published the first reported case of taurodontism in the deciduous dentition, where he
described it as a definite family trait in Afro-American children.[21] Subsequently, more cases were reported.
Goldstein and Gottlieb in 1973 reported cases of taurodontism in families of 14 persons. Familial relationships
of taurodontism are evidenced by the fact that 11 of the 14 persons were members of three families. Of the
remaining three cases, one is an isolated report, and two appear to have no familial relationship. [10]Bhat et al.
in 2004 reported a case of 5-yearold male child having taurodontism in all the deciduous molars. The permanent
molars -were normal. The mandibular deciduous molars required pulp therapy, which was performed under
local anesthesia in multiple sittings. [6] Rao and Arathi in 2006 reported taurodontism involving all the
deciduous and permanent molars (non-syndromic). [22]Bharti et al. in 2009 reported a case of endodontic
treatment in a maxillary right first primary molar with taurodontism. In this case, the maxillary right second
molar and maxillary left first and second molars were also taurodontic along with the maxillary right first
primary molar. [23]Tyagi in 2010 reported a case of a 5-year-old boy with taurodontic lower left second primary
molars, which was endodontically treated. [24] Reddy, 2010 reported a unique case of endodontic treatment in a
5-year-old male child with four taurodontic primary molars. [25]
The first report of taurodontism in modern man’s dentition was published in 1909 by Pickerill, who
used the term “radicular dentinoma” to describe the condition. He described two maxillary first molars
exhibiting an overall cuboidal or “bale” shape with normal crowns, and one central quadrilateral-shaped pulp
cavity instead of individual root canals. The first permanent molars did not show this trait.[26] Senyurek in
1939 noted taurodontism in the teeth of ancient Egyptians, ancient Icelanders and early American Indians.
Following this initial case report, few case of taurodontism was reported in the literature during the next 50
years. Pillai et al. in 2007 reported the presence of taurodontism in premolar in a section of Trinidadian
population. Prevalence of taurodontism was assessed by the radiographic study 4.79%, and was found to be
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higher in the males as compared to females. Significant differences were also observed between mandibular and
maxillary premolars. [27]Joshy et al. in 2011 reported a rare case of a 15-year-old male patient who presented
with taurodontism involving all the developed molars in all four quadrants, which was not associated with any
other anomaly or syndrome. [28]
Figure 3: Hypotaurodontism involving right mandibular first and second molar
II. The Diagnosis And Classification Of Taurodontism
Clinically, taurodont teeth cannot be diagnosed because the CEJ and roots of a taurodont tooth lie
below the alveolar margin,[29] Therefore, the diagnosis of taurodontism is usually made from diagnostic
radiographs .[ 30]Taurodontism can be seen in both the permanent and primary teeth but considered rare in the
primary dentition.[15,29] Figure 1
Shaw classified taurodontism as hypotaurodontism, mesotaurodontism and hypertaurodontism based
on the relative displacement of the floor of the pulp chamber[20]:
A.Hypotaurodont: moderate enlargement of the pulp chamber at the expense of the roots.
B.Mesotaurodont: pulp is quite large and the roots short but still separate.
C.Hypertaurodont: prismatic or cylindrical forms where the pulp chamber nearly reaches the apex and then
breaks up into 2 or 4 channels.
This subjective, arbitrary classification commonly led to a misdiagnosis of taurodontism. Although
preferred, it is not regarded as an objective analysis. [31]
Figure 4: Preoperative radiograph of (mesotaurodontism on mandibular left first molar and hypotaurodontism
in second molar
It is important to diagnose taurodontism by means of metric analysis rather than just depending on a
visual radiographic assessment which is considered opinionated . [32]Taurodontism may be misdiagnosed in
teeth that exhibit attrition and wear-induced secondary dentine deposition in the pulp chambers. Caution should
thus be exercised when interpreting taurodontism in severe cases of attrition .[29] Keene suggested a taurodont
index that calculates the relation between the height of the pulp chamber and the length of the longest root. He
proposed three categories of taurodontism for this index: Normal teeth: index value of 0–24.9%; Hypotaurodont
teeth: index value of 25–49.9%; Mesotaurodontism: index value of 50–74.9%; Hypertaurodontism: index value
of 75–100%. The disadvantage noted was the use of landmarks that are considered biologically changeable
structures, as the pulp chamber undergoes changes with aging and the root length is subjected to change in
length, as in external resorption.[33]
Feichtinger and Rossiwall (1977) based the diagnosis of taurodontism on the distance from the
bifurcation or trifurcation of the root to the CEJ, which should be longer than the occluso-cervical distance.[34]
A biometric study conducted by Blumberg et al. used five variables to diagnose taurodontism, without
specific reference to any classification. The author was of the impression that taurodontism is a continuous
anomaly and therefore cannot be placed into strict categories.[3]
These variables are:
Variable 1: Mesio-distal distance between contact points of the crown.
Variable 2: Mesio-distal diameter taken at the level of the cement-enamel junction.
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Variable3: Perpendicular distance from baseline to highest point on pulp chamber floor.
Variable 4: Perpendicular distance from baseline to apex of longest root.
Variable 5: Perpendicular distance from baseline to lowest point on pulp chamber roof.
The biometric technique advised by Seow and Lai was employed to establish the diagnosis of taurodontism on
panoramic radiographs, by determining the crown-body length (CB) and root length (R) ratio. Based on this
ratio, normal teeth (Cynodont) had a CB: R ratio <1.10, whereas the teeth which had a ratio between 1.10-1.29
were considered hypotaurodontic. Mesotaurodont teeth had a ratio between 1.30 and 2.00, and lastly teeth with
ratio > 2.0 were considered hypertaurodontic. [36] Figure 2
Shifman and Chanannel [17] proposed a new classification derived from a taurodontism index (TI),
calculated by measuring two variables of molar teeth on radiographs:
Variable 1: This is the distance between the lowest point of the roof of the pulp chamber and the highest point
in the floor of the pulp chamber.
Variable 2: This is the distance between the lowest point of the roof of the pulp chamber and the apex of the
longest root.
Variable 3: The distance between a line connecting both CEJ points, and the highest point of the floor of the
pulp chamber.
Taurodont molar teeth were diagnosed when the TI was above 20 and variable 3 measured more than
2.5 mm. By using the taurodontism index TI, the degrees of taurodontism were classified as: hypotaurodontism
has a TI from 20 to 30, mesotaurodontism has TI from 30 to 40, while a TI from 40 to 75 presents
hypertaurodontism. This is regarded as the most widely used system to date.[17]
In addition to all these methods, Tulensalo et al. examined a simple method of assessing taurodontism
using panoramic radiographs by measuring the distance between the baseline (a line connecting the mesial and
distal points of the CEJ) and the highest point of the floor of the pulp chamber. [37]A tooth was diagnosed as
taurodontic when that distance reached or exceeded 3.5 mm. They concluded that this technique is reliable in
epidemiologic investigations for assessing taurodontism in a developing dentition .[38]
In certain metabolic conditions including pseudo-hypoparthyroidism, hypophosphatasia, and
hypophosphatemic vitamin D-resistant and dependent rickets, the pulp chamber may be enlarged but the teeth
are of relatively normal form. Another differential diagnosis is in the early stages of dentinogenesis imperfecta,
where the appearance may resemble the large pulp chambers found in taurodontism. Moreover, the developing
molars may appear similar to taurodonts; however, an identification of wide apical foramina and incompletely
formed roots helps in the differential diagnosis.dentification of the condition can only be done by radiographic
examination as the external morphology of the teeth is within normal configurations. The radiographic
examination is the only way to visualize a rectangular configuration of the pulp chamber.[39]
Diagnosis of taurodontism has been based on the subjective radiographic evaluation. The appearance of
the taurodont tooth is very characteristic, and the unusual nature of this condition is best visualized on the
radiograph. Involved teeth assume a rectangular shape preferably than tapering towards the roots. The pulp
chamber is extremely large with a greater apical-occlusal height than normal and lacks the usual constriction at
the cervical region of the teeth with exceedingly short roots. The bifurcation or trifurcation may be only a few
millimetres (mm) above the apices of the roots.[39]
Figure 5: Orthopantamograph showing bilateral taurodontic mandibular first and second primary molars with
bilateral primary maxillary first molars with a single root
III. Clinical Considerations
The clinical implication of taurodontism has potentially increased risk of pulp exposure because of decay and
dental procedures. Taurodontism may complicate orthodontic and/or prosthetic treatment planning.
Taurodontism, although not very common has to be emphasized due to its influence on various dental
treatments.
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3.1.Pedodontic consideration
Pulp therapy for taurodonts is a challenging treatment, with increased incidence of haemorrhage during
access opening which may be mistaken for perforation. Since the roots are short and pulpal floor is placed
apically, care should be taken to prevent perforation. Conventional obturating materials like Zinc oxide eugenol
in bulk may take longer time to resorb which may delay the natural exfoliation of the tooth. In such cases
combination of calcium hydroxide can act as a wonderful material due to its resorption rate. Endoflas as
anobturating material can be used, which is a combination of zinc oxide eugenol, iodoform, calcium hydroxide
and barium sulphate. This material has added advantage of faster rate of resorption due to presence of calcium
hydroxide and iodoform. [6,25,31] Figure 1
3.2.Endodontic considerations:
A taurodont tooth shows wide dissimilarity in the size and shape of the pulp chamber, varying degrees
of obliteration and canal configuration, apically positioned canal orifices, and the potential for additional root
canal systems. [12] From an Endodontist‟s view, taurodontism presents a challenge during negotiation,
instrumentation and obturation in root canal treatment. Because of the difficulty of the root canal, anatomy and
proximity of buccal orifices complete filling of the root canal system in taurodont teeth are challenging. A
modified filling technique, which consists of combined lateral compaction in the apical region with vertical
compaction of the elongated pulp chamber, has been proposed. [13] Recently, a case report highlights the use of
high-end diagnostic imaging modalities such as spiral computerized tomography in making a valid diagnosis of
the multiple morphologic abnormalities such as taurodontism, dens invaginations, pyramidal cusps of the
premolars, dens evaginatus.[14] The selection of endodontic therapy in these situations will be conservative.
Therefore, root canal treatment becomes a difficult. Though taurodontism is of rare occurrence, the clinician
should be aware of the complex canal system for its successful endodontic treatment.[2.3] Figure 4
Each taurodont tooth may have extraordinary root canals in terms of shape and number. A complicated root
canal treatment has been reported for a mandibular taurodont tooth with five canals, only three of which could
be instrumented to the apex . [40]Therefore, careful exploration of the grooves between all orifices, especially
with magnification , has been recommended to reveal additional orifices and canals.[41]
Figure 5:Endodontic treatment of a mandibular hypertaurodontic second molar
Because the pulp of a taurodont is usually voluminous, in order to ensure complete removal of the
necrotic pulp, 2.5% sodium hypochlorite has been suggested initially as an irrigant to digest pulp tissue .
[42]Moreover, as adequate instrumentation of the irregular root canal system cannot be anticipated, Widerman
& Serene suggested that additional efforts should be made by irrigating the canals with 2.5% sodium
hypochlorite in order to dissolve as much necrotic material as possible.[43] Application of final ultrasonic
irrigation may ensure that no pulp tissue remains . [42]Because of the complexity of the root canal anatomy and
the proximity of the buccal orifices, complete filling of the root canal system in taurodontism is challenging. A
modified filling technique has been proposed, which consists of combined lateral compaction in the apical
region with vertical compaction of the elongated pulp chamber, using the system B device (EIE/Analytic
Technology, San Diego, CA, USA) .[44] Another endodontic challenge related to taurodonts is intentional
replantation. The extraction of a taurodont tooth is usually complicated because of a dilated apical third . [41]In
contrast, it has also been hypothesized that because of its large body, little surface area of a taurodont tooth is
embedded in the alveolus. This feature would make extraction less difficult as long as the roots are not widely
divergent ). Finally, it should be noted that in cases of hypertaurodont (where the pulp chamber nearly reaches
the apex and then breaks up into two or four channels) vital pulpotomy instead of routine pulpectomy may be
considered as the treatment of choice .[17,30] Figure 5,6
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3.3.Periodontal considerations:
From a periodontal view taurodont teeth may, in specific cases, offer favourable prognosis. Where
periodontal pocketing or gingival recession occurs, the chances of furcation involvement are considerably less
than those in normal teeth because taurodont teeth have to demonstrate significant periodontal destruction
before furcation involvement occurs[42,43,44].
3.4.Surgical considerations:
The extraction of a taurodont tooth is usually complicated because of shift in the furcation to apical
third. In contrast, it has also been hypothesized that the large body with little surface areaof a taurodont tooth is
embedded in the alveolus.[2,3] This feature would make extraction less difficult as long as the roots are not
widely divergent. It is reported that extraction of such teeth may not be a problem unless theroots are not widely
divergent. However, some authors believe that hypertaurodonts may pose some problem during extraction
because of apical shift of furcation and also due to difficulty in placement of forceps beaks. This problem can
be resolved by proper usage of surgical tooth elevators.[14,32]
3.5.Prosthetic considerations:
For the prosthetic treatment of a taurodont tooth, it has been advocated that post placement is avoided
for tooth reconstruction. Because less surface area of the tooth is embedded in the alveolus, a taurodont tooth
may not have as much strength as a cynodont when used as an abutment for either prosthetic or orthodontic
purposes . Since the placement of the stainless steel, crown is considered the ultimate extra coronal restoration
in pediatric dentistry, the lack of a cervical constriction tends to deprive the tooth of the buttressing effect of
excessive loading of the crown.[13]
It is very important for a general dental practitioner to be familiar with taurodontism not only with
regards to clinical complications but also its management. Taurodontism also provides a valuable clue in
detecting its association with many syndromes and other systemic conditions.
IV. Conclusion
Taurodontism is a morpho-anatomical developmental anomaly that usually appears in the form of
multi-rooted teeth. Taurodontism is a dental rarity. A thorough knowledge of etiology, anatomic and
radiographic features and its association with other syndromes of dental rarity should be well understood. From
this review, we conclude, it is very important for a pediatric dentist to be well known with taurodontism not only
with regards to clinical complications but also its management. Taurodontism also provides a valuable clue in
detecting its relation with many syndromes and other systemic conditions
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