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CASE REPORT
Year : 2013  |  Volume : 4  |  Issue : 2  |  Page : 67-69

Talon cusp: A case report with management guidelines for practicing dentists


1 Department of Prosthodontics, Indira Gandhi Government Dental College, Jammu, India
2 Department of Oral Pathology, Himachal Pradesh Government Dental College, Shimla, Himachal Pradesh, India
3 Department of Pediatric and Preventive Dentistry, Himachal Pradesh Government Dental College, Shimla, Himachal Pradesh, India
4 Private Practitioners, Jammu and Kashmir, India

Date of Web Publication5-Jun-2013

Correspondence Address:
Reecha Gupta
House No. 129/3, Channi Himmat, Jammu - 180 015, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2155-8213.113020

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  Abstract 

Introduction: Talon cusp is an uncommon odontogenic anomaly which most frequently affects maxillary permanent incisors. Its presence causes the problem in esthetics, prevention of caries, and occlusal accommodation for the patient and problems in the diagnosis and clinical management for the dentist. Case Report: This article reports a case of talon cusp on the palatal surface of the permanent maxillary central incisor. Discussion: Since, the presence of talon cusp usually demands that definitive treatment be instituted; it represents a problem of clinical significance. The dentist should be able to diagnose it as the maxillary incisor is also the principal site for supernumerary tooth.

Keywords: Management, permanent maxillary central incisor, talon cusp


How to cite this article:
Gupta R, Thakur N, Thakur S, Gupta B, Gupta M. Talon cusp: A case report with management guidelines for practicing dentists. Dent Hypotheses 2013;4:67-9

How to cite this URL:
Gupta R, Thakur N, Thakur S, Gupta B, Gupta M. Talon cusp: A case report with management guidelines for practicing dentists. Dent Hypotheses [serial online] 2013 [cited 2018 Jul 17];4:67-9. Available from: http://www.dentalhypotheses.com/text.asp?2013/4/2/67/113020


  Introduction Top


Talon cusp is an uncommon odontogenic anomaly comprising of an accessory cusp like structure, more commonly seen on the palatal surfaces of the maxillary incisors. This unusual dental anomaly showing an accessory cusp-like structure projecting from the cingulum to the cutting edge was first described by Mitchell in 1892. [1] It was thereafter named talon cusp by Mellor and Ripa [2] due to its resemblance to an eagle's talon. Since then, this odontogenic anomaly has been given several descriptions, such as, prominent accessory cusp-like structure, [3] exaggerated cingula, [4] additional cusp, [5] cusp-like hyperplasia, [6] accessory cusp [7] and supernumerary cusp. [8] It has been defined as a supernumerary accessory talon-shaped cusp projecting from the lingual or facial surface of the crown of a tooth and extending for at least half the distance from the cemento-enamel junction to the incisal edge. [7]

There is a wide variation in size and shape of this anomaly. Due to this variation, and in order to have diagnostic criteria, it has been classified into 3 types by Hattab et al.: [9]

  • Type 1: Talon - Refers to a morphologically well-delineated additional cusp that prominently projects from the palatal (or facial) surface of a primary or permanent anterior tooth and extends at least half the distance from the cemento-enamel junction to the incisal edge.
  • Type 2: Semi talon - Refers to an additional cusp of a millimeter or more extending less than half the distance from the cemento-enamel junction to the incisal edge. It may blend with the palatal surface or stand away from the rest of the crown.
  • Type 3: Trace talon - An enlarged or prominent cingula and their variations, i.e., conical, bifid or tubercle-like.

  Case Report Top


A 9-year-old child accompanied with his mother reported to the Department of Pediatric and Preventive Dentistry with the chief complaint of "an extra small tooth present on the back of upper front tooth causing trouble as it strikes with the lower tooth." An intra-oral examination revealed a talon cusp on the palatal surface of the permanent maxillary right central incisor [Figure 1]. An intraoral periapical X-ray was taken to confirm the finding [Figure 2].
Figure 1: Occlusal view of talon cusp on permanent maxillary right central incisor

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Figure 2: Intraoral periapical X-ray of the same tooth

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There was labial tipping of the permanent maxillary right central incisor as talon cusp was interfering during the chewing as mandibular right central incisor was striking against it. We ground the talon cusp to disocclude it and applied Flucal Solute over it for 5 min and recalled the patient after 6 weeks for review examination.


  Discussion Top


Talon cusp is an unusual and relatively rare anomaly which most frequently affects maxillary permanent incisor. The term, talon cusp refers to the same condition as Dens evaginatus, but on the anterior teeth. It is composed of enamel, dentine and a varying amount of pulp tissue. [10],[11]

It is more common in the permanent dentition (75%) than in the primary dentition while 92% affect the maxillary teeth. [8],[9] The maxillary lateral incisor is the most frequently affected in the permanent dentition while the maxillary central incisor is the most affected in the primary dentition. [8] The reported prevalence is 0.6% in Mexicans, 7.7% in a northern Indian, 2.5% in a Hungarian, 5.2% in Malaysian and 2.4% in Jordanian population. [12]

Etiology

The exact etiology is not known, but it is suggested to be a combination of genetic and environmental factors. [9]

It is thought to arise during the morphodifferentiation stage of tooth development, as a result of out-folding of the enamel organ or hyperproductivity of the dental lamina. [9] It is suggested that disturbances during morphodifferentiation such as altered endocrine function might affect the shape and size of the tooth without impairing the function of ameloblasts and odontoblasts. There is also a suggestion of a strong genetic influence in its formation as evidenced by its occurrence in close family members. Talon cusp may occur in isolation or with other dental anomalies such as mesiodens, odontome, unerupted or impacted teeth, peg-shaped maxillary incisor, dens invaginatus, cleft lip, and distorted nasal alae, bilateral gemination, fusion, supernumerary teeth, and enamel clefts. [13] It has also been associated with some systemic conditions such as Mohr syndrome (oro-facial-digital II),  Sturge- Weber syndrome More Details More Details (encephalo-trigeminal angiomatosis), Rubinstein-Taybi syndrome, incontinentia pigmenti achromians, and Ellis-van Creveld syndrom. [14]

Using the classification given by Hattab et al., [9] we grade our case as a Type 1 talon cusp. Superimposition of the cusp over the main tooth made it difficult to determine the extent of pulp tissue in the anomalous cusp. There was no associated systemic or local condition in this patient nor is there history of occurrence in any family member.

Management

Management depends upon the case. A small asymptomatic talon cusp needs no treatment. 24],[33 Large talon cusps may cause clinical problems including occlusal interference, displacement of the affected tooth, irritation of the tongue during the speech and mastication, carious lesion in the developmental grooves that delineate the cusp, pulpal necrosis, periapical pathosis, attrition of the opposing tooth and periodontal problems due to excessive occlusal forces. [15]

Fissure sealing and composite resine restoration can be carried out in cases of deep developmental grooves. [2]

An essential step, especially in case of occlusal interference is to reduce the bulk of the cusp gradually and periodically and the application of topical fluoride, or total reduction of the cusp and calcium hydroxide pulpotomy. [16] Sometimes complete removal of cusp is done along with the pulp extirpation and root canal therapy. [17] Orthodontic correctin may become necessary when there is tooth displacement or malalignment of affected or opposing teeth. [18]

In this case, talon cusp was interfering with the occlusion and there was labial tipping of the maxillary right central incisor. Therefore, we ground it to disocclude the tooth and Flucal Solute was applied over it for 5 min to reduce the sensitivity and the patient was recalled after 6 weeks.

 
  References Top

1.Mitchell WH. Letter to the editor. Dent Cosm 1892;34:1036.  Back to cited text no. 1
    
2.Mellor JK, Ripa LW. Talon cusp: A clinically significant anomaly. Oral Surg Oral Med Oral Pathol 1970;29:225-8.  Back to cited text no. 2
    
3.Mader CL. Talon cusp. J Am Dent Assoc 1981;103:244-6.  Back to cited text no. 3
    
4.Davis JM, Law DB, Lewis TM. An Atlas of Pedodontics. 2 nd ed. Philadelphia: W.B. Saunders Co; 1981. p. 62.  Back to cited text no. 4
    
5.Davis PJ, Brook AH. The presentation of talon cusp: Diagnosis, clinical features, associations and possible aetiology. Br Dent J 1986;160:84-8.   Back to cited text no. 5
    
6. Chen RJ, Chen HS. Talon cusp in primary dentition. Oral Surg Oral Med Oral Pathol 1986;62:67-72.  Back to cited text no. 6
    
7.Jowharji N, Noonan RG, Tylka JA. An unusual case of dental anomaly: A facial talon cusp. ASDC J Dent Child 1992;59:156-8.   Back to cited text no. 7
    
8. Dankner E, Harari D, Rotstein I. Dens evaginatus of anterior teeth. Literature review and radiographic survey of 15,000 teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;81:472-5.   Back to cited text no. 8
    
9. Hattab FN, Yassin OM, al-Nimri KS. Talon cusp in permanent dentition associated with other dental anomalies: Review of literature and reports of seven cases. ASDC J Dent Child 1996;63:368-76.  Back to cited text no. 9
    
10.Shafer WG, Hine MK, Levy BM. A Textbook of Oral Pathology. 3 rd ed. Philadelphia: W.B. Saunders Co; 1974. p. 38.  Back to cited text no. 10
    
11.Dash JK, Sahoo PK, Das SN. Talon cusp associated with other dental anomalies: A case report. Int J Paediatr Dent 2004;14:295-300.   Back to cited text no. 11
    
12. Hamasha AA, Safadi RA. Prevalence of talon cusps in Jordanian permanent teeth: A radiographic study. BMC Oral Health 2010;10:6.  Back to cited text no. 12
    
13.Oredugba FA. Mandibular facial talon cusp: Case report. BMC Oral Health 2005;5:9.  Back to cited text no. 13
    
14.Hattab FN, Yassin OM, Sasa IS. Oral manifestations of Ellis-van Creveld syndrome: Report of two siblings with unusual dental anomalies. J Clin Pediatr Dent 1998;22:159-65.  Back to cited text no. 14
    
15.Shafer WG, Hine MK, Levy BM. Developmental disturbances of oral and paraoral structures. In: Sivapathsundaram B, Rajendran R, editors. A Textbook of the Oral Pathology. 5 th ed. New Delhi: Elsevier; 2008. p. 3-112.   Back to cited text no. 15
    
16. Pledger DM, Roberts GJ. Talon cusp: Report of a case. Br Dent J 1989;167:171-3.  Back to cited text no. 16
    
17.Segura JJ, Jiménez-Rubio A. Talon cusp affecting permanent maxillary lateral incisors in 2 family members. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:90-2.  Back to cited text no. 17
    
18.Pitts DL, Hall SH. Talon-cusp management: Orthodontic-endodontic considerations. ASDC J Dent Child 1983;50:364-8.  Back to cited text no. 18
    


    Figures

  [Figure 1], [Figure 2]


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