|Year : 2013 | Volume
| Issue : 2 | Page : 67-69
Talon cusp: A case report with management guidelines for practicing dentists
Reecha Gupta1, Narbir Thakur2, Seema Thakur3, Bhavna Gupta4, Mohit Gupta4
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 Publication||5-Jun-2013|
House No. 129/3, Channi Himmat, Jammu - 180 015, Jammu and Kashmir
Source of Support: None, Conflict of Interest: None
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
| Introduction|| |
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.  It was thereafter named talon cusp by Mellor and Ripa  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,  exaggerated cingula,  additional cusp,  cusp-like hyperplasia,  accessory cusp  and supernumerary cusp.  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. 
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.: 
- 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|| |
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|
Click here to view
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|| |
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. ,
It is more common in the permanent dentition (75%) than in the primary dentition while 92% affect the maxillary teeth. , 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.  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. 
The exact etiology is not known, but it is suggested to be a combination of genetic and environmental factors. 
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.  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.  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. 
Using the classification given by Hattab et al.,  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 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. 
Fissure sealing and composite resine restoration can be carried out in cases of deep developmental grooves. 
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.  Sometimes complete removal of cusp is done along with the pulp extirpation and root canal therapy.  Orthodontic correctin may become necessary when there is tooth displacement or malalignment of affected or opposing teeth. 
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|| |
|1.||Mitchell WH. Letter to the editor. Dent Cosm 1892;34:1036. |
|2.||Mellor JK, Ripa LW. Talon cusp: A clinically significant anomaly. Oral Surg Oral Med Oral Pathol 1970;29:225-8. |
|3.||Mader CL. Talon cusp. J Am Dent Assoc 1981;103:244-6. |
|4.||Davis JM, Law DB, Lewis TM. An Atlas of Pedodontics. 2 nd ed. Philadelphia: W.B. Saunders Co; 1981. p. 62. |
|5.||Davis PJ, Brook AH. The presentation of talon cusp: Diagnosis, clinical features, associations and possible aetiology. Br Dent J 1986;160:84-8. |
|6.|| Chen RJ, Chen HS. Talon cusp in primary dentition. Oral Surg Oral Med Oral Pathol 1986;62:67-72. |
|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. |
|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. |
|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. |
|10.||Shafer WG, Hine MK, Levy BM. A Textbook of Oral Pathology. 3 rd ed. Philadelphia: W.B. Saunders Co; 1974. p. 38. |
|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. |
|12.|| Hamasha AA, Safadi RA. Prevalence of talon cusps in Jordanian permanent teeth: A radiographic study. BMC Oral Health 2010;10:6. |
|13.||Oredugba FA. Mandibular facial talon cusp: Case report. BMC Oral Health 2005;5:9. |
|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. |
|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. |
|16.|| Pledger DM, Roberts GJ. Talon cusp: Report of a case. Br Dent J 1989;167:171-3. |
|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. |
|18.||Pitts DL, Hall SH. Talon-cusp management: Orthodontic-endodontic considerations. ASDC J Dent Child 1983;50:364-8. |
[Figure 1], [Figure 2]