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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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CASE REPORT
Year : 2005  |  Volume : 23  |  Issue : 2  |  Page : 89-91
 

Double facial and a lingual trace talon cusps: A case report


Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere, India

Correspondence Address:
N D Shashikiran
Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere - 577 004, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.16449

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   Abstract 

Talon cusp is an uncommon odontogenic anomaly, presented as an accessory cusp like structure on the crown of an anterior tooth. Their presence may create diagnostic, esthetics, occlusal, pulpal and periodontal problems. This case report describes an unusual double facial talon cusp along with lingual trace talon on left maxillary central incisor.


Keywords: Cusp, double talon, facial, trace talon


How to cite this article:
Shashikiran N D, Babaji P, Reddy V V. Double facial and a lingual trace talon cusps: A case report. J Indian Soc Pedod Prev Dent 2005;23:89-91

How to cite this URL:
Shashikiran N D, Babaji P, Reddy V V. Double facial and a lingual trace talon cusps: A case report. J Indian Soc Pedod Prev Dent [serial online] 2005 [cited 2020 May 31];23:89-91. Available from: http://www.jisppd.com/text.asp?2005/23/2/89/16449


A talon cusp is a morphologically well delineated, supernumerary accessory talon shaped cusp, projecting from the lingual or the facial surface of the crown of an incisor and extending at least half the distance from the cementoenamel junction to the incisal edge. [1],[2] Talon cusp occurs in both primary and permanent dentition, in maxillary or mandibular teeth, and it may be either unilateral or bilateral.[2],[3],[4] It has predilection for maxilla over mandible and higher frequency in males over females. [2]-[6] It is composed of normal enamel, dentin and varying extensions of pulp tissue. [1],[7],[8] It varies in size, shape, structure, location and site of origin. [6] Hattab et al. [4] classified this accessory cusp into talon, semitalon and trace talon according to the extent of accessory cusp from cementoenamel junction towards the incisal edge.


   Case Report Top


An 8-year-old female reported to the department of Pedodontics and Preventive Dentistry, College of dental sciences, Davangere, with complaint of an abnormally shaped left maxillary central incisor. Her medical history was noncontributory. No other family members had similar dental anomaly.

Examination of the oral cavity revealed good dental health, no soft tissue abnormalities; bilateral Class I molar relationship with slightly mesially rotated maxillary central incisor.

Maxillary left central incisor exhibited double accessory well-defined cusps on facial side [Figure - 1], each measuring 7.0 ´ 3.5 mm and 7.5 ´ 4.0 mm in length and breadth. Cusps were separated from rest of crown structure by noncarious developmental grooves. Lingually, left central incisor was more concave mesiodistally as compared to contralateral and had little cone-shaped projection [Figure - 2], directly from cingulum area (Trace talon). Cusp tips were not causing trauma to her lips.

Radiographic examination revealed, double V-shaped radio-opaque structures, superimposed on the image of an affected tooth, composed of normal enamel, dentin and pulp tissue [Figure - 3]. Diagnosis of double facial talon cusp with a lingual trace talon cusp was made.


   Discussion Top


The exact etiology of this condition remains unknown. It is thought to occur during morphodifferentiation stage, as a result of outward folding of an inner enamel epithelial cells (precursors of ameloblasts) and a transient focal hyperplasia of the mesenchymal dental papilla (precursor of odontoblasts) or combination of genetic and environmental factors (multifactorial). [4],[6],[9],[10] Talon cusp may occur as an isolated entity or in association with other dental abnormalities like exaggerated cusp of carabelli, microdent tooth, megadont, odontome, bifid cingulum, double teeth, fusion, dens evaginatus, dens invaginatus, shovel-shaped tooth, supernumerary teeth, congenitally missing teeth and impacted tooth. [2],[3],[6],[9] Chawla and Tewari [11] in North Indian children, Buenviaje and Rapp [12] in American children, Sedano et al. [13] in Mexican children and Mean [14] in Malaysian children reported, 7.7, 0.17, 0.6 and 5.2% prevalence of talon cusp, respectively.

Talon cusp may present as an asymptomatic and incidental dental finding during routine dental examination. Clinical problems associated with talon cusp include compromised esthetic, irritation of the tongue during speech and mastication, accidental cusp fracture, pulpal exposure due to cuspal attrition, pulpal necrosis, periapical pathology, periodontal pocket, pain in periodontal ligament secondary to traumatic occlusion, displacement of teeth, occlusal interference and possibility of temporomandibular joint pain [3],[5], [15],[16],[17],[18],[19] plaque retention in associated grooves may cause early caries. [3],[9],[15]

Talon cusps usually occur on the lingual surface, although in rarity it may be seen on the facial surfaces of maxillary teeth. [1],[5],[15],[17],[20] Abbott [5] reported a labial and palatal talon cusp on the same tooth. Gorlin and Goldmn [21] have reported cusp formation in mesial and distal marginal ridge of maxillary incisors and double palatal dental tubercle (talon cusp) in maxillary lateral incisor. Al-Omari et al. [3] reported a case of double palatal talon cusps on maxillary central incisor. In this case report, a rare occurrence of double facial and lingual trace talon cusps on the left maxillary central incisor is presented.

Occurrence of accessory cusps, especially on the facial surface of anteriors may cause esthetic and psychological trauma to the patient.

Small talon cusps are asymptomatic and need no treatment, but large and prominent cusps may cause occlusal, pulpal, periodontal and esthetic problems and may require treatment. [5],[3],[17]

Following three procedures can be considered for the treatment of talon cusp if they are causing trauma and esthetic problems [22],[23]

1. Periodic reduction of accessory cusp over a 6-8-week interval with application of fluoride as a desensitizing agent, so that it will avoid possibility of pulpal exposure and helps in reparative dentine formation. Fissure sealants or glass-ionomer cement to seal associated grooves as prophylactic measure.

2. Complete reduction of cusp followed by calcium hydroxide pulpotomy for an immature tooth, if there is pulpal exposure.

3. Complete cuspal reduction followed by root canal treatment.



 
   References Top

1.Jowharji N, Noonansr RG, Tylka JA. An unusual case of dental anomaly: A facial talon cusp. J Dent Child 1992;59:156-8.  Back to cited text no. 1    
2.Mader CL. Talon cusp. J Am Dent Assoc 1981;103:244-6.  Back to cited text no. 2  [PUBMED]  
3.Al-Omari MAO, Hattab FN, Darwazeh AMG, Dummer PMH. Clinical problems associated Vvith unusual cases of talon cusp. Int Endod J 1999;21:183-90.  Back to cited text no. 3    
4.Hattab FN, Yassin OM, Al-Nimrin KS.Talon cusp in permanent dentition associated with other dental anamalies: Review of literature and report of seven cases. J Dent Child 1996. p. 368-76.  Back to cited text no. 4    
5.Abbott PV. Labial and palatal "talon cusps" on the same tooth: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85:726-30.  Back to cited text no. 5  [PUBMED]  
6.Hattab FN, Yassin OM, Nimri KS. Talon cusp-clinical significance and management: Case reports. Quintessence Int 1995;26:2:115-20.  Back to cited text no. 6  [PUBMED]  
7.Natkin E, 'Pitts DL, Worthington P. A case of talon cusp associated with other odontogenic abnormalities. J Ended 1983;9:491-5.  Back to cited text no. 7    
8.Shafer WG, Hine MK, Levy BM. Textbook of oral pathology. 4th Ed. Philadelphia: W.B. Saunders Company; 1993. p. 40.  Back to cited text no. 8    
9.Davis PJ, Brook AH. The Presentation of talon cusp: Diagnosis, clinical features, associations and possible etiology. Br Dent J 1985:159: 84-8.  Back to cited text no. 9    
10.Sarkar S, Misra J, Das G. Talon cusp-heredity origin-a case report. J Indian Soc Pedod Prev Dent 1999;17:126-8.  Back to cited text no. 10    
11.Chawla HS, Tewari A. Talon cusp, prevalence study. J Indian Soc Pedod Prev Dent 1983. p. 28-34.  Back to cited text no. 11    
12.Buenviaje TM, Rapp R. Dental anamalies in children: A clinical and radiographic survey. J Dent Child 1984;51:42-6.  Back to cited text no. 12  [PUBMED]  
13.Sedano HO, Freyre IC, Garza de la Garza ML, et al. Clinical orodental abnormalities in Mexican children. Ora Surg Oral Med Oral Pathol Oral Radiol Endod 1989;68:300-11.  Back to cited text no. 13    
14.Mean R. Talor cusp in Malayasia. Aust Dent J 1991;36:11-4.  Back to cited text no. 14    
15.De Sousa SMG, Ta\ano SMR, Bramante CM. Unusual case of bilateral talon cusp associated with dens invaginatus. Int Endod J 1999;32:494-8.  Back to cited text no. 15    
16.Mader CL. Mandibular talon cusp. J Am Dent Assoc 1982;105:651-3.  Back to cited text no. 16  [PUBMED]  
17.McNamara T, Haeussler AM, Keane J. Facial talon cusp, hit. J Ped Dent 1997;7:259-62.  Back to cited text no. 17  [PUBMED]  
18.Pledger DM, Roberts GJ. Talon cusp. Report of a case. Br Dent J 1989;167:171-3.  Back to cited text no. 18  [PUBMED]  
19.Shey Z, Eytal R. Clinical management of an unusual case of dens evaginatus in maxillary central incisor. J Am Dent Assoc 1983;106:346-8.  Back to cited text no. 19    
20.Tsutsumi T, Oguchi H. Labial talon cusp in a child with incontinentia pigmentia achromians: Case report. Pediatric Dent 1991;13:4:236-7.  Back to cited text no. 20  [PUBMED]  
21.Gorlin JR, Goldmn HM. Thoma's Oral pathology. 6th Ed. Vol I. London: CV Mosby Company; 1970. p. 96-978.  Back to cited text no. 21    
22.Hattab FN, Mok Nyc, Agnew EC. Artificially formed caries like lesions around restorative materials. J Am Dent Assoc 1989;118:193-7.  Back to cited text no. 22    
23.Myers CL. Treatment of talon cusp incisor, report of a case. J Dent Child 1980;47:119-21.  Back to cited text no. 23  [PUBMED]  


Figures

[Figure - 1], [Figure - 2], [Figure - 3]


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