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CASE REPORT
Year : 2006  |  Volume : 24  |  Issue : 5  |  Page : 41-43
 

Dens evaginatus of anterior teeth (talon cusp) associated with other odontogenic anomalies


Department of Pedodontics and Preventive Dentistry, Govt. Dental College and Hospital Postgraduate, Institute of Medical Sciences, Rohtak - 124 001, Haryana, India

Correspondence Address:
Amita Sharma
48/9J, Medical Campus, Rohtak-124001, Haryana
India
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Source of Support: None, Conflict of Interest: None


PMID: 16891752

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  Abstract 

Depending on tooth location, usually, dens evaginatus describes an anomaly of posterior teeth and talon cusp as an anomaly of anterior teeth. From the standpoint of developmental, morphological and histological considerations dens evaginatus is a more acceptable term to use and talon cusp should be considered as a subset of dens evaginatus. It mostly occurs as an isolated finding rather than an integral part of any disorder. Two cases of dens evaginatus along with other dental anomalies are reported.


Keywords: Associated anomalies, dens evaginatus, talon cusp


How to cite this article:
Sharma A. Dens evaginatus of anterior teeth (talon cusp) associated with other odontogenic anomalies. J Indian Soc Pedod Prev Dent 2006;24, Suppl S1:41-3

How to cite this URL:
Sharma A. Dens evaginatus of anterior teeth (talon cusp) associated with other odontogenic anomalies. J Indian Soc Pedod Prev Dent [serial online] 2006 [cited 2019 Sep 21];24, Suppl S1:41-3. Available from: http://www.jisppd.com/text.asp?2006/24/5/41/26039



  Introduction Top


Dens evaginatus is an odontogenic developmental anomaly that can be defined as a tubercle or protuberance from the involved surface of the affected tooth consisting of an outer layer of enamel, a core of dentin and may contain a slender extension of pulp tissue. Dens evaginatus has also been referred to as: the simplest type of dilated composite odontoma, occlusal tubercle, Leong's premolar, tuberculated premolar, odontomas of axial core type, evaginated odontoma or occlusal enamel pearl.[1],[2],[3],[4] It is most often reported in premolars but can also occur in molars, canines and incisors.[3],[4],[5],[6] It may occur in the form of a drop, a pointed or cylindrical cone on the occlusal surface of the posterior teeth, while in the anterior teeth a conically shaped extension of the cingulum is observed.[2],[5]

Talon cusp is an accessary cusp like structure projecting from cingulum area or cementoenamel junction of maxillary or mandibular anterior teeth and is composed of normal enamel, dentin and varying extensions of pulp tissue. Based on the degree of their formation and extension, the anomaly can be classified as - Talon, Semitalon and Tracetalon.[7] Majority of the cases reported in the literature indicate talon cusp as an isolated anomaly however it may be associated with other somatic and odontogenic abnormalities.[7],[8],[9],[10],[11]

The present report describes two cases of bilateral dens evaginatus (talon cusp) of maxillary permanent lateral incisors in association with other dental findings.


  Cases Report Top


Case 1

An eight year old female patient reported to the department with the complaint of malalignment of upper anterior teeth. No relevant family/medical history was reported. General physical examination revealed that the patient was normal. Intraoral examination [Figure - 1] showed a mixed dentition stage with class I molar relationship. The maxillary permanent lateral incisors exhibited pronounced cusp like structure projecting from the cingulum area (semitalon). The tip of the cusp was in close proximity to the crown surface and the developmental grooves on the lateral sides of the cusp were non-carious. The anomalous cusp did not irritate the tongue during speech and mastication nor interfere with occlusion. The teeth responded normally to electric pulp testing. Radiographically, separate enamel and. dentin were seen in the V-shaped structure, but pulp extension could not be traced [Figure - 2].

The other dental abnormality recorded was bilaterally, palatally erupting two supernumerary teeth in the maxillary incisors region [Figure - 1]. Radiographic examination also confirmed two well developed mesiodens, supplemental in form [Figure - 2]. The two supernumeraries were extracted.

Case 2

A nine year old boy reported with the chief complaint of odd looking upper front teeth. Nothing abnormal was detected during history taking or general physical examination. Oral examination [Figure - 3] revealed both the maxillary permanent lateral incisors with enlarged or prominent cingula (tracetalon) which were not troublesome to the patient, contained no caries and did not interfere with the occlusion. Response to electrical pulp testing of the affected teeth was within normal limits. Other odontogenic variations detected were shovel-shaped central incisors with bifid cingula and a palatally erupted, conical supernumerary tooth between the maxillary central incisors (mesiodens). Radiographic examination [Figure - 4] confirmed the same. The mesiodens was extracted.


  Discussion Top


Earlier authors have treated dens evaginatus and talon cusp as separate anomalies describing them as an anomaly of posterior teeth and anterior teeth respectively.[12],[13] However, certain cases previously reported as dens evaginatus of anterior teeth have been considered to be talon cusps by some authors.[10],[14] Talon cusp and dens evaginatus show similar morphological and histological appearance, due to identical pathogenesis. A multifactorial etiology combining both genetics and environmental factors has been postulated, though their exact mechanism of formation is not known. Thus, it was proposed that talon cusp and dens evaginatus are the same anomaly and that talon cusp is a subset of dens evaginatus.[15]

The anomaly appears to be more prevalent in patients with Rubinstein-Taybi syndrome, Mohr syndrome and  Sturge- Weber syndrome More Details More Details. Various dental abnormalities in association with talon cusp have been reported like peg shaped lateral incisors, impacted mesiodens, complex odontoma, supernumerary teeth, megadont, dens invaginatus, shovel shaped maxilla incisors, bifid cingula, exaggerated cusps of carabelli etc.[7],[8],[9],[10],[11] The present report showed the association of dens evaginatus with supernumerary teeth, shovel shaped incisors and bifid cingula. However, no somatic abnormalities were observed in both the cases.

It is essential to have a precise criteria for categorization and standardized terminology of an accessory cusp for future prevalence surveys and evaluation of its clinical significance. Despite occasional report of cases, to date, there has been no controlled clinical trial conducted to evaluate the effectiveness of a particular type of treatment for this anomaly. Stewart et al grouped the treatment of dens evaginatus into those techniques employed on vital or non-vital teeth.[12] The treatment varies with the circumstances of individual case ranging from selective grinding and prophylactically resorting the grooves to endodontic therapy.[6],[16],[17],[18],[19] Some patients require no treatment at all (as in the present cases reported), if esthetic appearance is satisfactory, function is within normal limits, no caries or advanced attrition are present and if the anomalous cusp is not sharp to irritate the tongue or affect speech. Early recognition and continued monitoring, however is the key to proper treatment.

 
  References Top

1.Tratman FK. An unrecorded form of the simplest type of dilated composite odontome. Br Dent J 1949;86:271-5.  Back to cited text no. 1    
2.Merrill RG. Occlusal anomalous tubercles on premolars in Alaskan Eskimos and Indians. Oral Surg 1964;17:484-96.  Back to cited text no. 2  [PUBMED]  
3.Lau TC. Odontomes of the axial core type. Br Dent J 1955;99:219-25.  Back to cited text no. 3    
4.Oehlers FAC. The tuberculated premolar. Dent Prac 1956;6:144-8.  Back to cited text no. 4    
5.Shey Z, Eytel R. Clinical management of an unusual case of dens evaginatus in a maxillary central incisor. J Am Dent Assoc 1983;106:346-8.  Back to cited text no. 5  [PUBMED]  
6.Yong SL. Prophylactic treatment of dens evaginatus. J Dent Child 1974;41:289-92.  Back to cited text no. 6  [PUBMED]  
7.Hattab FN, Yassin OM, AI-Nimri KS. Taloncusp in permanent dentition associated with other dental anomalies:review of literature and reports of seven cases. J Dent Child 1996;63:368-76.  Back to cited text no. 7    
8.Mader CL. Talon cusp. J Am Dent Assoc 1981;103:244-6.  Back to cited text no. 8  [PUBMED]  
9.Natkin E, Pitts DL, Worthington P. A case of talon cusp associated with other odontogenic abnormalities. J Endod 1983;9:491-5.  Back to cited text no. 9  [PUBMED]  
10.Davis PJ, Brook AH. The presentation of talon cusp: diagnosis, clinical features, associations and possible aetiology. Br Dent J 1985;159:84-8.   Back to cited text no. 10    
11.Lehl GK. Talon cusp associated with other dental anomalies - A case report. J Ind Soc Pedo Prev Dent 1999;17:13-4.  Back to cited text no. 11  [PUBMED]  
12.Stewart RE, Dixon GH, Graber RB. Dens evaginatus (tuberculated cusps): genetic and treatment considerations. Oral Surg 1978;46:831-6.   Back to cited text no. 12  [PUBMED]  
13.Mellor JK, Ripa LW. Talon cusp: a clinically significant anomaly. Oral Surg 1970;29:225-8.  Back to cited text no. 13  [PUBMED]  
14.Richardson DS, Knudson KG. Talon cusp: a preventive approach to treatment. J Am Dent Assoc 1985;110:60-2.  Back to cited text no. 14  [PUBMED]  
15.Uyeno DS, Lugo A. Dens evaginatus: A review. J Dent Child 1996;63:328-32.  Back to cited text no. 15  [PUBMED]  
16.Hill FJ, Bellis WJ. Dens evaginatus and its management. Br Dent J 1984;156:400-2.  Back to cited text no. 16  [PUBMED]  
17.Chen, Ruey-Song: Conservative management of dens evaginatus. J Endod 1984;10:253-7.  Back to cited text no. 17    
18.Shay, Jing-Chuan. Dens evaginatus: Case report of a successful treatment. J Endod 1984;10:324-6.  Back to cited text no. 18    
19.Su, Huey-Li. Dens evaginatus: Report of case of continued root development after Ca (OH)2 apexification. J Dent Child 1992;59:285-8.  Back to cited text no. 19    


    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]


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   Abstract
   Introduction
   Cases Report
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   References
   Article Figures

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