|Year : 2011 | Volume
| Issue : 3 | Page : 248-250
Talon cusp in a primary incisor: A rare entity
A Kapur, A Goyal, S Bhatia
Department of Pediatric and Preventive Dentistry, Oral Health Sciences Center, PGIMER, Chandigarh, India
|Date of Web Publication||10-Oct-2011|
Department of Pediatric and Preventive Dentistry, Oral Health Sciences Centre, PGIMER, Sector 12, Chandigarh
| Abstract|| |
This case report describes the presence of a talon cusp in a right primary incisor in a 6-year-old girl. It is a rare entity with only three cases having been reported from the Indian population. The talon cusp showed presence of wear facets along with altered morphology of the involved tooth. No treatment was done apart from sealing the cusp-tooth interface with fissure sealant.
Keywords: Primary incisor, talon cusp
|How to cite this article:|
Kapur A, Goyal A, Bhatia S. Talon cusp in a primary incisor: A rare entity. J Indian Soc Pedod Prev Dent 2011;29:248-50
| Introduction|| |
Talon cusp as a developmental anomaly is easily diagnosed due to its prominent and characteristic appearance. It is projected as an accessory cusp from the cingulum area of an anterior tooth resembling an eagle's talon, which is the shape of an eagle's claw when hooked on to a prey. It may vary in its projection from a well-defined additional cusp prominently projecting from the palatal surface of an anterior tooth and extending at least half the distance from the cemento-enamel junction to the incisal edge- a Type 1 or true talon, to just an enlarged and prominent cingulum- a type III talon; type II being an additional cusp of 1 mm that extends less than half the distance from the cemento-enamel junction to the incisal edge, which either blends with the palatal surface or stands away from the crown, known as a semi-talon. , The most accepted hypothesis regarding its etiology is the aberrant hyperactivity of the anterior part of the dental lamina.  The role of genetic and environmental influences is yet unclear. This anomaly has more commonly been reported in the permanent dentition with prevalence ranging from 0.06−7.7%. The total number of reported cases in the primary dentition worldwide is 39, with one or more teeth affected; 21 of these individuals are males.  There are, however, only three cases reported from the Indian population. ,, This article adds one more case to the existing pool of cases in primary dentition.
| Case Report|| |
A 6-year-old Indian girl belonging to the low socio-economic group reported to the Out Patient Department of Unit of Pediatric Dentistry with the chief complaint of decayed teeth. Extra-oral findings were not significant. Intra-oral findings revealed an early mixed dentition stage with multiple carious teeth and erupting permanent manibular incisors. A prominent talon cusp (type I) was visible on the palatal surface of the right maxillary primary incisor [Figure 1]. No other anterior tooth had this projection. Occlusion was end-on and there was no interference on closure, in spite of wear facets on the tip of the talon's cusp [Figure 2], as the mandibular primary central incisors had exfoliated and the permanent incisors were still erupting. Family history was doubtful as the patient's mother was not aware of the present condition as well. The involved incisor on closer examination was found to be morphologically different form its antimere with a concavity present on the labial surface corresponding to the projection on the palatal side, giving it a 'pulled back' appearance [Figure 3]; along with a sagged or U-shaped incisal edge [Figure 4]. It was similar in dimensions to the contra lateral tooth and was positioned labially. An intra-oral peri-apical radiograph revealed the pulp horn extending to nearly half the length of the talon's cusp [Figure 5]. No treatment was rendered apart from sealing the sides of the talon with a fissure sealant and routine restorative care [Figure 6].
|Figure 5: Intra-oral periapical view showing pulp extension into half length of the talon cusp|
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| Discussion|| |
Talon cusp was first reported by William Mitchell in the year 1892 in a permanent incisor, which showed an accessory cusp-like structure, projecting lingually from the cingulum. , The term 'talon' was coined by Mellor and Ripa in 1970 because of its characteristic resemblance to an eagle's talon. The first reported case in primary dentition is by Sawyer et al. (1976) found in the archeological remains of prehistoric times.  Since then, nearly 39 more case reports have been published, one of them being present in the archeological remains of a 5-year-old child in UK, dating back to the period AD 950-1350,  The first clinical case in the primary dentition was reported by Henderson in 1977 in a 4-year-old Filipino girl. , All these cases depicted talon's cusp on the palatal surfaces of primary maxillary incisors except one case report, which showed its presence in the primary mandibular lateral incisors.  Batra P et al. (2006) for the first time, reported talon cusp on the facial aspect of primary lateral incisors in two non-syndromic cleft lip and palate cases.  Siraci et al. (2006) reported the presence of both facial and palatal talon on a supernumerary tooth in a 3.5-year-old boy with cleft lip and palate. 
This abnormality has been more frequently reported in the Asian population.  Based on their clinical experience, Chen and Chen stated that there does not appear to be a difference in the prevalence of talon cusp in the primary and permanent teeth in the Chinese population.  This point is worth noting as its prevalence in primary dentition in the Indian population may also be more than reported. In the present case too, it had not been observed by the parent and had got noticed during a routine clinical examination.
The presence of a talon's cusp can cause problems such as occlusal interferences; predisposition to dental caries and unpleasant esthetics as was seen in the present case. The occlusal disturbance could be diagnosed from the wear facets on the cusp tip of the talon. A few more complications such as tongue irritation, accidental cusp fracture, advanced attrition leading to pulp exposure, misinterpretations of radiographs, displacement of opposing teeth, damage to periodontium due to excessive occlusal force and temporomandibular joint pain have also been reported. ,
Preventive treatment towards dental caries should be done in every case by sealing the interface of the talon and the palatal surface of the involved tooth with a fissure sealant as was done in the present case. Occlusal disturbances and unpleasant esthetics necessitates cusp reduction, which should be done at periodical intervals with an aim to facilitate formation of reparative dentin. The presence of a pulp horn in all cases of talon cusp is doubtful; but care should be taken to avoid inadvertent pulp exposure while reduction, in case the pulp extension is visible radio graphically.
| References|| |
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]