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CASE REPORT |
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| Year : 2014 | Volume
: 32
| Issue : 2 | Page : 185-189 |
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Talon cusps in mandibular incisors: Report of eight rare cases
Shiu-yin Cho
Department of Health, Fanling School Dental Clinic, School Dental Care Service, Fanling, New Territories, Hong Kong
| Date of Web Publication | 17-Apr-2014 |
Correspondence Address:
Shiu-yin Cho
Fanling School Dental Clinic, 2/F Fanling Health Centre, 2 Pik Fung Road, Fanling, New Territories
Hong Kong
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0970-4388.131004
 Abstract | | |
Talon cusps in mandibular anterior teeth are very rare. Talon cusps in mandibular anterior teeth associated with other anomalies are even rarer and that a bilateral case in the mandible has not been reported before. In this report, eight such rare cases of talon cusps in permanent mandibular incisors are presented. It includes a bilateral case that in the author's knowledge is the first case reported in the English literatures.
Keywords: Dens evaginatus, dens invaginatus, double tooth, permanent dentition
How to cite this article:
Cho Sy. Talon cusps in mandibular incisors: Report of eight rare cases. J Indian Soc Pedod Prev Dent 2014;32:185-9 |
| Introduction | |  |
A talon cusp is an accessory cusp-like structure projecting from the cingulum area of the maxillary or mandibular anterior teeth. [1],[2] It is described as a true talon if the accessory cusp extends more than half the crown height of the affected tooth. [2],[3] Evaluating prevalence rates of talon cusp is difficult because of the differences in methodologies and definitions used in different studies. [3] It has been suggested that talon cusps are more commonly found in Asian than in Caucasian populations. [3] The prevalence rates have been reported to be 0.6% in Chinese, [3] 0.9% in Japanese, [4] 2.4% in Jordanian, [1] and 5.2% in Malaysian. [5] In most of the prevalence studies, talon cusps were found only in maxillary teeth. [1],[4],[5] Talon cusps in mandibular anterior teeth are very rare. [6] Bilateral cases in the mandible and talon cusps in mandibular anterior teeth associated with other anomalies are even rarer. In this report, eight such rare cases of talon cusps in permanent mandibular incisors are presented. It includes a bilateral case that in the author's knowledge is the first case reported in the English literatures.
| Case Report | | |
All cases were ethnic Chinese and their medical and family histories were unremarkable. The age at diagnosis ranged from 6 to 13. All but two of the cases were females. The clinical and radiographic fi ndings of these cases are summarized in [Table 1]. One case involved both central incisors bilaterally [Figure 1] and [Figure 2], two cases presented with talon cusps associated with dens invaginations in the same teeth [Figure 3], [Figure 4], [Figure 5], [Figure 6], and five cases were talon cusps found in anterior double teeth [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11] [Figure 12], [Figure 13] [Figure 14], [Figure 15]. Among these latter five cases, talon cusps were seen on the labial surface in one case, lingual in two cases, and both labial and lingual surfaces in two cases. The accessory cusps in all cases extended more than half their crown heights, i.e. they were true talons. All but one of those unilateral cases was found on the left side. None of these patients made complains about the talon cusps nor their occlusions were affected by those accessory cusps, and hence no reduction of tooth tissues had been initiated. All patients have been followed up clinically and radiographically and no periapical pathology was seen in those teeth with talon cusps. | Figure 1: Lower occlusal view of Case 1 showing the talon cusps on labial surfaces of teeth 31 and 41
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 | Figure 2: Periapical radiograph of Case 1 taken at age 13 showing the talon cusps on teeth 31 and 41
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 | Figure 3: Periapical radiograph of Case 2 taken at age 12 showing dens invagination on tooth 31 extended beyond cementoenamel junction. No periapical pathology was seen
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 | Figure 4: Mirror image of tooth 31 of Case 2 showing intact fi ssure sealant over the talon cusp and invagination
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 | Figure 5: Mirror image of tooth 31 of Case 3 showing a lingual talon cusp
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 | Figure 6: Periapical radiograph of Case 3 taken at age 7 showing dens invagination on tooth 31 extended to root apex
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 | Figure 7: Lower occlusal view of Case 4 showing the talon cusps on labial and lingual surfaces of the double tooth
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 | Figure 8: Lower occlusal radiograph of Case 4 at age 7 showing a double tooth with two root canals and talon cusps
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 | Figure 9: Anterior view of Case 5 showing the labial and lingual talon cusps on a double tooth
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 | Figure 10: Lower occlusal radiograph of Case 5 taken at age 11 showing two talon cusps on the double tooth
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 | Figure 11: Anterior view of Case 6 showing a labial talon cusp on a double tooth
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 | Figure 12: Lower occlusal radiograph of Case 6 taken at age 7 showing the talon cusp on a double tooth
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 | Figure 13: Lower occlusal radiograph of Case 7 taken at age 12 showing the talon cusp on a double tooth
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 | Figure 14: Mirror image of the double tooth with a lingual talon cusp of Case 8
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 | Figure 15: Panoramic radiograph of Case 8 taken at age 8 showing the talon cusp on a double tooth
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| Discussion | | |
Talon cusps in mandibular anterior teeth are very rare. Dankner et al., examined 1350 patients in Israel and found only one such case. [6] In this report, a bilateral case of mandibular talon cusp is presented. To the best of the author's knowledge, this is the first published case in the English literatures. Talon cusps in mandibular anterior teeth with concomitant development anomalies are very rare. There were only two previous reports on dens invaginatus and talon cusps co-occurring in the same mandibular incisors. The first one was found in a girl from Turkey [7] and the second one in a boy from India. [8] This case report adds two further cases to the literatures. Talon cusps in double teeth in the mandible are also very rare and only three cases have been reported previously. [2],[9],[10] Among them were one Chinese girl, one Chinese boy, and one Indian boy, respectively. All the mentioned rare cases in the literatures and also the cases presented in this report were Asians, which seemed to concur with the suggestion that talon cusps were more common in the Asian populations. [3]
The etiologies of talon cusps, double teeth, and dens invaginatus are still unknown. All these developmental anomalies are believed to originate from the morphodifferentiation stage of tooth development. [2],[7] Double teeth, based on their morphology and number of teeth in the affected dentitions, may be named as fusion or gemination. [2] If the double tooth is counted as two teeth and no extra tooth is present, then it is probably an example of fusion, whereas if an extra tooth is present, then the double tooth may be a geminated tooth or fusion between a normal tooth with a supernumerary. [2] According to this definition, the double teeth presented in this reports are believed to be fusion of the central and lateral incisors. Dens invaginatus is defined as a deep surface invagination of the crown, which is lined by enamel and results from the invagination of the enamel organ into the dental papilla during morphodifferentiation. [8] It has been classified into three categories according to the depth of invaginations. [7],[8] Type 1 is that when the invagination ends as a blind sac confined to the crown. In Type 2, the invagination extends apically beyond the cementoenamel junction, also ending as a blind sac. In Type 3, the invagination extends to the apical tissues and may form a second apical foramen. In Cases 2 and 3 of this report, the radiographic findings suggest that they belong to Type 2 and 3, respectively. The invaginations often allow the entry of microbes into an area that is separated from the pulpal tissues by only a thin layer of tooth substances and may therefore lead to pulpal infection easily. In the two cases of this report, the openings of the invaginations were sealed as soon as the conditions were diagnosed, and regular reviews revealed normal development of the root structures with no sign of infection.
Talon cusps can interfere with speech, occlusion, and esthetics, whereas the developmental grooves around them may be plaque retentive and make the areas caries prone. It has been suggested that gradual grinding of the cusps followed by topical fluoride could be carried out when reduction is indicated. [1] In the cases of this report, no active treatment of the talon cusps was carried out, as the accessory cusps blended smoothly with the adjacent tooth structures, had not posed any problems, and the patients and parents were not bothered by the appearance.
In summary, talon cusps in mandibular teeth are very rare. This case report adds eight rare cases of mandibular talon cusps to the literatures and represents the largest collections of such cases up to the time of writing.
| References | | |
| 1. | Hamasha AA, Safadi RA. Prevalence of talon cusps in Jordanian permanent teeth: A radiographic study. BMC Oral Health 2010;10:6. 
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| 2. | Ekambaram M, Yiu CKY, King NM. An unusual case of double teeth with facial and lingual talon cusps. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:E63-7.
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| 3. | Cho SY, Ki Y, Chu V, Lee CK. An audit of concomitant dental anomalies with maxillary talon cusps in a group of children from Hong Kong. Prim Dent Care 2008;15:153-6.
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| 4. | Ooshima T, Ishida R, Mishima K, Sobue S. The prevalence of developmental anomalies of teeth and their association with tooth size in the primary and permanent dentitions of 1650 Japanese children. Int J Paediatr Dent 1996;6:87-94.
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| 5. | Meon R. Talon cusp in Malaysia. Aust Dent J 1991;36:11-4.
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| 6. | 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.
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| 7. | Siraci E, Gungor HC, Cehreli ZC. Dens invaginatus and talon cusp co-occurring in a mandibular central incisor: A case report. J Dent Child (Chic) 2008;75:177-80.
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| 8. | Nagaveni NB, Umashankara KV, Vidyullatha BG, Sreedevi S, Radhika NB. Permanent mandibular incisor with multiple anomalies-report of a rare clinical case. Braz Dent J 2011; 22:346-50.
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| 9. | Li RW. Clinical variants in tooth number and crown form: A report of bilateral double teeth associated with a talon cusp. Dent Update 2002;29:403-8.
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| 10. | Dinesh Rao D, Hegde S. A talon cusp on fused teeth associated with hypodontia: Report of a unique case. Eur J Dent 2010;4:75-80.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15]
[Table 1]
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