Double facial and a lingual trace talon cusps A case report by mifei


									                                                                                                                         ISSN 0970 - 4388

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


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.

Key words: Cusp, double talon, facial, trace talon

A talon cusp is a morphologically well delineated, supernu-                 trauma to her lips.
merary accessory talon shaped cusp, projecting from the
lingual or the facial surface of the crown of an incisor and                Radiographic examination revealed, double V-shaped radio-
extending at least half the distance from the cementoenamel                 opaque structures, superimposed on the image of an affected
junction to the incisal edge.[1,2] Talon cusp occurs in both                tooth, composed of normal enamel, dentin and pulp tissue
primary and permanent dentition, in maxillary or mandibu-
lar teeth, and it may be either unilateral or bilateral.[2-4] It
has predilection for maxilla over mandible and higher fre-
quency 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 acces-
sory cusp from cementoenamel junction towards the incisal

Case Report

An 8-year-old female reported to the department of Pedo-
dontics and Preventive Dentistry, College of dental sciences,
Davangere, with complaint of an abnormally shaped left
maxillary central incisor. Her medical history was noncon-                  Figure 1: Maxillary left central incisor with double facial talon
tributory. No other family members had similar dental

Examination of the oral cavity revealed good dental health,
no soft tissue abnormalities; bilateral Class I molar relation-
ship 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
 Professor, bPostgraduate Student, cProfessor and Head, Department
of Pedodontics and Preventive Dentistry, College of Dental Sciences,        Figure 2: Maxillary left central incisor with double facial talon
Davangere, India                                                            cusps and lingual trace talon

                                                                       89                           J Indian Soc Pedod Prev Dent - June 2005

                                                                                                                                    89 CMYK
                                               Double facial and a lingual trace talon cusps

                                                                          cusp formation in mesial and distal marginal ridge of maxil-
                                                                          lary 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 lin-
                                                                          gual trace talon cusps on the left maxillary central incisor is

                                                                          Occurrence of accessory cusps, especially on the facial sur-
                                                                          face 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 treat-
Figure 3: Radiographic picture of talon cusps
[Figure 3]. Diagnosis of double facial talon cusp with a lin-             Following three procedures can be considered for the treat-
gual trace talon cusp was made.                                           ment of talon cusp if they are causing trauma and esthetic
Discussion                                                                1. Periodic reduction of accessory cusp over a 6-8-week
                                                                              interval with application of fluoride as a desensitizing
The exact etiology of this condition remains unknown. It is                   agent, so that it will avoid possibility of pulpal exposure
thought to occur during morphodifferentiation stage, as a                     and helps in reparative dentine formation. Fissure seal-
result of outward folding of an inner enamel epithelial cells                 ants or glass-ionomer cement to seal associated grooves
(precursors of ameloblasts) and a transient focal hyperpla-                   as prophylactic measure.
sia of the mesenchymal dental papilla (precursor of odonto-               2. Complete reduction of cusp followed by calcium hydrox-
blasts) or combination of genetic and environmental fac-                      ide pulpotomy for an immature tooth, if there is pulpal
tors (multifactorial).[4,6,9,10] Talon cusp may occur as an iso-              exposure.
lated entity or in association with other dental abnormali-               3. Complete cuspal reduction followed by root canal treat-
ties like exaggerated cusp of carabelli, microdent tooth,                     ment.
megadont, odontome, bifid cingulum, double teeth, fusion,
dens evaginatus, dens invaginatus, shovel-shaped tooth,                   References
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