Labial Talon Cusp on Permanent Central Incisor A Case Report

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					                                                                                                       ISSN 0970 - 4388

Labial Talon Cusp on Permanent Central Incisor: A Case Report.

ABSTRACT                                                                 Goldman defined talon cusp as a very high accessory cusp,
                                                                         which may connect with the incisal edge to produce a T-form
Talon cusp is a supernumerary crown structure, a developmental
                                                                         or, if lower in level, a Y-shaped crown contour. Henderson
disturbance in the shape of teeth that causes various diagnostic,
functional and esthetic problems. Some synonyms for talon cusp           (1977) first reported a case of talon cusp in a primary tooth
are dens evaginatus of anterior teeth, interstitial cusp, tuberculated   involving maxillary central incisor of a 4-year-old Filipino girl.
tooth, odontoma of the axial core type, evaginated odontoma, enamel                    4
                                                                         Chawla et al reported 7.7% prevalence of talon cusp in the
pearl, supernumerary cusp etc. The lingual location on incisors, which
frequently affects occlusion, is pathognomonic of the talon cusp.
                                                                         North Indian children. Reports of lingual location of talon cusp
This report describes a rare odontogenic, isolated anomaly rather        are many but very few cases have been reported with facial
                                                                                    9 -13
than an integral part of any disorder, a case of talon shaped cusp       talon cusp.
projecting from the labial surface of a maxillary permanent central
incisor.                                                                 CASE REPORT
Keywords: Labial, Permanent maxillary incisor, Talon cusp.
                                                                         A 9-year-old girl reported to the Department of Pedodontics
                                                                         and Preventive Dentistry, College of Dental Sciences,
                                                                         Davangere for restoration of carious teeth. Examination of
Talon cusp is a morphologically well delineated accessory                the oral cavity revealed a well-defined unilateral accessory
cusp like anomalous structure projecting from the cingulum               anomalous cusp on the labial surface of the maxillary left
area or cementoenamel junction, extending atleast half the               permanent central incisor (Figs 1,2 and 3). It extended from
distance to incisal edge of maxillary or mandibular anterior             the cementoenamel junction to 1 mm short of the incisal
teeth in both primary and permanent dentitions and which is              edge, perpendicular to the mesiodistal plane of the tooth
composed of normal enamel, dentin and varying extensions                 forming a three pronged pattern, measuring 9 mm in length
                 1,2                                                     from base to the tip, 3 mm in width and projecting 3 mm
of pulp tissue. Usually males show a higher frequency of
occurrence of Talon cusp than females and may be unilateral              away from the crown labially. It was pyramidal in shape, with
or bilateral, with a predilection for maxilla over mandible and          a rounded tip, and did not irritate the upper lip. Developmental
common in the permanent dentition. The most commonly                     grooves were present at the junction of the cusp and labial
involved teeth are the maxillary lateral incisor in the permanent        surface of the crown. The affected tooth responded normally
dentition and maxillary central incisor in the primary dentition.        to electric pulp testing. The medical history was non-
Talon cusps can create problems like compromised esthetics,              contributory.
occlusal interference, displacement of the affected tooth,               Radiographic examination showed a typical V-shaped radio-
carious developmental grooves and pulpal necrosis,                       opaque structure superimposed over the image of the affected
periodontal problems due to excessive occlusal forces,                   crown, with the point of 'V’ towards the incisal edge
advanced attrition leading to pulpal exposure and periapical             (Figure 4). Two distinct white lines converging from the
pathosis, irritation of the tongue during speech and mastication         cervical area demarcated the cusp, and a pulpal extension
and interference with tongue space.                                      could be traced towards the base of the cusp. Clinically
W.H.Mitchell was first to describe a talon cusp in an upper              as well as radiographically no other dental abnormality
central incisor of a woman as "a process of horn-like shape              was detected. Inspite of questionable esthetics, parents
curving from the base downward to the cutting edge". Mellor              refused treatment, as the appearance did not affect the
and Ripa named the accessory cusp as "Talon cusp" because                patient.
of its resemblance in shape to an eagle's talon. Gorlin and

 a. Post Graduate Student, b. Associate Professor, c. Professor
                                         Labial Talon Cusp on Permanent Central Incisor

Fig 1: Frontal view of maxillary left central incisor              Fig 2 : Lateral view showing connection of Talon cusp
       with labial Talon cusp.                                             to labial surface of tooth extending from the
                                                                           cervical portion to the incisal edge.

Fig 3 : Occlusal view of cast showing a T- shaped                  Fig 4 : Intra - oral periapical radiograph showing V-
        appearance on 21.                                                  shaped cusp with normal enamel, dentin and
                                                                           a pulp Horn.

The etiology of the condition remains unknown. It is suggested     environmental conditions that are associated with anomalies
that this condition has a multifactorial etiology combining        of teeth.
both genetic and environmental factors. The aberrant               Talon cusp may be associated with other somatic and
hyperactivity of the dental lamina may also be responsible         odontogenic anomalies like peg shaped lateral incisor and
for its occurrence. Talon cusp originates during the morpho        impacted mesiodens and canine; complex odontoma; and
differentiation stage of tooth development, may occur as a         supernumerary teeth, megadont and dens evaginatus. The
result of outward folding of inner enamel epithelial cells         anomaly also appears to be more prevalent in patients with
(precursors of ameloblast) and transient focal hyperplasia of      Rubinstein-Tyabi syndrome, Mohr syndrome (oral facial -
the peripheral cells of mesenchymal dental papilla (precursors     digital II syndrome) and Sturge Weber syndrome (encephalo-
                  1                                                                         1
of odontoblast). Occurrence of talon cusp in Chinese and           trigeminal angiomatosis).
Arabs indicates that this anomaly is not a rarity in certain       Tsutsumi and Oguchi reported a case of labial talon cusp in
racial groups. The substantial racial and sex differences,         6-year-old Japanese female with Incontinentia pigmenti
bilateral distribution in some cases and its association with      achromians, a rare disease involving the skin, hair, eyes,
other dental abnormalities suggest that talon cusps may be         central nervous system and musculoskeletal system.
                        14                                                       10
genetically determined. While intrauterine environmental,          Jowharji et al reported a facial talon cusp in an 8-year-old
nutritional, systemic conditions, trauma and other factors,        female not associated with any other condition. Mc Namara
                                             Labial Talon Cusp on Permanent Central Incisor

a 13-year-old Caucasian boy with marked tubercles of                   REFERENCES
carabelli on maxillary first permanent molars and right
                                                                       1.    Hattab F.N., Yassin O.M. and Al-Nimri K.S.: "Talon cups in
mandibular second premolar with a bifid root; while the other
                                                                             permanent dentition associated with other dental anomalies:
was reported in a 15-year-old Caucasian female with a talon
                                                                             Review of literature and reports of seven cases". ASDC J
cusp on the facial surface of maxillary permanent right canine
                                                                             Dent Child. 1996; Sept-Oct. 63 (5): 368 - 376.
with bifid root in all 4-second premolars. Abbott reported a           2.    Davis P.J. and Brook A.H.: The presentation of talon cusp:
rare case of labial and palatal talon cusps together on a                    diagnosis, clinical features, associations and possible
maxillary left permanent central incisor of a 9-year-old girl;               aetiology. Br Dent J. 1986; Feb 8, 160 (3): 84 - 88.
this tooth caused poor esthetics and periodontal pocketing.            3.    Gorlin R.J. and Goldman H.M.: Thoma's Oral Pathology. 6
The labial cusp irritated the upper lip and palatal cusp interfered          Edition, St. Louis. C.V. Mosby Co. 1970, Pg.96.
                                                                       4.    Chawla H.S., Tewari A., Gopalakrishnan N.S.: Talon cusp -
with occlusion. The labial and palatal talon cusps were
                                                                             a prevalence study. J Ind Soc Pedo Prev Dent. 1983: (1): 28
removed, creating two pulp exposures, followed by root canal
treatment and composite restoration, de Sousa et al                    5.    Subba Reddy V.V. and Mehta D.S.: Talon cusp on primary
presented a case of labial talon cusp on permanent maxillary                 lateral incisor: Report of a case. J Ind Soc. Pedod Prev Dent.
right central incisor of a 22 year old black female, which was               1989 Mar 7(1), 20-22.
associated with lingual talon cusp on left permanent maxillary         6.    Nandkarni U.M., Munshi A. and Damle S.G.: Unusual
central incisor and type 1 dens invaginatus in right maxillary               presentation of talon cusp: Two case reports. International
permanent lateral incisor. The early involvement of the pulp                 J of Paed Dent. 2002 (12): 332 - 335.
                                                                       7.    Sarkar S., Misra J., Das G. : "Talon cusp - Heredity origin" -
tissue of the right central incisor with a labial talon cusp
                                                                             case report. J Ind Soc Ped Prev Dent. 1999:17(4): 126 -128.
resulted in necrosis and periradicular pathosis, possibly as a
                                                                       8.    Lehl G.K.: Talon cusp associated with other dental anomalies
result of the reduction of the talon cusp allowing bacterial                 - A case report. J Ind Soc Ped Prev Dent. 1999 Mar 17 (1) :
infiltration of the pulp. The present report, presents a facial              13- 14.
talon cusp not associated with any medical condition or other          9.    Tsutsumi T. and Oguchi H.: Labial talon cusp in a child with
dental anomaly.                                                              incontinentia pigmenti achromians : A case repot. Ped Dent.
 Wide variations exist in shape, size, structure and location                1991;13(4): 236 - 237.
 of talon cusp from a slight tubercle like projection to a well-       10.   Jowharji N., Noonam R.G. and Tylka J. A.: An unusual case
                                                                             of dental anomaly: A facial talon cusp. ASDC J Dent Child.
delineated prominent cusp extending at least half the distance
                                                                             1992; (59): 156 -158.
from cementoenamel junction to incisal edge (Trace-Talon,
                                                                       11.   McNamara T, Haeussler A.M. and Keane J.: "Facial talon
Semi-Talon to Talon), occurring lingually or labially in primary             cusps". Int J Paed Dent 1997; 7: 259 - 262.
or permanent dentition or on supernumerary teeth. Some                 12.   Abbott P. V.: Labial and palatal "talon cusp" on the same
talon cusps are quite sharp and spike like, while others have                tooth - A case report. Oral Surg Oral Med Oral Pathol Oral
rounded and smooth tips, which may stand away from rest of                   Radiol Endod. 1998; 85: 726 - 730.
the crown or may be in close approximation to the tooth                13.   de Sousa S.M.G, Tavano S.M.R. and Bramante C.M.:Unusual
                                                                             case of bilateral talon cusp associated with dens
surface. It can be horn like, conical or pyramidal in shape
                                                                             invaginatus". International Endodontic Journal. 1999; 32:
and extensions of pulp tissue may or may not be present.
                                                                             494 - 498.
Most cases of talon cusp need definitive treatment. The
                                                                       14.   Hattab F.N., Yassin O.M. and Al-Nimri K.S.: Talon cusp -
developmental grooves susceptible to caries should be                        Clinical significance and management: Care reports.
prophylactically sealed. If removal of talon cusp is planned                 Quintessence Int. 1995; 26 (2): 115-120.
(preferably after root formation is complete), reduction should        15.   Bailit H.L.: Dental variations among populations.
be gradual and on consecutive visits at 6-8 weeks intervals,                 Anthropologic View in "Symposium on Genetics". DCNA.
to allow deposition of reparative dentin for pulpal protection,              1975; Jan. Vol.19: No.1. Pg. 125

followed by application of a desensitizing agent, preferably
                 1                                                     Reprint Requests to
fluoride varnish. Partial reduction with composite camouflage
                                                                       Dr. Sukhdeep Singh
 can also be done          . So it is essential to have precise        Associate Professor
 diagnostic criteria and standardization of terminology for            Department Of Pedodontics and
 categorization of an accessory cusp as a talon cusp.                  Preventive Dentistry College of

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