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Mandibular talon cusp.

Talon cusp is a developmental malformation characterized by the presence of an extra cusp that takes the form of a tubercle arising from the occlusal or lingual surface. (1) It is a rare anomalous odontogenic structure first described by Mitchell in 1892. (2) It is composed of enamel, dentin and a varying amount of pulp tissue. (3) In the literature, this malformation has also been referred as interstitial cusp, tuberculated premolar, odontome of the axial core type, evaginated odontome, occlusal enamel pearl, occlusal anomalous tubercule, supernumerary cusp and dens evaginatus of anterior teeth.4 Review of the reported cases indicated that this condition usually affects the maxillary incisor teeth and those talon cusps of the mandibular incisors are extremely rare.

Case Report :

A 18 year old female patient reported to the Department of Periodontics, College of Dental Sciences, Davangere with no relevant medical history. On intraoral examination, a prominent accessory cusp on the lingual surface of the mandibular right permanent central incisor (inverted V shape) was present (Fig. 1). The accessory cusp was extended from cemento-enamel junction and curved towards the incisal edge of the incisor. An intraoral periapical radiograph of this tooth showed enamel and dentin and a horn of pulpal tissue extension (type I talon cusp) (5) (Fig. 2). The patient had no discomfort, hence treatment was not done.

Discussion :

Talon cusp occurs in primary and permanent incisors (6) affecting both the sexes and may be unilateral or bilateral. (7,8) The literature review evaluated that dens evaginatus is more common in the permanent dentition (77%) than in the primary dentition (23%), while in the permanent dentition 94% affect the maxillary teeth and 6% mandibular teeth. (4) Out of which about 4% affect the mandibular central incisor, whereas 33% affect the maxillary central incisor. (4) This case report with one permanent mandibular central incisor (41) with talon cusp, therefore seems to signify a unique and rare presentation.

Talon cusp may occur in isolation or with other dental anomalies such as mesiodens, odontoma, unerupted or impacted teeth, peg-shaped maxillary incisor, dens invaginatus, cleft lip and distorted nasal alae, bilateral germination fusion, supernumerary teeth and enamel clefts. (1,2) According to the literature, it has also been associated with some systemic conditions such as Mohr syndrome (Orofacial-digital talon cusp) (9), Sturge-weber syndrome (10), Rubinstein-Taybi syndrome (11), incontinentia pigmenti achromians and Ellis-Van creveld syndrome. (12) However, no such associated syndrome or dental anomalies was seen in this case.

Millor and Ripa (1970) (13) coined the term talon cusp because it resembles an eagle's talon in shape. Davis and Brook (1986) (14) defined talon cusp as an additional cusp that predominantly projects from the lingual surface of primary or permanent anterior teeth and is morphologically well defined and extends at least half the distance from the CEJ to the incisal edge. Schulze (1970) (15) referred to the very high accessory cups as a T. form or if lower a Y-shaped crown contour. Gardner and Girgis (1979) (11) said that talon cusp is a markedly enlarged cingulum on a maxillary tooth. It is apparent from these comments that a general understanding exists as to what a talon cusp is but no strict diagnostic criteria exist. Clinically in this case the talon cusp was a well delineated additional cusp that projects from the lingual surface of permanent central incisor tooth that extends at least half the distance from the cemento enamel junction to the incisal edge. (type I talon cusp). (5)

The extent of pulp into cusp is difficult to determine because of its superimposition over the main pulp chamber. While some indicated that talon cusps contain pulp tissue, some found no evidence of pulp extension into the cusp. However, it has been suggested that large talon cusps, especially those that stand away from the tooth crown are more likely to contain pulp tissue. (16) This phenomenon has been reported both in primary and permanent dentition. Radiologically in this case a horn of pulp tissue was extending into the cusp.

The complications of talon cusp are diagnostic, functional aesthetic and pathological "A large talon cusp is unaesthetic and presents clinical problems. It may present diagnostic problems if it is unerupted and resembles a compound odontoma or a supernumerary tooth and so leads to unnecessary surgical procedure. Functional complications include occlusal interference, trauma to the lip and tongue, speech problems and displacement of teeth. The deep grooves which join the cusp to the tooth may act as stagnation areas for plaque and debris, becomes carious and cause subsequent periapical pathology, management will depend on individual presentation and complications. Small talon cusps are asymptomatic and need no treatment. Where there are deep developmental grooves, simple prophylactic measures such as tissue seeking and composite resin restoration can be carried out. An essential step especially in case of occlusal interference, is to reduce the bulk of the cusp gradually and periodontally and application of topical fluoride gel to reduce sensitivity, and stimulate reparative dentin formation for pulp protection or outright total reduction of the cusp and calcium hydroxide pulpotomy. It may also become necessary sometimes, to fully reduce the cusp, extirpate the pulp and carryout root canal therapy. Orthodontic correction may become necessary when there is tooth displacement or malalignment of affected or opposing teeth. Although infrequent, it merits some clinical consideration, pulp necrosis and periapical pathosis may develop. In addition, the extra cusp is pron to abrasion or fracture. (17,18) However, talon cusp in this case was asymptomatic and the patient did not complain of any discomfort and did not present any clinical problem esthetically or functionally. However the management and treatment outcome of talon cusp depends on the size, present complications and patient co-operation.

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REFERENCES :

(1) Shafer WG, Heine MK, Levy BM, eds. A textbook of oral pathology. 4th ed. Philadelphia : WB Saunders, 1983:40-1.

(2) Mitchell WH. Case report. Dent Cosmos 1892;34:1036.

(3) Shafer WG, Hine M. K, Levy BM : A textbook of oral pathology, 9th edition. Philadelphia : W. B. Saunders Co.

(4) Eitan Donkner, DMD, M. Sc., Doron, Harari DMD, and Ilan Rotstein CD, Jerusalem, Israel. Dens evaginatus of anterior teeth. Oral Surg Oral Med Oral Pathol Oral Radiol, Endod 1996;81:472-6.

(5) Hattab FN, Yassin OM, Al-Nimri KS. Talon cusp in the permanent dentition associated with other dental anomalies : Review of literature and reports of seven cases. J Dent Child 1996;63:368-376.

(6) Natkin E, Pitts DL, Worthington P. A Case of talon cusp associated with odontogenic abnormalities. J of Endodontics 1983;9:491-495.

(7) Sohana Hegde and B. R. Ashok Kumar. Mandibular talon cusp : report of two rare cases. International Journal of Pediatric Dentistry 1999 Dec;9(4):303-6.

(8) Mader CL, Talon cusp. Journal of the American Dental Association 1981;103:244-246.

(9) Goldstein E, Medina JL. Mohr syndrome on oral-facial-digital II: report of two cases. Journal of the American Dental Association 1974;89:377-382.

(10) Chen RJ, Chen HS. Talon cusp in primary dentition. Oral Surg, Oral Med, Oral Pathol 1986;62:67-72.

(11) Gardner DG, Girgis SS. Talon Cusps : a dental anomaly in the Rubinstein--Taybi syndrome. Oral Surg, Oral Med, Oral Pathol 1979;47:519-521.

(12) Shafer WG, Hine MK, Levy BM. A textbook of Oral Pathology, 3rd ed., Philadelphia, W. B. Saunders Co. 1974;p. 38.

(13) Mellor JK, Ripa LW. Talon Cusp : a clinically significant anomaly : Oral surgery, Oral Medicine, Oral Pathology 1970;29:225-228.

(14) Davis PJ, Brook AH. The presentation of talon cusp diagnosis, clinical features, associations and possible aetiology. British Dental Journal 1986;160:84-88.

(15) Schulze C. Developmental abnormalities of the teeth and jaws. In : Gorlin RJ, Goldman HM (eds). Thoma's oral pathology, edn 6. St. Louis: The C. V. Mosby Company, 1970:96-97.

(16) Mader CL : Mandibular talon Cusp. J Am Dent Ass 1982;105:651-653.

(17) Mader CL, Kellogg SL : Primary talon Cusp. Journal of Dentistry for Children 1985;52:223-226.

(18) Abbot PV: Labial and Palatal talon cusp on the same tooth. A Case report. Oral Surg Oral Med, Oral Pathol, Oral Radiol and Endod 1998;85:726-730.

Babitha GA [1], Shobha Prakash [2], Mithul Mishra [3]

Department of Periodontics, College of Dental Sciences, Davangere.

Associate Professor [1]

Professor and Head [2]

Post Graduate [3]

Article Info

Received: October 9, 2010

Review Completed: November 14, 2010

Accepted: December 9, 2010

Available Online: April, 2011

Email for correspondence: e-mail:drbabitha37@yahoo.co.in
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Title Annotation:Case Report
Author:Babitha, G.A.; Prakash, Shobha; Mishra, Mithul
Publication:Indian Journal of Dental Advancements
Article Type:Report
Date:Jan 1, 2011
Words:1403
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