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Table of Contents   
CASE REPORT  
Year : 2014  |  Volume : 25  |  Issue : 3  |  Page : 398-400
Facial talon cusp on mandibular incisor: A rare case report with review of literature


1 Department of Oral Medicine and Radiology, Surendera Dental College and Research Institute, SriGanganagar, Rajasthan, India
2 Department of Oral Medicine and Radiology, Maharana Partap College of Dentistry and Research Centre, Gwalior, Madhya Pardesh, India
3 Department of Pedodontics and Preventive Dentistry, Surendera Dental College and Research Institute, SriGanganagar, Rajasthan, India

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Date of Submission12-Nov-2013
Date of Decision26-Mar-2014
Date of Acceptance12-Apr-2014
Date of Web Publication7-Aug-2014
 

   Abstract 

Talon cusp is a relatively rare developmental dental anomaly thought to arise as a result of evagination on the surface of a tooth crown before calcification has occurred. It is characterized by cusp-like projections from the cingulum area, or cemento-enamel junction of maxillary or mandibular anterior teeth, in both the primary and permanent dentition, usually observed on the lingual surface of the affected tooth. The cusp may or may not contain an extension of the pulp. The etiology remains unknown. The incidence is 0.04-8%. Any tooth may have a talon cusp but most of the cases involve maxillary lateral incisors. The anomaly has been reported to be rare especially when it occurs on mandibular teeth. This article reports a case of talon cusp on permanent mandibular central incisor that too on facial aspect which makes it a rare entity

Keywords: Facial, mandible, permanent teeth, talon′s cusp

How to cite this article:
Sachdeva SK, Verma P, Dutta S, Verma KG. Facial talon cusp on mandibular incisor: A rare case report with review of literature. Indian J Dent Res 2014;25:398-400

How to cite this URL:
Sachdeva SK, Verma P, Dutta S, Verma KG. Facial talon cusp on mandibular incisor: A rare case report with review of literature. Indian J Dent Res [serial online] 2014 [cited 2020 Jul 6];25:398-400. Available from: http://www.ijdr.in/text.asp?2014/25/3/398/138355
Talon cusp is a well-delineated cusp like anomalous structure located on the surface of primary or permanent anterior teeth. The talon cusp is composed of normal enamel and dentine with a varying degree of pulp tissue. It may present unilaterally or bilaterally in males or females. [1] The first recorded case of talon cusp was described by W. Mitchell in 1892, on the lingual surface of an upper central incisor as 'a process of horn like shape curving from the base downward to the cutting edge' in a female patient. [2] The name 'talon' cusp was given by Mellor and Ripa in 1970 because of its characteristic shape resemblance to an eagle's talon. [3]

The prevalence of talon cusp is low, with estimates ranging from less than 1% to approximately 8% of the population. [4]

Hattab et al. [5] classified these anomalous cusps into three types based on the degree of cusp formation and extension: 1. Talon - a morphologically well-delineated additional cusp that prominently projects from the Palatal/labial surface of a primary or permanent anterior tooth, and extends at least half the distance from the cemento-enamel junction to the incisal edge. 2. Semi-talon - an additional cusp of one millimeter or more, but extending less than half the distance from the cemento-enamel junction to the incisal edge. It may blend with the palatal surface or stand away from the rest of the crown. 3. Trace talon-an enlarged or prominent cingula in any of its variants (i.e. conical, bifid or tubercle-like) originating from the cervical third of the root.

This article documents a very rare case of facial talon cusps on permanent mandibular central incisors.


   Case report Top


A 35-year-old male reported to Department of Oral Medicine and Radiology, for a routine dental checkup. The patient's medical history and family history was non-contributory. General examination did not reveal any abnormality. On intraoral examination, one linear cusp like structure was present on the facial surface of the mandibular left central incisor, which extended to incisal edge of the tooth [Figure 1]a]. The tooth appeared T-shaped when viewed incisally [Figure 1]b]. There was no soft tissue irritation to lip as the margins were smooth. Mild attrition of the cusp like structure was also noted because of occlusal interference. The cusp merged smoothly with the labial surface of the tooth with no deep developmental groove at this junction. The vitality test did not show any abnormality. Dental fluorosis was the other dental finding. On radiographic examination, periapical radiograph revealed an inverted V-shaped radiopaque structure on the mandibular left central incisor [Figure 2]a and b]. The extent of pulp tissue into the cusp could not be determined on the periapical radiograph. A diagnosis of type 1 talon cusp was made, according to Hattab's classification. As the talon cusp did not cause any problem, the patient was not willing for any contouring of the crown of the tooth with facial talon cusp. The patient was advised periodic follow-up.
Figure 1: (a) Frontal view shows talon cusp on facial aspect of mandibular left central incisor (b) Incisal view of same tooth showing T-form

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Figure 2: (a) Intra-oral periapical radiograph shows inverted V-shape radiopacity on coronal portion of mandibular left central incisor. (b) Incisal view of radiograph with same radiopaque, inverted V shape on coronal portion of same tooth

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   Discussion Top


Talon cusp occurs in primary and permanent incisors, affecting both the sexes and may be unilateral or bilateral. [1] A review of the literature suggests that 75% of talon cusps are in the permanent dentition and 25% are in the primary dentition. Males show a higher frequency than females. 92% of cases affect the maxilla and the 8% affects mandible. Only central incisors are involved in the primary dentition, and the maxillary lateral incisor is most often affected in the permanent dentition (67%), followed by the central incisor (24%) and canine (9%). The shape, size, structure, location and the site of origin of talon cusp vary widely. The anomaly is commonly unilateral, but one-fifth of the cases are bilateral in occurrence. [5]

Mandibular talon cusps have been reported in the literature, to best of knowledge 14 cases [1] have been reported, with facial mandibular talon cusps only in 5 cases [Table 1]. [6],[7],[8],[9],[10]
Table 1: Reported cases of mandibular facial talon cusps


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This case report of facial talon cusp on permanent mandibular central incisor therefore seems to signify a unique and rare presentation.

Radiographically, it may appear typically as a V-shaped radiopaque structure, as in true talon or semi-talon, or tubercle-like, as in trace talon, originating from the cervical third of the root, superimposed over the crown of the tooth. The point of the 'V' is inverted in mandibular cases. This appearance varies with the shape and size of the cusp, and the angle at which the radiograph is taken. [8] It is composed of enamel, dentine and a varying amount of pulp tissue. [1] The extent of pulp extension into the cusp is however difficult to determine because of its superimposition over the main pulp chamber. It has been suggested that large talon cusps are more likely to contain pulp tissue. [5]

The exact etiology is not known, but it is suggested to have multi-factorial etiology which includes a combination of environmental and genetic factors. [5] It is thought to arise during the morpho-differentiation stage of tooth development, as a result of out-folding of the inner enamel epithelial cells and a transient focal hyperplasia of mesenchymal dental papilla organ or hyper-activity of the dental lamina. [5] The occurrence of talon cusp in close family members has suggested a strong genetic influence. Talon cusp may occur as an isolated findings and or may be associated with other dental anomalies such as mesiodens, complex odontome, macrodontia, unerupted or impacted teeth, peg-shaped maxillary incisor, dens invaginatus. [5]

It has been reported frequently with syndromes like  Sturge- Weber syndrome More Details More Details (encephalotrigeminal angiomatosis), Rubinstein-Taybi syndrome, [11] Mohr syndrome (orofacial-digital II), [12] incontinentia pigmenti achromians syndrome, [13]  Ellis-van Creveld syndrome More Details, [14] Alagille's syndrome [15] and Berardinelli-Seip syndrome. [16] This case presented as an isolated finding of talon cusp with no local or systemic syndromic condition.

The complications of talon cusp are aesthetic, diagnostic, functional, and pathological. A large talon cusp gives unaesthetic appearance to tooth. Diagnostic problem occurs if the talon cusp is unerupted; it may resemble a compound odontome or a supernumerary tooth on radiograph, leading to a wrong diagnosis. Functional problems include occlusal interference, displacement of teeth, trauma to the lip and tongue, and speech problems. The pathological complication includes carious involvement of deep grooves, causing periapical pathology. Abnormal occlusal forces produced may result in traumatic occlusion, accidental cusp fracture and even displacement of teeth. Severe attrition of these cusps may lead to pulp exposure and periapical pathology. [3]

Management of talon cusp includes conservative or radical, depending on individual presentation and related complications. As small talon cusps are asymptomatic, so no treatment is required. In cases where the deep developmental grooves are presents, simple prophylactic measures can be done like fissure sealing or composite restoration. [3] In case of occlusal interference, the bulk of the cusp is gradually and periodically reduced with topical fluoride application, to reduce sensitivity and stimulate reparative dentine formation. In some cases it is necessary to reduce the cusp completely followed by root canal treatment. If tooth displacement or mal-alignment of affected or opposing teeth is present, orthodontic correction can be done. [8]

Mandibular talon cusps especially that present on facial aspect is a rare clinical entity as only five cases have been reported in the literature. [6],[7],[8],[9],[10] Most cases occurs as an isolated findings as in the present case; the patient did not give a history of its occurrence in any family member. This case report supports previous reports of higher prevalence of this condition in males. The present case is a type 1 talon cusp.

In this case, the cusp was prominent and sharply defined and projected from the facial cervical region to the incisal edge of the tooth. This resulted in occlusal interference, which resulted in attrition of the tip of the cusp and the opposing maxillary incisor. The condition was asymptomatic as the patient did not complain of any discomfort and was less concerned. The patient was kept under regular follow-up.


   Conclusion Top


Talon cusp is a not an innocuous dental anomaly, as it may provide a challenge during diagnosis and treatment planning to clinician. The management and treatment outcome of talon cusp depends on the size, presenting complications and patient cooperation. The aim of early diagnosis of talon cusp is to minimize local problems, such as caries, periodontal diseases, and malocclusion. Talon cusp is occasionally present in association with other systemic conditions and dental anomalies. Clinicians should always be aware of the developmental anomalies, their variations, clinical complications and treatment option available for their management. The various management options includes selective cuspal grinding of accessory cusp, along with application of fluoride as a desensitizing agent, complete reduction of cusp followed by root canal treatment depending upon the severity of complications present.

 
   References Top

1.Ramalingam K, Gajula P. Mandibular talon cusp: A rare presentation with the literature review. J Nat Sci Biol Med 2011;2:225-8.  Back to cited text no. 1
    
2.Mitchell WH. Case report. Dent Cosmos 1892;34:1036.  Back to cited text no. 2
    
3.Mellor JK, Ripa LW. Talon cusp: A clinically significant anomaly. Oral Surg Oral Med Oral Pathol1970;29:225-8.  Back to cited text no. 3
[PUBMED]    
4.Chawla HS, Tewari A, Gopalakrishnan NS. Talon cusp: A prevalence study. J Indian SocPedodPrev Dent1983;1:28-34.  Back to cited text no. 4
    
5.Hattab FN, Yassin OM, al-Nimri KS. Talon cusp in permanent dentition associated with other dental anomalies: Review of literature and reports of seven cases. ASDC J Dent Child1996;63:368-76.  Back to cited text no. 5
    
6.McNamara T, Haeussler AM, Keane J. Facial talon cusps. Int J Paediatr Dent 1997;7:259-62.  Back to cited text no. 6
    
7.Llena-Puy MC, Forner-Navarro L. An unusual morphological anomaly in an incisor crown.Anterior dens evaginatus. Med Oral Patol Oral Cir Bucal 2005;10:13-6.  Back to cited text no. 7
    
8.Oredugba FA. Mandibular facial talon cusp: Case report. BMC Oral Health 2005;5:9.  Back to cited text no. 8
[PUBMED]    
9.Ekambaram M, Yiu CK, King NM. An unusual case of double teeth with facial and lingual talon cusps. Oral Surg Oral Med Oral Pathol Oral RadiolEndod2008;105:e63-7.  Back to cited text no. 9
    
10.Rao PK, Mascarenhas R, Shetty SR. Facial talon in mandibular incisor: An unusual occurrence. Dent Res J (Isfahan) 2011;8:229-31.  Back to cited text no. 10
    
11.Kinirons MJ. Oral aspects of Rubenstein-Taybi syndrome. Br Dent J1983;154:46-7.  Back to cited text no. 11
[PUBMED]    
12.Goldstein E, Medina JL. Mohr syndrome or oral-facial-digital II: Report of two cases. J Am Dent Assoc1974;89:377-82.  Back to cited text no. 12
[PUBMED]    
13.Tsutsumi T, Oguchi H. Labial talon cusp in a child with incontinentiapigmentiachromians: Case report. Pediatr Dent1991;13:236-7.  Back to cited text no. 13
    
14.Hattab FN, Yassin OM, Sasa IS. Oral manifestations of Ellis-van Creveld syndrome: Report of two siblings with unusual dental anomalies. J ClinPediatr Dent1998;22:159-65.  Back to cited text no. 14
    
15.Chatterjee M, Mason C.Talon cusps presenting in a child with Alagille's syndrome--a case report. J ClinPediatr Dent2007;32:61-3.  Back to cited text no. 15
    
16.Solanki M, Patil SS, Baweja DK, Noorani H, Pk S.Talon cusps, macrodontia, and aberrant tooth morphology in Berardinelli-Seip syndrome. Oral Surg Oral Med Oral Pathol Oral RadiolEndod2008;105:e41-7.  Back to cited text no. 16
    

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Correspondence Address:
Suresh K Sachdeva
Department of Oral Medicine and Radiology, Surendera Dental College and Research Institute, SriGanganagar, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.138355

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