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| CASE REPORT |
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| Year : 2016 | Volume
: 13
| Issue : 3 | Page : 162-164 |
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Palatal talon's cusp of a permanent maxillary lateral incisor: A case report
M Saleem, D Deepa PhD
Department of Periodontology, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India
| Date of Submission | 02-Apr-2016 |
| Date of Acceptance | 10-May-2016 |
| Date of Web Publication | 29-Sep-2016 |
Correspondence Address:
D Deepa
Professor of Periodontology, Subharti Dental College and Hospital, Meerut, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1687-8574.191435
Talon's cusp is a relatively rare dental developmental anomaly characterized by the presence of an accessory cusp-like structure projecting from the cingulum area or cemento-enamel junction. This anomaly occurs as a result of disturbances during the morphodifferentiation stage of tooth development. It mainly occurs in either maxillary or mandibular anterior teeth in both the primary and permanent dentition. Here, we report a case of talon's cusp on a permanent maxillary lateral incisor tooth.
Keywords: lateral incisor, maxillary, permanent teeth, Talon's cusp
How to cite this article:
Saleem M, Deepa D. Palatal talon's cusp of a permanent maxillary lateral incisor: A case report. Tanta Dent J 2016;13:162-4 |
| Introduction | |  |
Talon's cusp is an uncommon tooth anomaly projecting from the cingulum area or cemento-enamel junction of maxillary or mandibular anterior teeth [1]. It contains enamel and dentin with varying degrees of pulp tissue [2]. It was first recorded by Mitchell in 1892 [3], described as 'a process of a horn-like shape curving from the base downward to the cutting edge' mostly seen on the lingual aspect of the maxillary central incisor. Synonyms of talon cusp are dens evginatus, interstitial cusp, tuberculated premolar, odontoma of axial core type, evaginated odontoma, occlusal anomalous tubercle, and supernumerary cusp [4].
A review of the literature suggests that 75% of the cases were in the permanent dentition and 25% in the primary dentition [5]. This anomaly has a greater predilection in the maxilla (with more than 90% of cases reported) than in the mandible (only 10% of cases) [6]. In the permanent dentition, 55% of the cases involved maxillary lateral incisors, 33% involved central incisors, and 4% involved canines [7]. Here we report a case of talon's cusp on the palatal aspect of the permanent maxillary right lateral incisor.
| Case Report | | |
A healthy 30-year-old male patient reported to the Department of Periodontology, Subharti Dental College, Meerut, Uttar Pradesh, with a chief complaint of malaligned upper front teeth. Intraoral examination revealed the presence of an extension on the tooth structure on the palatal aspect of the maxillary right lateral incisor. There was an absence of soft-tissue abnormalities as well as tenderness on percussion or palpation. Medical and dental history was noncontributory. No family member had similar dental anomaly. There was only slight proclination of the right lateral incisor, and the extension was confirmed to be talon's cusp ([Figure. 1]), which was seen as a V-shaped conical prominent cusp on the permanent maxillary lateral incisor. There was no pulpal involvement of the cusp; only enamel and dentin were involved ([Figure. 2]). Radiographic examination confirmed the finding ([Figure. 3]). There was no other hard-tissue or soft-tissue abnormality. Pulp vitality test was performed and found to be vital. The study model showed the cusp to be about 3 mm wide mesiodistally and 6 mm cervico-incisally ([Figure. 4]). As the patient was asymptomatic he was not willing to undergo tooth contouring or reshaping of the lateral incisor. Occlusal analysis was done. The fremitus test was performed to assess the degree of trauma from occlusion and demonstrated degree one vibrations that were mild. Occlusal correction was done to relieve the trauma with the carbide bur, and again occlusion was checked with articulating paper. The patient was given an explanation about the treatment options for management of talon's cusp, including tooth recontouring, endodontic treatment, and bleaching. In this case, phase I periodontal therapy was complete, which included scaling and root planing with occlusal correction. Currently, the patient is under follow-up. After re-evaluation, periodontal surgery will be considered if required. Cone beam computed tomography (CBCT) was not performed in this patient as the tooth was asymptomatic and no intervention was planned. | Figure 4: Study model showing talon's cusp on the palatal surface of the maxillary lateral incisor.
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| Discussion | | |
Talon's cusp is so named because its shape resembles an eagle's talon. Several theories have been proposed regarding the etiology of talon's cusp. The most accepted one suggests that talon's cusp might occur as a result of an outward folding of inner enamel epithelial cells and a transient focal hyperplasia of the mesenchymal dental papilla [8]. The susceptibility of maxillary lateral incisors may be due to the compression of the tooth germ in the morphodifferentiation stage from the adjacent central incisor and canine, which develops 7 months earlier than the lateral incisor [9]. Hattab and colleagues classified this anomaly into three types on the basis of the degree of cusp formation and extension. Type I (talon) has an additional cusp that projects from the palatal surface of an anterior tooth and extends at least one half the distance from the cemento-enamel junction to the incisal edge. Type II (semi-talon) has an additional cusp 1 mm or more in length but extending less than one half the distance from the cemento-enamel junction to the incisal edge. Type III (trace-talon) manifests as enlarged and prominent cingula and their variations [10]. According to Hattab et al. [10] this case was of type I in which the additional cusp projected from the palatal surface of the anterior tooth and extended more than one half of the distance from the cemento-enamel junction to the incisal edge.
There are several treatments for talon's cusp, such as conservative or radical, depending on factors such as shape, location, size, and tooth affected. Periodic and gradual reduction of the cusp, with application of a desensitizing agent, reduction of cusp with or without endodontic therapy, sealant application on the grooves, and esthetic restorations are options of treatment [11]. Bleaching can improve the appearance of discolored teeth while preserving the tooth structure, and it avoids more costly invasive dental treatment [12].
| Conclusion | | |
Early diagnosis and prompt treatment may minimize various local problems like caries, periodontal disease, and malocclusion. Talon's cusp may pose a substantial challenge to clinicians during diagnosis and treatment planning. This patient was followed up with a strict oral hygiene regime and periodic review.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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| 9. | Logan WHG, Kronfeld R. Development of the human jaws and surrounding structures from birth to the age of fifteen years. J Am Dent Assoc 1933; 20:379–427. |
| 10. | Hattab FN, Yassin OM, Al-Nimri KS. Talon cusp in permanent dentition associated with other dental anomalies: review of literature and report of seven cases. J Dent Child 1996; 63:368–376. |
| 11. | Soares AB, de Araújo JJ, de Sousa SM, Veronezi MC. Bilateral talon cusp: case report. Quintessence Int 2001; 32:283–286. |
| 12. | Hattab FN, Qudeimat MA, al-Rimawi HS. Dental discoloration: an overview. J Esthet Dent 1999; 11:291–310. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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