Clinical Significance of Talon Cusp in a Mixed Dentition Patient

Abstract

Talon cusp is a developmental dental anomaly with supernumerary structure projecting from the dento-enamel junction towards the incisal edge of an anterior tooth. The etiology is usually unknown but studies states that talons cusp can occur due to the hyperactivity of the enamel organ during morph differentiation. The incidence is 0.04-10% and the prevalence is more in maxillary incisors than mandibular incisors and more in palatal aspect of the teeth. The most common complications are esthetics, increased risk for caries and occlusal accommodation. This article reports a case of talon cusp on the palatal surface of the permanent maxillary lateral incisor. Due to its clinical significance the dentist should be able to diagnose the supernumerary tooth and definitive treatment should be done.

INTRODUCTION

Talon cusp is an unusual dental anomaly in which cusp-like mass of hard tissue protrudes from the cingulum of maxillary or mandibular teeth. This anomaly was first reported by Mitchell in 1892.[1] It was named talon cusp due to its resemblance to Eagle's talon by Mellor and Ripa.[2]

Hattab et al. have reported more prevalence in maxillary lateral incisors with higher prevalence in men.[3] Davis and Brook has reported there may be an element of consanguinity as an etiological factor.[4]

CASE REPORT

In our case, a 13-year-old boy reported for noneruption of canine and clinically, a talon cusp was noticed in the left maxillary lateral incisor in the cingulum region [Figure 1]. The patient's parents had a consanguineous marriage.

Figure 1.

Labial view of talons cusp of maxilary left lateral incisors

Clinical and radiographical analysis showed a tendency for impaction of canines [Figure 2]. There is large mesiodistal width of the left upper maxillary lateral incisor 10 mm, whereas the left central incisor was only 7.5 mm. The pulpal tissue of the tooth was well into the talon cusp in the radiograph [Figure 3].

Figure 2.

Talons cusp – palatal view and impacted canine

Figure 3.

OPG

DISCUSSION

Hattab et al. have classified talon cusp into three types as talon cusp, semitalon cusp, and trace cusp for diagnostic purpose.[5] Hattab et al. have reported that talon cusp has been associated with certain syndromes such as Mohr syndrome (orofacial – digital II), Sturge–Weber syndrome, Rubinstein–Taybi syndrome, incontinentia pigmenti achromians, and Ellis-van Creveld syndrome.[6]

According to Ozcelik and Atila, exposure of the pulp was a concern during complete cuspal reduction. Endodontic therapy could be the treatment of choice when treatment by protective measure is not possible.[7]

CONCLUSION

Primary concerns in any mixed dentition patients with talon cusps in permanent teeth are:

1. Problem of crowding due to large size of tooth

2. Caries surrounding the talon cusp to be addressed

3. Problem of hitting in lower teeth causing

   1. Proclination

   2. Malocclusion

   3. Periodontal damage to the tooth.

4. Root of the tooth may also show variations and pose difficulty in endodontic management

5. Larger talon cusp may interfere with tongue.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.