Restorative Dentistry Dens evaginatus of anterior teeth (talon cusp): Report of five cases Juan J. Segura-Egea, DDS, MD, PhD1/Alicia Jiménez-Rubio, DDS, MD, PhD2/ José V. Ríos-Santos, DDS, MD, PhD3/Eugenio Velasco-Ortega, DDS, MD, PhD3 The talon cusp, or Dens evaginatus of anterior teeth, is a relatively rare dental developmental anomaly characterized by the presence of an accessory cusplike structure projecting from the cingulum area or ce- mentoenamel junction. This occurs in either maxillary or mandibular anterior teeth in both the primary and permanent dentition. This article reports five cases of talon cusp, two of them bilateral, affecting perma- nent maxillary central and lateral incisors and canines that caused clinical problems related to caries or occlusal interferences. (Quintessence Int 2003;34:xxx–xxx) Key words: dens evaginatus, dental anomalies, occlusal interference, talon cusp ens evaginatus is a developmental anomaly char- volved (67%), followed by the central incisors (24%) Dacterized by the presence of an extra cusp, occur- and canines (9%).7,8 ring more frequently in mandibular premolars.1 In ca- Family histories of cases reported previously re- nines and incisors, Dens evaginatus originates usually vealed that sometimes talon cusp affected patients who in the palatal cingulus as a tubercle projecting from had consanguineous parents.6,9 Moreover, there are sev- the palatal surface; however, the anomaly also has af- eral dates [Au: What is meant by “dates?” Reports?] fected the labial surface of the tooth.2,3 Mitchell4 first in the literature that support the hereditary character of described this dental anomaly as a “process of horn- talon cusp: the anomaly has been described affecting like shape, curving from the base downward to the two siblings,10,11 two sets of female twins,12 and two cutting edge” on the lingual surface of an maxillary family members,9 and the prevalence of talon cusp is central incisor of a female patient. Mellor and Ripa5 high in some racial groups.13–16 The family involvement named the accessory cusp talon cusp because of its re- and the association of the talon cusp with other dental semblance in shape to an eagle’s talon. abnormalities, suggest that genetics may be a major Talon cusp occurs more frequently in the perma- causative factor. However, sporadic occurrences of this nent than in the primary dentition and shows a abnormality probably are induced by trauma or other predilection for the maxilla over the mandible.6 The localized insults affecting the tooth germ. Talon cusp af- maxillary lateral incisors are the most frequently in- fects both sexes and commonly is unilateral, but one fifth of the cases are bilateral.9 The anomalous talon cusp is composed of normal enamel and dentin with varying extensions of pulp 1Associate Professor, Dental Pathology and Therapeutics, Department of tissue. Shay17 reported that pulp tissue can extend to Stomatology, School of Dentistry, University of Seville, Seville, Spain. the center of the tubercle and, once fractured, the 2Associate Professor, Dental Anatomy, Department of Morphological Sciences, School of Medicine, University of Seville, Seville, Spain. pulp is exposed. When talon cusp interferes with the normal occlusion, an occlusal adjustment by grinding 3Professor of Comprehensive Dentistry, Department of Stomatology, School of Dentistry, University of Seville, Seville, Spain. the palatal projection must be performed, with the Reprint requests: Dr Juan J. Segura-Egea, C/ Cueva de Menga nº 1, por- possibility of exposure of the dentin-pulp complex tal 3, 6º-C, 41020-Sevilla, Spain. E-mail: [email protected] and, consequently, pulp necrosis.18 Quintessence International 1 Segura-Egea et al Fig 1 Case 1. Occlusal view showing a prominent accessory Fig 2 Case 1. Periapical radiograph. cusp on the palatal surface of the right canine. Darkly stained de- velopmental grooves are evident. The cases reported in the literature as talon cusp packed with dental plaque. A carious lesion was de- are very different since this anomaly varies widely in tected clinically in the distal groove. The affected tooth shape, size, structure, location, and site of origin.19 The was responsive to electric pulp testing. The cusp did tip of the cusp may stand away from the crown or may not irritate the tongue during speech and mastication be in close approximation to the lingual surface.6 and did not interfere with the occlusion. Radiographs Some cusps are quite sharp and spiked, while others showed the presence of enamel, dentin, but not pulp are teatlike and have rounded and smooth tips. Talon horn in the palatal accessory cusp (Fig 2) [Au: Edits cusps may be markedly enlarged or exaggerated cin- ok?]. The left canine did not show tahn cusp. gula on the maxillary incisors.20 Others have described them as hornlike, conical, or pyramidal.7,9 Davis and Case 2 Brook21 stated that talon cusp may represent the ex- treme of a continuous variation progressing from a A 28-year-old male was seen for oral prophylaxis. normal cingulum, to an enlarged cingulum, to a small Clinical examination disclosed prominent cusplike accessory cusp, to a talon cusp. structures on the palatal surfaces of both the left max- This article reports five cases of talon cusp, two of illary lateral incisor and the left maxillary canine (Fig them bilateral, affecting permanent maxillary central 3). The accessory cusp of the lateral incisor was pyra- and lateral incisors and canines that caused clinical midal in shape and extended from the cementoenamel problems related to caries or occlusal interferences. junction one third to the incisal edge. It was attached to the palatal surface and extended distally. The cusp tip was pointed and slightly sharp. The cusp measured CASE REPORTS 3.7 mm in length (incisocervically), 3.9 mm in width (mesiodistally), and 3.3 mm in thickness (labiolin- Case 1 gually). Noncarious, but stained, developmental grooves were observed laterally. A caries lesion was A healthy 21-year-old female was seen for a routine evident in the mesial surface of the tooth. dental examination. Her medical and dental history The accessory cusp of the canine also was pyrami- was unevenfful. The right maxillary canine exhibited a dal in shape and extended from the cementoenamel small prominent cusp on the palatal surface (Fig 1). junction one quarter to the incisal edge. It was at- The accessory cusp on the right canine, conical in tached to the palatal surface and extended perpendic- shape, was projected from the cementoenamel junction ular to the mesiodistal surface of the crown. and extended less than halfway to the incisal edge. The Noncarious developmental grooves were observed lat- cusp measured 3.3 mm in length (incisocervically), 4.3 erally. The cusp measured 2.9 mm in length (incisocer- mm in width (mesiodistally), and about 2.6 mm in vically), 2.7 mm in width (mesiodistally), and 2.4 mm thickness (labiolingually). A small bridge of enamel in thickness (labiolingually). connected the accessory cusp to the palatal surface of The talon cusps did not irritate the tongue during the tooth. The developmental grooves on the distal and speech and mastication, but, due to the reduced over- the mesial side of the cusp were darkly stained and bite, the taloned teeth, mainly the left lateral incisor, 2 Volume 34, Number 4, 2003 Segura-Egea et al Fig 3 Case 2. Anomalous cusplike structures on the palatal as- Fig 4 Case 3. Talon cusps on maxillary lateral incisors (mirror pects of both maxillary left lateral incisor and canine. photograph). interfered slightly with the occlusion. An occlusal ad- justment by grinding the palatal projection of the lat- eral incisor was performed in one appointment. Case 3 A 19-year-old male presented to the dental clinic for a routine dental examination at the end of an orthodon- tic treatment. The patient appeared healthy and of normal physical development for his age. There was no reported history of orofacial trauma. The occlusion was a Class I molar relationship. Both maxillary right and left lateral incisors showed an accessory cusp on Fig 5 Case 4. The talon cusp on right maxillary lateral incisor is the palatal aspect (Fig 4). The accessory cusp on the pointed and sharp and coincides with the midline (mirror photo- left maxillary lateral incisor measured 2.7 mm in graph). length (incisocervically), 3.9 mm in width (mesiodis- tally), and 2.2 mm in thickness (labiolingually). The talon cusp was pyramidal in shape and located on the Case 4 center of the crown, with the tip of the cusp attached to the crown. The accessory cusp extended from the A 10-year-old male presented for the treatment of sev- cementoenamel junction more than one third to the eral carious lesions. Clinical examination disclosed a incisal edge. Noncarious but slightly stained develop- prominent cusplike structure on the palatal surface of mental grooves were present at the junction of the the maxillary right lateral incisor (Fig 5). The talon talon cusp and the palatal surface of the tooth. The cusp was pyramidal in shape and extended from the anomalous cusp on the right maxillary lateral incisor cementoenamel junction halfway to the incisal edge. It measured 2.6 mm in length (incisocervically), 3.5 mm was attached to the palatal surface and extended per- in width (mesiodistally), and 2.0 mm in thickness pendicular to the mesiodistal surface of the crown. (labiolingually). The talon cusp was conical in shape The cusp tip was pointed and sharp and coincided and located in the distal half of the crown, with the tip with the midline of the long axis of the tooth, forming of the cusp attached to the crown. The accessory cusp a Y-shaped crown outline.