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Talons Cusp in Primary Incisors: a Rarity 10.5005/jp-journals-10011-1302 DhanuCASE GaneshREPORT Rao et al Talons Cusp in Primary Incisors: A Rarity Dhanu Ganesh Rao, Vijeev Vasudevan, Manjunath Venkatappa, Nagendran Jeyavelpandiyan ABSTRACT any significant clinical problems, corrective treatment for Talon cusp is an uncommon anomaly in the primary dentition. the tooth was not instituted. Patient was advised for a The present report describes a case of bilateral talon cusps on periodic recall visit. the maxillary primary central incisors in a 1-year, 4-month-old Indian boy. Both central incisors exhibited a sharp prominent DISCUSSION accessory cusp on the palatal surface which extended from the cementoenamel junction to the incisal edge. There were no Talons cusp is more common in the permanent dentition associated developmental syndromes. (75%) than in the primary dentition, while 92% affect the 5,10 Keywords: Talon cusp, Primary incisors, Cingulum. maxillary teeth. The maxillary lateral incisor is the most frequently affected in the permanent dentition while the How to cite this article: Rao DG, Vasudevan V, Venkatappa M, Jeyavelpandiyan N. Talons Cusp in Primary Incisors: A Rarity. maxillary central incisor is the most affected in the primary 10 J Indian Aca Oral Med Radiol 2012;24(3):230-231. dentition. Most times it occurs unilaterally but bilateral cases, including multiple talon cusps have also been Source of support: Nil reported.5,11-14 Conflict of interest: None declared Hattab et al classified talon cusps as Type 1 talon, 5 INTRODUCTION Type 2 semi talon and Type 3 trace talon. This classification was later modified by Stephen-Ying et al.15-17 Talon cusp is a supernumerary structure projecting from the dentoenamel junction to a variable distance toward the Type 1, major talon: A morphologically well delineated incisal edge of an anterior incisor tooth. It was described additional cusp that prominently projects from the facial or by Mitchell in 1892.1 Due to its resemblance to an eagle’s palatal/lingual surface of an anterior tooth and extends at talon it is named as talon cusp by Mellor and Ripa.2 It is least half the distance from the cementoenamel junction to composed of enamel, dentine and a varying amount of pulp the incisal edge. 3,4 tissue. Type 2, minor talon: A morphologically well-defined addi- The exact etiology is not known, but it is suggested to tional cusp that projects from the facial or palatal/lingual 5-7 be a combination of genetic and environmental factors. surface of an anterior tooth and extends more than one- It is thought to arise during the morphodifferentiation stage fourth, but less than half the distance from the of tooth development, as a result of outfolding of the enamel cementoenamel junction to the incisal edge. organ or hyperproductivity of the dental lamina.5,8 It is also suggested that disturbances during morphodifferentiation, Type 3, trace talon: Enlarged or prominent cingula and their such as altered endocrine function might affect the shape variations, which occupy less than one-fourth the distance 15 and size of the tooth without impairing the function of from the cementoenamel junction to the incisal edge. ameloblasts and odontoblasts.9 Caries susceptibility, occlusal interferences, compromised esthetics are common problems associated CASE REPORT Parents of 16-month-old boy reported to our department with the complaint of extra teeth in upper anterior region. Clinical examination revealed enamel projections on palatal aspect of both the maxillary primary central incisors, which extended from the cingulum up to the incisal edge of the tooth (Fig. 1).The tooth appeared T-shaped when viewed incisally. The talon cusp merged smoothly with the lingual surface of the tooth. The deep developmental groove, which is normally seen at this junction, was not present. The margins of the talon cusp were smooth and did not cause any discomfort to the child. Caries was not detected and no functional or esthetic problems were present (Fig. 2). On the basis of its characteristic clinical appearance, a Fig. 1: Enamel projections on palatal aspect of both the diagnosis of talon cusp was made. As the tooth did not pose maxillary primary central incisors 230 JAYPEE JIAOMR Talons Cusp in Primary Incisors: A Rarity 7. Rantanen AV. Talon cusp. Oral Surg 1971;32:398-400. 8. Sicher S, Bhasker SN, Orban S. Oral histology and embryology (7th ed). St Louis, MO: CV Mosby Co 1972;49. 9. Meon R. Talon cusps in two siblings. NZ Dent J 1990;86:42-49. 10. Danker E, Harari D, Rotstein I. Dens evaginatus of anterior teeth. Literature review and radiographic survey of 15,000 teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;81:472-76. 11. Mader CL. Talon cusp. J Am Dent Ass 1981;103:244-46. 12. Chen RJ, Chen HS. Talon cusp in primary dentition. Oral Surg Oral Med Oral Pathol 1986;62:67-72. 13. Oredugba FA, Orenuga O. Talon cusp: Clinical significance and management with reference to aetiology and presentation. Nig Qt J Hosp Med 1998;8:56-59. 14. Sanu O. Talon cusps in two siblings. J Med Med Sc 2001;3: 35-38. 15. Hsu Chin-Ying S, Girija V, Fei YJ. Bilateral talon cusps in primary teeth: Clinical significance and treatment. J Dent Child Fig. 2: intraoral photograph showing no caries 2001;68:239-43. with talon cusps.5,11,15,18 Management will depend on 16. Jowharji N, Noonan RG, Tylka RA. An unusual case of dental anomaly: A facial talon Cusp. J Dent Child 1992;59:156-58. individual presentation and complications. Small talon cusps 17. McNamara T, Haeussler AM, Keane J. Facial talon cusps. Int J 13,19 are asymptomatic and need no treatment. Pediatr Dent 1997;7:259-62. In cases of talon cusp in the primary dentition it is 18. Davis PJ, Brook AJ. The presentation of talon cusp, diagnosis, important to monitor regularly the occlusion during the clinical features, associations and possible etiology. Br Dent J 1985;159:84-88. eruption of a tooth with talon cusp as well as their opposing 19. Hattab FN, Yassin OM. Bilateral talon cusps on primary central 15,20 teeth in order to prevent potential crossbite. Occlusal incisors: A case report. Int J Paediatr Dent 1996;6(3):191-95. interferences might necessitate selective occlusal grinding 20. Nadkarni UM, Munshi A, Damle SG. Unusual presentation of and there is an increased chance of pulpal exposure for talon cusp: Two case reports. Int J Paediatr Dent 2002;12:332-35. which an endodontic procedure, such as partial pulpotomy 21. Myers CL. Treatment of a talon-cusp incisor: Report of a case. 5,11,21 J Dent Child 1980;47:43-45. or root canal treatment may be needed. 22. Goldstein E, Medina JL. Mohr syndrome or oral-facial-digital It has also been associated with some systemic II report of two cases. J Am Dent Ass 1974;89:377-82. conditions such as Mohr syndrome (orofacial-digital II),22 23. Gardener DG, Girgis SS. Talon cusps: A dental anomaly in the Rubinstein-Taybi syndrome,23 incontinentia pigmenti Rubinstein-Taybi syndrome. Oral Surg 1979;47:519-21. 24 25 24. Tsutsumi T, Oguchi H. Labial talon cusp in a child with achromians and Ellis-van Creveld syndrome. incontinentia pigmenti achromians: Case report. Pediatr Dent The presence of a talon cusp is not always an indication 1991;13:236-37. for dental treatment unless it is associated with problems 25. Hattab FN, Yassin OM, Sasa IS. Oral manifestations of Ellisvan such as compromised esthetics, occlusal interference, tooth Creveld syndrome: Report of two siblings with unusual dental displacement, caries, periodontal problems or irritation of anomalies. J Clin Pediatr Dent 1998;22:159-65. the soft tissues during speech or mastication. This case report will help dentist in diagnosing and in managing the clinical ABOUT THE AUTHORS cases of talon cusp, and it is of utmost importance because Dhanu Ganesh Rao the earlier the detection will reduce the future complications. Professor and Head, Department of Pedodontics and Preventive Dentistry Krishnadevaraya College of Dental Sciences and Hospital, Bengaluru REFERENCES Karnataka, India 1. Mitchell WH. Letter to the editor. Dental Cosmos 1892;34:1036. 2. Mellor JK, Ripa LW. Talon cusp a clinically significant anomaly. Vijeev Vasudevan Oral Surg 1971;29:225-28. Professor and Head, Department of Oral Medicine and Radiology 3. Shafer WG, Hine MK, Levy BM. A textbook of oral pathology Krishnadevaraya College of Dental Sciences and Hospital, Bengaluru (3rd ed). Philadelphia: WB Saunders Co 1974;38. Karnataka, India 4. Dash JK, Sahoo PK, Das SN. Talon cusp associated with other anomaly: A case report. Int J Paediatr Dent 2004 Jul;14(4):295- Manjunath Venkatappa (Corresponding Author) 300. 5. Hattab FN, Yassin OM, Al-Nimri KS. Talon cusp in the perma- Senior Lecturer, Department of Oral Medicine and Radiology nent dentition associated with other dental anomalies: Review Krishnadevaraya College of Dental Sciences and Hospital, Bengaluru of literature and reports of seven cases. J Dent Child 1996;63: Karnataka, India, e-mail: [email protected] 368-76. Nagendran Jeyavelpandiyan 6. Segura JJ, Jimenez-Rubio A. Talon cusp affecting permanent maxillary lateral incisors in 2 family members. Oral Surg Oral Dentist, Department of Pedodontics and Preventive Dentistry, MS Med Oral Pathol Oral Radiol Endod 1999;88:90-92. Ramiah Dental College and Hospital, Bengaluru, Karnataka, India Journal of Indian Academy of Oral Medicine and Radiology, July-September 2012;24(3):230-231 231.
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