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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 9  |  Issue : 2  |  Page : 85-88

Talon cusp on palatally erupted mesiodens


1 Department of Oral and Maxillofacial Pathology, Panineeya Mahavidyalaya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
2 Private Practitioner, Denta On'e Advanced Dental Care Centre, Hyderabad, Telangana, India

Date of Web Publication26-Jul-2017

Correspondence Address:
Ashalata Gannepalli
Department of Oral and Maxillofacial Pathology, Panineeya Mahavidyalaya Institute of Dental Sciences and Research Centre, Road No. 5, Kamala Nagar, Dilshukhnagar, Hyderabad - 500 060, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jorr.jorr_28_17

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  Abstract 

Talon cusp is an accessory cusp-like structure or an extra cusp on an anterior tooth arising as a result of evagination on the surface of the crown before calcification has occurred. The cusp is composed of normal enamel and dentin containing varying extensions of pulp tissue. It is associated with few developmental anomalies such as peg laterals, dens invaginatus, and mesiodens. Mesiodens is a supernumerary tooth located in the premaxillary central incisor region which is supplemental or rudimentary type. Association of mesiodens with talon cusp is a rare occurrence with 25 cases reported. The presence of Talon cusp or a supernumerary tooth – mesiodens – leads to clinical implications such as poor esthetics, crowding, rotations, and also occlusal discrepancies. In this report, we present a case report of an 18-year-old male having a talon cusp on palatally erupted mesiodens.

Keywords: Maxillary anterior teeth, mesiodens, occlusal interference, talon cusp


How to cite this article:
Gannepalli A, Ayinampudi BK, Perkari S, Appala A, Podduturi SR. Talon cusp on palatally erupted mesiodens. J Oral Res Rev 2017;9:85-8

How to cite this URL:
Gannepalli A, Ayinampudi BK, Perkari S, Appala A, Podduturi SR. Talon cusp on palatally erupted mesiodens. J Oral Res Rev [serial online] 2017 [cited 2019 Nov 22];9:85-8. Available from: http://www.jorr.org/text.asp?2017/9/2/85/211634


  Introduction Top


Developmental dental disorders may be due to abnormalities in the differentiation of the dental lamina and the tooth germs, that is, anomalies in number, size, and shape, or due to abnormalities in the formation of the dental hard tissues, that is, anomalies in structure.[1]

Talon cusp is a developmental dental anomaly seen as an accessory cusp-like structure or an extra cusp on an anterior tooth which was named by Mellor and Ripa in 1970, because of its resemblance to eagle's talon, arising as a result of evagination on the surface of the crown before calcification has occurred.[2] Etiopathogenesis of talon cusp is multifactorial and thought to be polygenetic with some environmental influences during the morphodifferentiation stage of tooth development.[3] Mesiodens is a supernumerary tooth located in the premaxillary central incisor region which is supplemental or rudimentary type, and association of mesiodens with talon cusp is a rare occurrence. Hence, we report a rare case of presence of talon cusp on palatally erupted mesiodens.


  Case Report Top


An 18-year-old male patient presented to the private dental clinic with a chief complaint of pain in the maxillary left back tooth region and irregularly placed maxillary front teeth. The patient appeared healthy and of normal physical development for his age, and his medical and family history were noncontributory.

On extraoral examination, no abnormalities were detected. On intraoral examination, no soft tissue abnormalities were observed. There was dental caries seen in relation to the maxillary left first molar (26) and on further examination of maxillary anterior region, there was crowding; the right central incisor (11) was mesiolabially rotated overlapping the mesial surface of left central incisor (21) which was mesiopalatally rotated. The right canine(13) was labially erupted. A completely erupted supernumerary tooth palatal to 11.21 was observed. The supernumerary tooth resembled maxillary central incisor on the labial aspect, and a well-developed accessory cusp with a deep developmental groove was appreciated [Figure 1]. The patient had a class I molar relation and there was occlusal interference with right first premolar (14) out of occlusion and supernumerary teeth occluding mandibular lower incisors [Figure 2]. The patient gave a history of thrusting the tongue against the supernumerary tooth.
Figure 1: The supernumerary tooth – mesiodens – with talon cusp present palatal to permanent central incisor

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Figure 2: The supernumerary tooth with mesiodens interfering with occlusion. The right canine (13) displaced labially and the right first premolar (14) is out of occlusion

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An intraoral periapical radiograph revealed a supernumerary tooth – mesiodens – with well-developed crown and root with a single root canal. The palatal talon cusp appeared as a “V-” shaped radiopaque structure superimposing over the mesiodens and its tip extending toward the incisal edge [Figure 3]. The clinical and radiographic examination confirmed the presence of supernumerary tooth – mesiodens – with talon cusp.
Figure 3: Intraoral periapical radiograph reveals well-developed crown and root with a single root canal

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The patient underwent an ultrasonic scaling, and his chief complaint was addressed with the restoration of 26. Extraction of the mesiodens with talon cusp was advised as it was interfering with occlusion followed by orthodontic correction of the remaining teeth.


  Discussion Top


Talon cusp is an accessory cusp-like structure or an extra cusp, which affects the permanent dentition (75%) and the primary dentition (25%) with more male predilection. It occurs as sporadic in normal individuals and may be associated with other dental anomalies or syndromes such as Rubinstein and Taybi, Berardinelli-Seip, Mohr, Ellis-van Creveld, Sturge-Weber, and incontinentia pigmenti achromians.[4] The prevalence varies from 0.04% to 10% with permanent dentition (75%) affected more frequently than primary dentition (25%), and there is a slight male predilection. In permanent dentition, maxillary lateral incisor is most commonly affected (67%) followed by central incisor (24%) and canines (9%), whereas maxillary central incisor was more affected in primary dentition.[3],[5]

It varies in size, shape, length, and morphological appearance ranges from an enlarged cingulum to a large, well-delineated cusp extending beyond the incisal edge of the tooth. The cusp is composed of normal enamel and dentin containing varying extensions of pulp tissue. It may connect with the incisal edge to produce a T-form or, if more cervical, a Y-shaped crown contour.[6] Radiographically, the talon cusp appears to be similar to that of normal tooth structure presenting with radiopaque enamel and dentin, with or without extension of pulpal tissues. Typically, it looks like a V-shaped structure superimposed over the normal image of the crown. Although several reports indicated talon cusps usually contain an extension of the pulp tissue, the identification of the pulpal configuration inside the talon cusp on a periapical radiograph may be difficult due to superimposition.[7]

Hattab et al. classified talon cusps into three types based on the degree of cusp formation and extension: Type 1: Talon – refers to a morphologically well-delineated additional cusp that prominently projects from the palatal (or facial) surface of a primary or permanent anterior tooth and extends at least half the distance from cementoenamel junction to the incisal edge; Type 2: Semi talon – refers to an additional cusp of a millimeter or more extending less than half the distance from cementoenamel junction to the incisal edge. It may blend with the palatal surface or stand away from the rest of the crown; Type 3: Trace talon – an enlarged or prominent cingula and their variations, i.e., conical, bifid, or tubercle-like.[7]

Talon cusp is also associated with few developmental anomalies such as dens invaginatus, peg lateral incisors, unerupted canines, bifid cingulum, shovel-shaped incisor, Odontomes, supernumerary teeth and mesiodens. Its association with mesiodens, which is a supernumerary teeth is an uncommon finding.[8]

The majority of supernumerary teeth are associated with the permanent dentition and occur predominantly in the premaxillary midline region and are termed mesiodens,[9] which can occur individually or as multiples (mesiodentes), maybe unilateral, bilateral, or often impacted.

Its overall prevalence is between 0.15% and 1.9%.[7],[8],[9] It can occur in primary dentition (mainly supplemental) and in permanent dentition (mainly rudimentary).[10]

It is classified on the basis of morphology as (i) conical, which usually occurs singly, peg-shaped, usually located palatally, may displace erupting permanent incisors, can be inverted, erupt into oral cavity and occasionally into nasal cavity, (ii) barrel shaped, with several tubercles or cusps and have incomplete or abnormal root formation, they rarely erupt but cause delayed eruption of teeth, and (iii) molariform mesiodens has premolar like crown and completely formed root.[10]

In our case, the mesiodens had a well-developed morphology, supplemental type as it resembled the central incisor–incisive form which was present palatal to 12. It had a well-developed talon cusp on palatal aspect. Radiographically, the mesiodens had a well-developed crown and root with a single root canal with a “V-” shaped radiopaque structure superimposing over the mesiodens with its tip extending toward the incisal edge as described in the literature.

Literature search of mesiodens with talon cusp revealed that so far 25 cases of talon cusp in mesiodens teeth have been reported in 21 case reports, of which, 21 cases were in the permanent dentition and 4 cases in the primary dentition. Based on the location of talon cusp, 13 cases have been reported to occur palatally, 9 cases have been reported to occur facially, and only 3 cases (Topaloglu et al., Siraci et al. and Baliarsingh et al.) have been reported to occur both facially and palatally. Based on the type of talon cusp, Type 1 has been reported in 17 cases, Type 2 in only 1 case, and Type 3 has been reported in 6 cases. Based on the shape, conical has been reported in 15 cases, multilobed in 2 cases, and supplemental in 5 cases.[5],[11]

In the present case, the mesiodens with talon cusp involved the permanent dentition, palatally present with a Type 1 talon cusp, and supplemental type of mesiodens.

Clinical complications that occur due to the presence of talon cusp are poor esthetics, stagnation of food, caries, crowding, spacing, impaction of permanent incisors, abnormal root formation, irritation of tongue during speech and mastication. The present case had mainly malocclusion and occlusal interference, thrusting of the tongue against the tooth, spacing and displacement of the teeth out of occlusion but did not have any severe clinical implications. Other lesser known complications are accidental cusp fracture, displacement of affected tooth, temporomandibular joint pain, occasionally cyst formation may happen or tooth might erupt into the nasal cavity.[12],[13]


  Conclusion Top


This paper presents a case of presence of Type 1 talon cusp associated with mesiodens on a permanent tooth which has incisive form displacing the incisors present on the lingual aspect and associated with tongue thrusting.

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.

 
  References Top

1.
Neena IE, Sharma R, Poornima P, Roopa KB. Gemination in primary central incisor. J Oral Res Rev 2015;7:55-7.  Back to cited text no. 1
  [Full text]  
2.
Mellor JK, Ripa LW. Talon cusp: A clinically significant anomaly. Oral Surg Oral Med Oral Pathol 1970;29:225-8.  Back to cited text no. 2
    
3.
Divyashree, Soumya, Hemanth, Hareeisha. Talon cusp: A rare anomaly on lower supernumerary tooth. IOSR J Dent Med Sci 2016;15:36-9.  Back to cited text no. 3
    
4.
Sarraf-Shirazi A, Rezaiefar M, Forghani M. A rare case of multiple talon cusps in three siblings. Braz Dent J 2010;21:463-6.  Back to cited text no. 4
    
5.
Ratnarenu B, Sweta M, Prashant G. Facial and Palatal talon cusp on a mesiodens associated with hypodontia- A rare occurrence. Annals and Essence of Dentsitry 2015. [ Doi 10.5368/aedj.2015.7.3.2.1].  Back to cited text no. 5
    
6.
Guttal KS, Naikmasur VG, Bhargava P, Bathi RJ. Frequency of developmental dental anomalies in the Indian population. Eur J Dent 2010;4:263-9.  Back to cited text no. 6
    
7.
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 Child 1996;63:368-76.  Back to cited text no. 7
    
8.
al-Omari MA, Hattab FN, Darwazeh AM, Dummer PM. Clinical problems associated with unusual cases of talon cusp. Int Endod J 1999;32:183-90.  Back to cited text no. 8
    
9.
Henry RJ, Post AC. A labially positioned mesiodens: Case report. Pediatr Dent 1989;11:59-63.  Back to cited text no. 9
    
10.
Russell KA, Folwarczna MA. Mesiodens – Diagnosis and management of a common supernumerary tooth. J Can Dent Assoc 2003;69:362-6.  Back to cited text no. 10
    
11.
Nagaveni NB, Shah R, Poornima P, Roshan NM. An unusual presentation of mesiodens tooth with talon cusp - Report of four cases and literature review. J Res Pract Dent 2014;2014. DOI: 10.5171/2014.183691.  Back to cited text no. 11
    
12.
Gade J, Lokade J, Gade V, Wankhade S. Talons cusp: A review and case report of mesiolabially rotated maxillary lateral incisors. Int J Contemp Dent 2010;1:39-43.  Back to cited text no. 12
    
13.
Meighani G, Pakdaman A. Diagnosis and management of supernumerary (mesiodens): A review of the literature. J Dent (Tehran) 2010;7:41-9.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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