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CASE REPORT
Year : 2014  |  Volume : 2  |  Issue : 2  |  Page : 130-133

Talon cusp on mesiodens: A report of two cases


1 Departments of Pedodontics and Preventive Dentistry, Dr R Ahmed Dental College and Hospital, Burdwan, West Bengal, India
2 Department of Periodontics, Dr R Ahmed Dental College and Hospital, Burdwan, West Bengal, India
3 Department of Orthodontics, Dr R Ahmed Dental College and Hospital, Burdwan, West Bengal, India

Date of Web Publication17-Nov-2014

Correspondence Address:
Santanu Mukhopadhyay
Department of Pediatric Dentistry, Burdwan Dental College and Hospital, Burdwan - 713 101, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-0149.144859

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  Abstract 

Talon cusp is a relatively uncommon developmental anomaly usually involves maxillary permanent lateral incisors. Mesiodens is the most common supernumerary tooth present in the palatal midline between the two maxillary central incisors. Both talon cusp and mesiodens are clinically significant developmental alterations giving rise to a variety of complications. The presence of talon cusp on supernumerary teeth is very rare. Till date very few cases have been reported in the literature. This paper describes two cases of talon cusp on the palatal surfaces of supplemental mesiodens. Both the patients reported for unsightly dental appearance and non-eruption of maxillary permanent central incisor. Here we extracted the anomalous teeth to facilitate eruption of permanent maxillary central incisor. Early diagnosis and management are important to avoid complications.

Keywords: Dental anomaly, mesiodens, supernumerary teeth, talon cusp


How to cite this article:
Mukhopadhyay S, Biswas C, Roy P. Talon cusp on mesiodens: A report of two cases . Niger J Exp Clin Biosci 2014;2:130-3

How to cite this URL:
Mukhopadhyay S, Biswas C, Roy P. Talon cusp on mesiodens: A report of two cases . Niger J Exp Clin Biosci [serial online] 2014 [cited 2021 May 12];2:130-3. Available from: https://www.njecbonline.org/text.asp?2014/2/2/130/144859


  Introduction Top


Talon cusp is an accessory cusp projecting from the lingual or labial surface of the crown of anterior teeth. [1],[2],[3],[4],[5],[6],[7],[8] Mitchell first described this anomaly in 1892 as a horn-like process on the palatal surface of a maxillary central incisor. [5] Mellor and Ripa first used the term'talon cusp' in 1971, because of its resemblance to an eagle's talon. [6] The accessory cusp occurs in both sexes, unilaterally or bilaterally, has a predilection for maxilla over the mandible and permanent over the primary dentition. The anomaly is composed of enamel, dentin and a variable amount of pulp tissue. Although lingual location of the anomaly is more common, facial talon cusps have also been reported. [9],[10] The most commonly affected teeth are maxillary lateral incisors (55%) central incisors (36%) and the canines (9%). [3] Talon cusp on a supernumerary tooth is a very rare finding. Till date very few cases have been reported in the literature. [9],[10],[11],[12],[13],[14],[15] The purpose of this article is to describe two cases of talon cusp on mesiodens.


  Case Reports Top


Case 1

An 8-year-old girl reported for non-eruption of an upper front tooth. Her parents also complained of unsightly dental appearance. The girl appeared normal for her age. Her medical and dental histories were non-contributory. Intra-oral examination showed a fully erupted mesiodens in a rotated position. [Figure 1] History revealed that the supernumerary tooth had erupted 6 months ago. The mesiodens resembled maxillary incisors in size and shape. On the palatal aspect, an accessory cusp was visible, extending from the cingulum to more than two- third of the incisal edge of the mesiodens. The accessory cusp was pyramidal in shape, and fused to the palatal surface of the supernumerary tooth. Non-carious developmental grooves were observed where the accessory cusp was attached with the mesiodens. The periapical radiograph showed a V-shaped radio-opaque structure superimposed on the image of the crown of the mesiodens.[Figure 2] Panoramic radiograph revealed another inverted mesiodens.[Figure 3] Clinical and radiographic examination did not show any other dental anomaly. No other family member had similar dental anomalies.
Figure 1: Talon cusp on the palatal surface of a rotated mesiodens

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Figure 2: Periapical radiograph of the taloned mesiodens

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Figure 3: Panoramic radiograph showed two mesiodens. One of them was aligned horizontally; the other one was vertically positioned (a) Photograph showing extracted mesiodens with talon cusp

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Based on clinical and radiographic findings, we diagnosed the case as talon cusp on mesiodens. After obtaining parental consent, we extracted the anomalous tooth extracted under local anesthesia. [Figure 3]a The patient was advised for recall visit.

Case 2

A 7-year-old girl reported for an ugly looking upper front tooth. The patient was the only sibling of her parents. Extra oral examination did not reveal any abnormality. The patient had an uneventful medical history. Intra-oral examination revealed that the maxillary right permanent central incisor was fully erupted and the crown of the maxillary left central incisor was partly visible. Between the two maxillary permanent central incisors a rotated mesiodens was present. An accessory cusp was visible from the cingulum to the two-third of the incisal edge of the mesiodens. [Figure 4] The accessory cusp was attached to the palatal surface of the supernumerary tooth. The periapical radiograph showed a V-shaped radio-opaque structure superimposed on the image of the supernumerary tooth crown. The tip of the V was directed towardthe incisal edge of the crown. [Figure 5] After clinical and radiographic investigations, we arrived at a diagnosis of talon cusp on mesiodens. After obtaining informed consent from the parents, we extracted the taloned mesiodens under local anesthesia. [Figure 6] The supernumerary tooth was categorized as supplemental, since morphology of the extracted mesiodens resembled maxillary central incisor in size and shape. The patient was kept under observation to monitor eruption of permanent teeth.
Figure 4: Mesiodens with a talon cusp

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Figure 5: Periapical radiograph showing a V-shaped structure superimposed on the image of the crown of the mesiodens with the tip of the V pointed toward the incisal edge of the mesiodens

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Figure 6: Photograph showing extracted taloned mesiodens

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  Discussion Top


Mesiodens is the most common supernumerary tooth in the palatal midline between the two maxillary central incisors. The prevalence of mesiodens varies from0.15% to 1.9% with a higher prevalence reported in the permanent than in the primary dentition. [16],[17],[18] Mesiodens may be single or in multiple, and are two times more common in men than in women. Single mesiodens accounts for 78% of cases, whereas two mesiodens occur in 22% of cases. [17] The majority of mesiodens, as high as 75%, remain impacted. [16] In the first case described here, one of the two mesiodens remained impacted. Mesiodens may be classified according to their morphology as conical (68%), supplemental (18%) and tuberculate (14%). [17]

Mesiodens is a clinically significant anomaly often associated with various complications like failure of eruption, midline diastema, displacement of incisors, root resorption of adjacent teeth, and cyst formation. [17],[18] In the present series, both the patients reported for unaesthetic dental appearance. Additionally, the majority of the mesiodens was diagnosed between 7 and 9 years of age, coincides with the eruption of maxillary permanent central incisors. [17] The two cases presented here also belonged to this age group.

The size, shape, location, and the structure of the accessory cusp shows wide variation. Hattab et al. classified talon cusp into three types. They are type 1 or major talon, type 2 or minor talon, and type 3 or trace talon. [7] Major talon is a morphologically well-defined additional cusp extending at least half the distance from the CEJ to the incisal edge of the tooth, whereas minor talon extends more than one-fourth, but less than half the distance from the CEJ to the incisal edge. Trace talon is a prominent cingulum occupying less than one-fourth the distances from the CEJ to the incisal edge of the tooth. Mader added that the term' talon cusp' be reserved for well-defined cusps that prominently project from the CEJ to the incisal edge covering at least half the distance. [8] In the present report both the accessory cusps belong to type 1 or major talon cusp category.

Complications of talon cusps are interference with occlusion, cusp fracture, pulp exposure, open bite, periodontal problems due to excessive occlusal force, poor esthetics, and caries at the developmental grooves. [1],[2],[3] Early diagnosis of talon cusp is important, and in most cases, a definitive treatment like sealing of developmental grooves, and grinding of accessory cusps in several appointments are required.

The etiology of both mesiodens and talon cusp are not clearly understood. Various theories like dichotomy of tooth bud, genetic factors, atavism, and hyperactivity of dental lamina have been proposed for supernumerary tooth formation. [16],[17],[18] Talon cusps may develop as a result of an outward folding of inner enamel epithelial cells, and a transient focal hyperplasia of mesenchymal dental papilla. [3]

Occurrence of talon cusp on supernumeraries is extremely rare. The search of PubMed and Medline reveals that only nine cases of talon cusp on supernumeraries in the permanent dentition has been reported till date. [9],[10],[11],[12],[13],[15] Lee et al., reported three cases of talon cusp on primary supernumerary teeth in people of mongoloid origin. [14]

Reports describing treatments of talon cusp on supernumerary teeth are few because the condition is not usual. In the two cases presented here, taloned mesiodens were extracted to facilitate eruption of permanent central incisors.


  Conclusions Top


Simultaneous occurrence of talon cusp and supernumerary teeth is rare. Both mesiodens and talon cusp are capable of causing a variety of clinical complications. Early diagnosis of these anomalies help in selecting correct treatment plan and avoid complications.



 
  References Top

1.
Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and maxillofacial pathology. 3 rd ed. Philadelphia: WB Saunders; 2009. p. 79.  Back to cited text no. 1
    
2.
Sumer AP, Zengin AZ. An unusual presentation of talon cusp: A case report. Br Dent J 2005;199:429-30.  Back to cited text no. 2
    
3.
Hattab FN, Hazza'a AM. An unusual case of talon cusp on geminated tooth. J Can Dent Assoc 2001;67:263-6.  Back to cited text no. 3
    
4.
Ekambaram M, Yiu CK, King NM. An unusual case of double teeth with facial and lingual talon cusps. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:e63-7.  Back to cited text no. 4
    
5.
Mitchell WH. Case report. Dent Cosmos 1892;34:1036.  Back to cited text no. 5
    
6.
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. 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.
Mader CL. Mandibular talon cusp. J Am Dent Assoc 1981;103:244-6.  Back to cited text no. 8
[PUBMED]    
9.
Busnur SJ, Naik SV, Govindappa KS, Thakkilipati HC, Shanbhog SV. Facial talon cusp in multilobed mesiodens. A rarest case report. Ann Trop Med Public Health 2013;6:109-11.  Back to cited text no. 9
  Medknow Journal  
10.
Topaloglu Ak A, Eden E, Ertugrul F, Sutekin E. Supernumerary primary tooth with facial and palatal talon cusps: A case report. J Dent Child (Chic) 2008;75:309-12.  Back to cited text no. 10
    
11.
Nadkarni UM, Munshi A, Damle SG. Unusual presentation of talon cusp: Two case reports. Int J Pediatr Dent 2002;12:332-5.  Back to cited text no. 11
    
12.
Salma FS, Hanes CM, Hanes PJ, Ready MA. Talon cusp: A review and two case reports on supernumerary primary and permanent teeth. ASDC J Dent Child 1990;57:147-9.  Back to cited text no. 12
    
13.
Nagaveni NB, Umashankara KV, Sreedevi, Reddy BP, Radhika NB, Satisha TS. Multi-lobed mesiodens with a palatal talon cusp: A rare case report. Braz Dent J 2010;21:375-8.  Back to cited text no. 13
    
14.
Lee CK, King NM, Lo EC, Cho SY. Management of supplental permanent maxillary lateral incisors in association with talon cusp on the primary predecessor: A report of 3 cases. J Dent Child (Chic) 2008;75:59-63.  Back to cited text no. 14
    
15.
Rani A K, Metgud S, Yakub SS, Pai U, Toshniwal NG, Bawaskar N. Endodontic and esthetic management of maxillary lateral incisor fused to a supernumerary tooth associated with a talon cusp by using spiral CT as a diagnostic aid: A case report. J Endod 2010;36:345-9.  Back to cited text no. 15
    
16.
Liu JF. Characteristics of premaxillary supernumerary teeth: A survey of 112 cases. ASDC J Dent Child 1995;62:262-5.  Back to cited text no. 16
[PUBMED]    
17.
Mukhopayay S. Mesiodens: A clinical and radiographic study in children. J Indian Soc Pedod Prev Dent 2011;29:34-8.  Back to cited text no. 17
    
18.
Russel 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. 18
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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