|Year : 2014 | Volume
| Issue : 2 | Page : 130-133
Talon cusp on mesiodens: A report of two cases
Santanu Mukhopadhyay1, Chhanda Biswas2, Pinaki Roy3
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 Publication||17-Nov-2014|
Department of Pediatric Dentistry, Burdwan Dental College and Hospital, Burdwan - 713 101, West Bengal
Source of Support: None, Conflict of Interest: None
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
| Introduction|| |
Talon cusp is an accessory cusp projecting from the lingual or labial surface of the crown of anterior teeth. ,,,,,,, Mitchell first described this anomaly in 1892 as a horn-like process on the palatal surface of a maxillary central incisor.  Mellor and Ripa first used the term'talon cusp' in 1971, because of its resemblance to an eagle's talon.  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. , The most commonly affected teeth are maxillary lateral incisors (55%) central incisors (36%) and the canines (9%).  Talon cusp on a supernumerary tooth is a very rare finding. Till date very few cases have been reported in the literature. ,,,,,, The purpose of this article is to describe two cases of talon cusp on mesiodens.
| Case Reports|| |
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 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.
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 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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| Discussion|| |
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. ,, 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.  The majority of mesiodens, as high as 75%, remain impacted.  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%). 
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. , 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.  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.  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.  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. ,, 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. ,, 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. 
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. ,,,,, Lee et al., reported three cases of talon cusp on primary supernumerary teeth in people of mongoloid origin. 
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|| |
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.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]