Multiple talon cusps on maxillary central incisor: A case report

Abstract

Dental anomalies affecting the teeth are relatively common. Simultaneous occurrence of multiple dental abnormalities in a single tooth is uncommon and relatively rare. One such abnormality routinely encountered in dental clinics is the talon cusp. It is also referred to as dens evaginatus, characterized by the presence of an accessory cusp-like structure projecting from the cingulum of anterior teeth. It has an increased predilection for maxillary teeth and permanent dentition. Although numerous cases of talon cusp have been reported in the literature, occurrence of multiple talon cusps in maxillary central incisors has not been found in the literature. This case report highlights the presence of talon cusps in maxillary anterior teeth with multiple impacted supernumerary teeth.

Talon cusps - functional solution: a case report

“…The talon cusp received this name due to its shape being similar to an eagle claw [15][16][17] . This anomaly in dental development is considered rare, its occurrence varies from 0.73% to 8% of the population 16 and is characterized by the presence of an accessory structure projected from the cincture, or at the cemento-enamel junction 15,[17][18][19][20] and can also be present in the posterior teeth, in the form of a cusp, called Evaginated Dens 18 . These projections may vary in shape, size and relationship with the incisal edge, depending on the projected extension, and are sufficient to hinder the occlusion and aesthetics of the individual 17,18,21 .…”

“…Histologically and radiographically, the presence of enamel, dentin and pulp 15,17,20,21 can be observed. Radiographically, an image is considered poorly defined due to excessive growth of the dental crown, showing a V-shaped radiopaque area comprising enamel and dentin due to the overlapping of the cusp on the affected dental crown, making it difficult to see 15,19 .…”

“…The exact etiology is still unknown 15,16 . The literature suggests that the condition may have a multifactorial etiology 16,18 as genetic 9,19,21 , ethnic 15,18 and environmental 15,17,18,19 factors, performing the development of this anomalous structure 15,19 . According to Guven et al 19 , it is related to disorders such as endocrine function impairment during the dental morphodifferentiation phase, resulting in the deployment of epithelial cells from enamel and focal hyperplasia of peripheral cells.…”

“…Other authors suggest trauma during the development of the dental element as a contributing factor 15 , that in certain ethnic groups, such as the Chinese and Arab populations, there is an increase in this condition in relation to the others 15,18,19 and, that genetic influences on the formation of talon cusp were also suggested, in the evidence of its occurrence in relatives and twin brothers 9,19,21 . Although not documented as an important part of any specific syndrome, the talon cusp may occur alone or in association with other dental anomalies such as gemination, fusion, canine agenesis, supernumerary and impacted teeth, complex odontomas 15,17,22 . and occasionally, may be associated with syndromes such as Ellis-van Creveld, Rubinstein-Taybi, Sturge-Weber and Mohr 15,17-20,23. In the present case, through anamense, clinical and radiographic examination, there were no reports relating the presence of the talon cusp with these factors.…”

“…The talon cusp can cause aesthetic alterations due to the presence, location and extent of the anomaly, predisposition to caries lesions due to food impaction and difficulty in hygiene and functional alterations such as occlusal traumas that can cause temporomandibular dysfunctions, periodontal alterations, pulpal exposures and periapical pathologies resulting from bite forces 15,18,20 . The time of diagnosis alters the prognosis and the painful sensation of this condition, facilitating the necessary treatment 17,22 . Mader and Kellogg 24 proposed that that talon cusp Type I present a greater pulpal extension, with a greater need for prevention 19 .…”