A facial talon cusp on maxillary permanent central incisors.

Talon cusp is a dental anomaly that occurs as an accessory cusp like structure, from the cingulum of maxillary and mandibular anterior teeth. Lingual location is usually considered pathognomic. This case report discuss about the unusual appearance of talon cusp on the facial surface of the maxillary left permanent central incisor and a mild talon cusp on the facial surface of the maxillary right permanent central incisor.

INTRODUCTION

Talon cusp is a morphologically well delineated accessory cusp. It is an anomalous structure projecting from the cingulum area or the cemento enamel junction, and extending to at least half the distance to the incisal edge of the maxillary or the mandibular anterior teeth in both the primary and permanent dentitions.[1] Lingual location of the talon cusp is considered pathognomonic.[2]

Males show a higher frequency of talon cusp than females. It may be unilateral or bilateral, with a predilection for maxilla over mandible, and more common in the permanent dentition. The most commonly involved teeth are the maxillary lateral incisors in the permanent dentition.[3] This is a case report of a patient with the rare anomaly of facial talon cusp on the maxillary left permanent central incisor and a mild talon cusp on the maxillary right permanent central incisor.

CASE REPORT

A 25-year-old male reported to the Department of Conservative Dentistry and Endodontics for the restoration of his carious teeth. Examination of the oral cavity revealed a well-defined talon cusp i.e 3 to 5 mm in width and extends in height from cemento enamel junction to 1 mm short of the incisal edgeon the facial surface of the maxillary left permanent central incisor and a mild talon cusp on the facial surface of the maxillary right permanent central incisor, and congenitally missing maxilary first pre-molars. Talon cusp of the maxillary left permanent central incisor extended from the cementoenamel junction to 1 mm short of the incisal edge from the crown labially [Figure 1]. Radiographic image shows a prominent V-shaped radioopaque structure superimposed on maxillary left permanent central incisor and mild V-shaped radioopaque structure superimposed on maxillary right permanent central incisor [Figure 2]. The affected tooth responded normally to electric pulp testing. The medical history was non contributory.

Figure 1

Facial talon cusp i.e 3 to 5 mm in width and extends in height from cemento enamel junction to 1 mm short of the incisal edge on the facial surface of the maxillary left permanent central incisor and a mild talon cusp on the facial surface of the maxillary right permanent central incisor

Figure 2

Radiographic image shows a prominent V-shaped radioopaque structure superimposed on maxillary left permanent central incisor and mild V-shaped radioopaque structure superimposed on maxillary right permanent central incisor

DISCUSSION

Talon cusp usually occurs on the lingual surfaces of teeth. Prevalence rates of the lingual talon cusps as per studies by different authors, and references to case reports of facial talon cusps in literature have been given in Tables 1 and 2 respectively. Talon cusp is usually asymptomatic, and often diagnozed as an incidental finding on routine dental examination. If symptomatic, talon cusp usually causes problems related to occlusion, speech and aesthetics. Associated grooves may lead to plaque retention leading to dental caries. If cusp is severely worn off due to masticatory forces, it may lead to pulpal exposure. Direct composite restorations can be considered for aesthetic correction of the talon cusp if present on labial surface.

Table 1

Prevalence of lingual talon cusps as per studies by different authors

Table 2

Case reports of facial talon cusps by various authors in literature

For the present case, no treatment was rendered due to lack of parental consent owing to superstitious beliefs. Occlusal Composite restorations were carried out for the posterior teeth which was the chief complaint of the patient.

Etiology of talon cusp is not clear. It has been postulated that the formation of this anomaly occurs during the morphodifferentiation stage. It is also suggested that its formation may be a result of upward folding of the inner enamel epithelial layer and transient focal hyperplasia of the mesenchymal dental papilla. According to another opinion, the formation of talon cusp may be due to hyperproductivity of the anterior ends of dental lamina. It is considered that talon cusp can originate as a result of the interaction of genetic and environmental factors.[4]

There was no data on the other affected family members and no history of consanguinity with the parents was present. Maxillary first premolar was missing in each quadrant. There were no clinical signs or symptoms of any genetic syndromes. No obvious developmental abnormalities were seen. For these reasons, the findings of facial talon cusp in this case should be considered as an isolated developmental abnormality.[10]