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Mandibular talon cusp: A case report
Mandibular talon cusp: A case report Freny R. Karjodkar, BDS, MDS,a and Ambika Gupta, BDS,b Mumbai, Maharashtra, India NAIR HOSPITAL DENTAL COLLEGE
Talon cusp is a rare dental anomaly, especially when it occurs on mandibular teeth. A case of talon cusp on a permanent mandibular central incisor is described and illustrated. This case was associated with periodontitis, but was otherwise symptom free. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:e86-e87)
A talon cusp is an uncommon anomaly that occurs as an accessory cusplike structure from the cingulum or cementoenamel junction in either primary or permanent teeth.1 This anomaly was first reported by Mitchell et al.2 in 1892, and the term talon cusp was given by Mellor and Ripa3 in 1970, due to its resemblance to an eagle’s talon. Since then, various synonyms for talon cusp have been used, such as interstitial cusp, odontoma of axial core type, and supernumerary cusp. Talon cusp is usually unilateral, with only 20% of talon cusp cases having a bilateral occurence.4 Hattab and Yassin5 classified talon cusp into 3 types based on degree of cusp formation and extension. A 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 the cementoenamel junction to the incisal edge. Type 2 (semi-talon) is an additional cusp of 1 mm or more extending to less than half the distance from the cementoenamel junction and the incisal edge. It may blend with the palatal surface or may stand away from the rest of the crown. Type 3 (trace talon) is present as an enlarged or prominent cingulum and its variations (i.e., tubercle, bifid, or conical).5 This short report presents a case of type 1 talon cusp occurring on a permanent mandibular central incisor tooth. CASE REPORT A 35-year-old male patient reported to the Department of Oral Medicine and Radiology, Nair Hospital Dental College with the complaint of a purulent discharge from mandibular
a
Professor and Department Head, Department of Oral Medicine, Diagnosis and Radiology, Nair Hospital Dental College. b Postgraduate Student, Department of Oral Medicine, Diagnosis and Radiology, Nair Hospital Dental College. Received for publication Oct 12, 2006; returned for revision Nov 22, 2006; accepted for publication Nov 23, 2006. 1079-2104/$ - see front matter © 2007 Mosby, Inc. All rights reserved. doi:10.1016/j.tripleo.2006.11.046
e86
anterior gingiva. The patient was in good health and had no history of any systemic disorder. Family history and personal history were not remarkable. On examination, general condition was good and vital signs were stable. Intraoral examination revealed an abscess draining from deep periodontal pockets in the mandibular anterior region. The right mandibular central incisor tooth had a prominent talon cusp on the lingual aspect, arising from cementoenamel junction and extending up to the incisal edge, producing a T-form pattern when seen from the occlusal aspect. Radiographic examination of the accessory cusp on the right mandibular central incisor showed a radiopaque shadow extending over the tooth crown from the cementoenamel junction to the incisal edge (Figs. 1 and 2). Vertical alveolar bone loss was evident in relation to the affected tooth, with loss of lamina dura around the tooth consistent with chronic localized periodontitis. The anomaly was diagnosed as a type 1 talon cusp.
DISCUSSION Talon cusp is a rare dental anomaly that has been reported in different ethnic groups, with more than 90% occurring in the maxilla— both for the primary and permanent dentitions. The distribution of the anomaly in the maxilla is 55% lateral incisor, 36% central incisor, and 9% canines.5 Different theories suggested for the origin of talon cusp include genetic and local environmental factors.6,7 Talon cusps originate during the morpho-differentiation stage of tooth development due to out-folding of the inner enamel epithelial cells and focal hyperplasia of peripheral cells of mesenchymal dental papilla.8 The presence of talon cusp can be symptom free or can be associated with compromised esthetics, occlusal interference, malocclusion, and irritation of the tongue during speech or mastication.9 The talon cusp has not been reported as an integral part of any specific syndrome, although it appears to be more prevalent in patients with Rubinstein-Tayabi syndrome,10 Mohr syndrome,11 and Sturge-Weber syndrome.12 In the present case, the patient had periodontal problems associated with the talon cusp. Our review of literature revealed reports of talon cusp on mandibular incisor to be infrequent. To the best
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Karjodkar and Gupta e87
of our knowledge, only 10 such cases have been reported.13-19 REFERENCES
Fig. 1. Intraoral photograph showing talon cusp on right mandibular central permanent incisor tooth.
1. Hattab FN, Yassin OM, Al Nimri KS. Talon cusp– clinical significance and management: case reports. Quintessence Int 1995;26:115-20. 2. Mitchell WH. Case report. Dent Cosmos 1892;34:1036. 3. Mellor JK, Ripa LW. Talon cusp: a clinically significant anomaly. Oral Surg Oral Med Oral Pathol 1970;29:225-8. 4. Segura JJ, Jimenez-Rubio A. Talon cusp affecting permanent maxillary central incisor in 2 family members. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:90-2. 5. Hattab FN, Yassin OM. Bilateral talon cusp on primary central incisors: a case report. Int J Paediatric Dent 199;6:191-5. 6. Davis PJ, Brook AH. The presentation of talon cusp: diagnosis, clinical features, associations and possible etiology. Br Dent J 1985;159:84-8. 7. Garn SM, Lewis AB, Kerewski RS. Genetic, nutritional and maturational correlates of dental development. J Dent Res 1965;44:228-42. 8. Abott PV. Labial and palatal “talon cusps” on the same tooth: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85:726-30. 9. Soares AB, de Araujo JJ, de Sousa SM, Veronezi MC. Bilateral talon cusp: a case report. Quintessence Int 2001;32:283-6. 10. Gardner DG, Girgis SS. Talon cusp: a dental anomaly in the Rubinstein-Tayabi syndrome. Oral Surg Oral Med Oral Pathol 1979;47:519-21. 11. Goldstein E, Medina JL. Mohr syndrome or oral-facial-digital. II. Report of two cases. J Am Dent Assoc 1974;89:377-82. 12. Chen RJ, Chen HS. Talon cusp in primary dentition. Oral Surg Oral Med Oral Pathol 1986;62:67-72. 13. Nadkarni UM, Munshi A, Damle SG. Unusual presentation of talon cusp: two case reports. Int J Paediatric Dent 2002;12:332-5. 14. Hegde S, Kumar BR. Mandibular talon cusp: report of two rare cases. Int J Paediatr Dent 1999;9:303-6. 15. Folakemi AO. Mandibular facial talon cusp: case report. BMC Oral Health 2005;8:5-9. 16. Hattab FN, Hazza’a AM. An unusual case of talon cusp on geminated tooth: case report. J Can Dent Assoc 2001;67:263-6. 17. Rayen R, Muthu MS, Sivakumar N. Aberrant talon cusps: report of two cases. J Indian Soc Pedod Prev Dent 2006;24:S7-10. 18. Dash JK, Sahoo PK, Das SN. Talon cusp associated with other dental anomalies: a case report. Int J Paed Dent 2004;14:295-300. 19. McNamara T, Haeussler AM, Keane J. Facial talon cusps. Int J Paediatr Dent 1997;7:259-62.
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Fig. 2. Periapical radiograph showing that the talon cusp contains a pulpal extension.
Ambika Gupta, BDS Department of Oral Medicine, Diagnosis and Radiology Nair Hospital Dental College A.L. Nair Road, Mumbai Central Mumbai-400008 Maharashtra, India [email protected]
Talon cusp is a rare dental anomaly, especially when it occurs on mandibular teeth. A case of talon cusp on a permanent mandibular central incisor is described and illustrated. This case was associated with periodontitis, but was otherwise symptom free. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:e86-e87)
A talon cusp is an uncommon anomaly that occurs as an accessory cusplike structure from the cingulum or cementoenamel junction in either primary or permanent teeth.1 This anomaly was first reported by Mitchell et al.2 in 1892, and the term talon cusp was given by Mellor and Ripa3 in 1970, due to its resemblance to an eagle’s talon. Since then, various synonyms for talon cusp have been used, such as interstitial cusp, odontoma of axial core type, and supernumerary cusp. Talon cusp is usually unilateral, with only 20% of talon cusp cases having a bilateral occurence.4 Hattab and Yassin5 classified talon cusp into 3 types based on degree of cusp formation and extension. A 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 the cementoenamel junction to the incisal edge. Type 2 (semi-talon) is an additional cusp of 1 mm or more extending to less than half the distance from the cementoenamel junction and the incisal edge. It may blend with the palatal surface or may stand away from the rest of the crown. Type 3 (trace talon) is present as an enlarged or prominent cingulum and its variations (i.e., tubercle, bifid, or conical).5 This short report presents a case of type 1 talon cusp occurring on a permanent mandibular central incisor tooth. CASE REPORT A 35-year-old male patient reported to the Department of Oral Medicine and Radiology, Nair Hospital Dental College with the complaint of a purulent discharge from mandibular
a
Professor and Department Head, Department of Oral Medicine, Diagnosis and Radiology, Nair Hospital Dental College. b Postgraduate Student, Department of Oral Medicine, Diagnosis and Radiology, Nair Hospital Dental College. Received for publication Oct 12, 2006; returned for revision Nov 22, 2006; accepted for publication Nov 23, 2006. 1079-2104/$ - see front matter © 2007 Mosby, Inc. All rights reserved. doi:10.1016/j.tripleo.2006.11.046
e86
anterior gingiva. The patient was in good health and had no history of any systemic disorder. Family history and personal history were not remarkable. On examination, general condition was good and vital signs were stable. Intraoral examination revealed an abscess draining from deep periodontal pockets in the mandibular anterior region. The right mandibular central incisor tooth had a prominent talon cusp on the lingual aspect, arising from cementoenamel junction and extending up to the incisal edge, producing a T-form pattern when seen from the occlusal aspect. Radiographic examination of the accessory cusp on the right mandibular central incisor showed a radiopaque shadow extending over the tooth crown from the cementoenamel junction to the incisal edge (Figs. 1 and 2). Vertical alveolar bone loss was evident in relation to the affected tooth, with loss of lamina dura around the tooth consistent with chronic localized periodontitis. The anomaly was diagnosed as a type 1 talon cusp.
DISCUSSION Talon cusp is a rare dental anomaly that has been reported in different ethnic groups, with more than 90% occurring in the maxilla— both for the primary and permanent dentitions. The distribution of the anomaly in the maxilla is 55% lateral incisor, 36% central incisor, and 9% canines.5 Different theories suggested for the origin of talon cusp include genetic and local environmental factors.6,7 Talon cusps originate during the morpho-differentiation stage of tooth development due to out-folding of the inner enamel epithelial cells and focal hyperplasia of peripheral cells of mesenchymal dental papilla.8 The presence of talon cusp can be symptom free or can be associated with compromised esthetics, occlusal interference, malocclusion, and irritation of the tongue during speech or mastication.9 The talon cusp has not been reported as an integral part of any specific syndrome, although it appears to be more prevalent in patients with Rubinstein-Tayabi syndrome,10 Mohr syndrome,11 and Sturge-Weber syndrome.12 In the present case, the patient had periodontal problems associated with the talon cusp. Our review of literature revealed reports of talon cusp on mandibular incisor to be infrequent. To the best
OOOOE Volume 103, Number 5
Karjodkar and Gupta e87
of our knowledge, only 10 such cases have been reported.13-19 REFERENCES
Fig. 1. Intraoral photograph showing talon cusp on right mandibular central permanent incisor tooth.
1. Hattab FN, Yassin OM, Al Nimri KS. Talon cusp– clinical significance and management: case reports. Quintessence Int 1995;26:115-20. 2. Mitchell WH. Case report. Dent Cosmos 1892;34:1036. 3. Mellor JK, Ripa LW. Talon cusp: a clinically significant anomaly. Oral Surg Oral Med Oral Pathol 1970;29:225-8. 4. Segura JJ, Jimenez-Rubio A. Talon cusp affecting permanent maxillary central incisor in 2 family members. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:90-2. 5. Hattab FN, Yassin OM. Bilateral talon cusp on primary central incisors: a case report. Int J Paediatric Dent 199;6:191-5. 6. Davis PJ, Brook AH. The presentation of talon cusp: diagnosis, clinical features, associations and possible etiology. Br Dent J 1985;159:84-8. 7. Garn SM, Lewis AB, Kerewski RS. Genetic, nutritional and maturational correlates of dental development. J Dent Res 1965;44:228-42. 8. Abott PV. Labial and palatal “talon cusps” on the same tooth: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85:726-30. 9. Soares AB, de Araujo JJ, de Sousa SM, Veronezi MC. Bilateral talon cusp: a case report. Quintessence Int 2001;32:283-6. 10. Gardner DG, Girgis SS. Talon cusp: a dental anomaly in the Rubinstein-Tayabi syndrome. Oral Surg Oral Med Oral Pathol 1979;47:519-21. 11. Goldstein E, Medina JL. Mohr syndrome or oral-facial-digital. II. Report of two cases. J Am Dent Assoc 1974;89:377-82. 12. Chen RJ, Chen HS. Talon cusp in primary dentition. Oral Surg Oral Med Oral Pathol 1986;62:67-72. 13. Nadkarni UM, Munshi A, Damle SG. Unusual presentation of talon cusp: two case reports. Int J Paediatric Dent 2002;12:332-5. 14. Hegde S, Kumar BR. Mandibular talon cusp: report of two rare cases. Int J Paediatr Dent 1999;9:303-6. 15. Folakemi AO. Mandibular facial talon cusp: case report. BMC Oral Health 2005;8:5-9. 16. Hattab FN, Hazza’a AM. An unusual case of talon cusp on geminated tooth: case report. J Can Dent Assoc 2001;67:263-6. 17. Rayen R, Muthu MS, Sivakumar N. Aberrant talon cusps: report of two cases. J Indian Soc Pedod Prev Dent 2006;24:S7-10. 18. Dash JK, Sahoo PK, Das SN. Talon cusp associated with other dental anomalies: a case report. Int J Paed Dent 2004;14:295-300. 19. McNamara T, Haeussler AM, Keane J. Facial talon cusps. Int J Paediatr Dent 1997;7:259-62.
Reprint requests:
Fig. 2. Periapical radiograph showing that the talon cusp contains a pulpal extension.
Ambika Gupta, BDS Department of Oral Medicine, Diagnosis and Radiology Nair Hospital Dental College A.L. Nair Road, Mumbai Central Mumbai-400008 Maharashtra, India [email protected]