Year : 2007 | Volume
: 25 | Issue : 1 | Page : 52--55
Talon's cusp: Report of four unusual cases
O Tulunoglu1, DU Cankala2, RC Ozdemir1,
1 Department of Pedodontics, Faculty of Dentistry, University of Gazi, Ankara, Turkey
2 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Gazi, Ankara, Turkey
Gazi Üniversitesi Dishekimligi Fakültesi Pedodonti Anabilim Dali, 06510, Emek Ankara
Talon cusp is a developmental dental anomaly thought to arise as a result of evagination on the surface of a tooth crown before calcification has occurred. The etiology remains unknown. The incidence is 0.04-10%. Any tooth may have a talon cusp but most of the cases involve maxillary lateral incisors, with some instances of bilateral involvement. The anomaly has been reported to be rare in the mandible. This article reports four cases of talon cusp. The first and the second cases describe bilateral involvement of talon cusp on palatal surfaces of maxillary primary centrals; in the third case talon tubercle occurs on palatal surfaces of both maxillary permanent lateral incisors and the maxillary left central incisor and in the last case a talon cusp in the lingual surface of mandibular permanent lateral incisor.
|How to cite this article:|
Tulunoglu O, Cankala D U, Ozdemir R C. Talon's cusp: Report of four unusual cases.J Indian Soc Pedod Prev Dent 2007;25:52-55
|How to cite this URL:|
Tulunoglu O, Cankala D U, Ozdemir R C. Talon's cusp: Report of four unusual cases. J Indian Soc Pedod Prev Dent [serial online] 2007 [cited 2022 Dec 1 ];25:52-55
Available from: http://www.jisppd.com/text.asp?2007/25/1/52/31993
Talon cusp is an uncommon, developmental dental abnormality in which an accessory cusp like structure thought to arise as a result of evagination on the surface of a tooth crown before calcification has occurred. 
It occurs with a frequency of 0.04-10% but the etiology still remains unknown. As with other abnormalities of tooth shape and size, talon cusp occurs early in odontogenesis, i.e., during the morpho-differentiation stage. It may occur as a result of outward folding of the inner enamel epithelial cells (precursors of ameloblasts) and a transient focal hyperplasia of the mesenchymal dental papilla (precursors of odontoblasts). 
The majority of reports about talon cusp show that the permanent dentition has been involved three times more often than the primary dentition and talon cusp affect both sexes but males have a higher incidence than females. 
Previously, the anomaly was considered rare, but the current widespread use of radiography has disclosed that talon cusp is not as rare as formerly thought. Any tooth may have an evagination, but the majority of cases involve the maxillary lateral incisors with some instances of bilateral involvement. Following affected teeth with a decreasing frequency are: central incisors, premolars, canines, and molars. The anomaly has been reported to be rare in the mandible.
The family involvement and the association of the talon cusp with other dental abnormalities suggest that genetics may be a major causative factor. However, sporadic occurrences of this abnormality probably are induced by trauma or other localized insults affecting the tooth germ.  Most of the cases are unilateral, but one fifth of the cases are bilateral. 
Although this anomalous cusp has not been reported as an integral part of any specific syndrome, it appears to be more prevalent in patients with Rubinstein-Taybi syndrome, Mohr syndrome (oral-facial-digital syndrome, type II), Sturge-Weber syndrome (encephalotrigeminal angiomatosis) or incontinentia pigmenti achromians. ,,
Clinical problems noted with talon cusp cases include attrition, breast-feeding problems, compromised esthetics, occlusal interference, accidental cusp fracture, interference with tongue space, temporomandibular joint pain, displacement of the affected tooth, irritation of tongue during speech and mastication, periodontal problems because of excessive occlusal force, misinterpretation of radiographs of taloned teeth before eruption and caries susceptibility because of developmental grooves on the talon. ,
This article reports four unusual cases of talon cusp, two of them bilaterally affecting primary maxillary central incisors, one of them affecting three of permanent incisors in maxilla and the last case is a talon cusp affecting mandibular permanent lateral incisor.
A 6-year-old girl, presented to Gazi University, Faculty of Dentistry, Department of Pedodontics complaining tooth decay. Bilateral talon tubercles on maxillary primary central incisors have been determined by clinical and radiographical examinations. In patient's medical history mental retardation has been found out but in familial history neither dental abnormality nor systemic disease has been observed. Because, anterior open bite and talon tubercles did not cause any occlusal interference, corrective treatment for the tooth was not instituted [Figure 1],[Figure 2].
A 3-year-old boy, presented to Gazi University, Faculty of Dentistry and Department of Pedodontics complaining extra teeth in the upper jaw. On clinical and radiographic examinations, talon tubercles bilaterally existing on maxillary deciduous central incisors have been determined. There were no positive findings for systemic condition and other members of his family did not have such a dental abnormality. Because of the anterior open-bite, talon cusps did not cause occlusal interference and there was not any pathological change, none of the treatment procedures has been performed. Similar abnormalities of permanent maxillary right central and lateral incisors and double-teeth in permanent dentition have been observed in radiographical examination [Figure 3],[Figure 4].
An 11-year-old boy, referred to Gazi University, Faculty of Dentistry, Department of Pedodontics complaining tooth decay. On clinical and radiographic examination, three talon tubercles on the palatal surfaces of both maxillary lateral incisors and maxillary left central incisor have been observed. The parents did not report a similar anomaly in dentitions of their family members. The patient's medical history was not relevant. Because the extra tubercles have effect on the occlusal interference and can cause occlusal trauma the treatment plan called for a gradual reduction of the talon cusps on consecutive visits and an application of fluoride at each visit [Figure 5],[Figure 6].
A 14-year-old girl was guided to Gazi University, Faculty of Dentistry and Department of Pedodontics by Department of Orthodontics. Fixed orthodontic therapy was being applied by Department of Orthodontics and because talon tubercle on mandibular permanent left lateral incisor has affected the occlusal relationship, the patient recoursed to Department of Pedodontics. In order, to correct the occlusal relationship the talon tubercle has been abraded gradually with diamond burs and fluoride therapy has been applied at each visit [Figure 7],[Figure 8],[Figure 9].
Talon cusp has been reported as a very rare dental anomaly ,, and data on the prevalence of talon cusps, criteria for categorization, association with other dental abnormalities, and management are insufficient.
The majority of reports about talon cusp show that the permanent dentition has been involved three times more often than the primary dentition.  In this case report, half of the cases were detected in the primary dentition.
Any tooth may have an evagination but most of the cases involve the maxillary lateral incisors with some instances of bilateral involvement. Following affected teeth with a decreasing frequency are; lateral incisors, central incisors, premolars, canines and molars. The anomaly has been reported to be rare in the mandible. In this article, seven of eight talon cusps involve the maxillary teeth and one involves the mandibular tooth; four talon cusps in the permanent dentition and four talon cusps in the primary dentition. In cases 1 and 2, talon cusps involved maxillary primary central incisors bilaterally. Also in case 3, bilateral involvement of maxillary permanent lateral incisors and unilateral involvement of the maxillary permanent central incisor have been observed in the same jaw. Previous reports show that most of the cases are unilateral but 1:5 of the cases are bilateral.  In case 4, talon cusp involves mandibular permanent lateral incisor which is reported to be seen very rarely.
Talon cusp occurs with a frequency of 0.04-10% and affects both sexes but males have a higher incidence than females. , In this report two cases involve female patients.
Talon cusp originates during the morpho-differentiation stage of tooth development but the etiology of the condition remains unknown. In the majority of cases reported, the talon cusp is isolated rather than an integral part of any disorder. Nevertheless, the abnormality has been reported in patients with Sturge-Weber syndrome (encephalotrigeminal angiomatosis), Rubinstein-Taybi syndrome, Mohr syndrome (oral-facial-digital syndrome, type II) or incontinentia pigmenti achromians. None of the cases reported here were associated with any known abnormal systemic developmental syndromes. ,,
It is clinically difficult to establish an accurate diagnosis without radiographic examination. The suspicion often arises from atypical morphology of the tooth crown or eruption difficulties of the suspected tooth. Extremely marked foramen cecum may also have indicated invagination.
Clinical problems noted with talon cusp cases include attrition, breast-feeding problems, compromised esthetics, occlusal interference, accidental cusp fracture, interference with tongue space, temporomandibular joint pain, displacement of the affected tooth, irritation of tongue during speech and mastication, periodontal problems because of excessive occlusal force, misinterpretation of radiographs of involved teeth before eruption and caries susceptibility because of developmental grooves on the talon.
Early diagnosis of talon cusp is important and in most cases definitive treatment is needed. Deep noncarious developmental grooves on the lateral aspects of the anomalous cusps should be cleaned with slurry of pumice, acid etched and sealed with fissure sealant. If the grooves are carious, the lesion should be removed and the cavity obdurate with glassionomer restorative material. In case of premature contact and occlusal interference, the talon cusp should be reduced gradually on consecutive visits over 6-8 week intervals to allow time for deposition of reparative dentin for pulpal protection. After each grinding procedure, the tooth surface should be covered with a desensitising agent. Under certain conditions, less conservative methods can be used such as complete reduction of the cusp followed by calcium hydroxide pulpotomy for an immature tooth or root-canal therapy. ,
In this case report, none of treatment options were used for two of cases because there were neither premature contacts and occlusal interferences nor pathological changes. In two of the cases talon cusp was grinded gradually in order to prevent occlusal interference and covered with desensitizing agent.
The aim of this case report is to present some unusual cases of talon cusp and to emphasize the importance of early diagnosis of talon cusp to avoid complications related with this condition. The association of talon cusp with other dental abnormalities suggests that, this anomaly is not an isolated trait. Possible etiological factors have been discussed and treatment options have been described. A correct and early diagnosis can prevent the occurrence of complications.
|1||Hattab FN, Yassin OM, Al-Nimri KS. Talon cusp-Clinical significance and management: Case reports. Quintessence Int 1995;26:115-20.|
|2||Segura-Egea JJ, Jimθnez-Rubio A, Rios-Santos JV, Velasco-Ortega E. Dens evaginatus of anterior teeth (talon cusp): Report of five cases. Quintessence Int 2003;34:272-7.|
|3||Güng φr HC, Altay N, Kaymaz FF. Pulpal tissue in bilateral talon cusps of primary central incisors: Report of a case. Oral Pathol Oral Radiol Endod 2000;89:231-5.|
|4||Al-Omari MA, Hattab FN, Darwazeh AM, Dummer PM. Clinical problems associated with unusual cases of talon cusp. Int Endod J 1999;32:183-90.|
|5||Hattab FN, Yassin OM, Al-Nimri KS. Talon cusp in permanent dentition associated with other dental anomalies: Review of literature and report of seven cases. J Dent Child 1996;63:368-76.|
|6||Chen RJ, Chen HS. Talon cusp in primary dentition. Oral Surg Oral Med Oral Pathol 1986;62:67-72.|
|7||Abbott PV. Labial and palatal 'talon cusps' on the same tooth: A case report. Oral Surg Oral Med Oral Pathol 1998;85:726-30.|