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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 4  |  Issue : 1  |  Page : 75-77

A case of fused teeth with facial and lingualtalon cusps in the mandibular anterior region:A case report


1 Department of Pedodontics and Preventive Dentistry, Burdwan Dental College and Hospital, Burdwan, India
2 Department of Pedodontics and Preventive Dentistry, Dr. R Ahmed Dental College and Hospital, Kolkata, West Bengal, India

Date of Web Publication2-Jun-2016

Correspondence Address:
Suchetana Goswami
65/2, Shastri Road, Naihati - 743 165, North 24 Parganas, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-4848.183376

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  Abstract 

Fused tooth and talon cusp are both developmental anomalies affecting mainly permanent dentition. Talon cusp is more common on the palatal surfaces of the permanent maxillary anteriors. Here is a case report of the fusion of mandibular anteriors with both the labial and lingual talon cusps.

Keywords: Fusion, mandibular central incisors, talon cusp


How to cite this article:
Goswami S, Mitra M, Saha S, Halder S. A case of fused teeth with facial and lingualtalon cusps in the mandibular anterior region:A case report. Arch Med Health Sci 2016;4:75-7

How to cite this URL:
Goswami S, Mitra M, Saha S, Halder S. A case of fused teeth with facial and lingualtalon cusps in the mandibular anterior region:A case report. Arch Med Health Sci [serial online] 2016 [cited 2019 Mar 26];4:75-7. Available from: http://www.amhsjournal.org/text.asp?2016/4/1/75/183376


  Introduction Top


Talon cusp is an unusual cuspal projection from an anterior tooth with normal enamel and dentin containing a varying degree of pulp tissue.[1] Talon cusp was first recognized by Mitchell in 1892 as a prominent cusp-like structure on the lingual surface of the maxillary central incisor.[2] In its typical shape, the anomaly resembles an eagle's talon [2] but it could also present as pyramidal, conical, or teat-like.[3]

Although these anomalies affect both dentitions, the accessory cusps are more common in permanent dentition. The lingual location of the anomaly is characteristic; however, a few cases have described facial talon cusps.[5],[6],[7],[8],[9],[10],[11] Males are affected more than females. The maxillary lateral incisors are the most frequently affected teeth in permanent dentition. Its prevalence in permanent dentition varies from 0.06% to 7.7% in the various populations studied.[7] These anatomic irregularities may appear as an isolated trait or is associated with various syndromes such as Rubinstein-Taybi syndrome, Mohr syndrome,  Sturge- Weber syndrome More Details More Details, incontinentia pigmenti , and  Ellis-van Creveld syndrome More Details.[5],[6]

Double teeth are another dental anomaly of tooth shape; they arise as a result of the union of adjacent teeth, or by an abnormal attempt of a single tooth bud to split into two halves. The former condition indicates fusion, whereas the latter condition denotes gemination.[12],[13],[14] The term “double teeth” indicates both gemination and fusion. Double teeth are more common in primary dentition than in permanent dentition, with a prevalence of 0.5% and 0.1%, respectively.[15] This case report presents a rare case of labial and palatal talon cusps on double teeth involving permanent mandibular central incisors. The search of the literature revealed only two other cases of facial and lingual talon cusps affecting double teeth.[15],[16]


  Case Report Top


A 10-year-old boy came to the department of pedodontics and preventive dentistry with a chief complaint of a painful decayed tooth in the upper left back region. His medical history and family history were unremarkable. Intraoral examination of the patient revealed double teeth involving the mandibular permanent central incisors. The double teeth exhibited accessory cusp-like projections from its lingual as well as facial surfaces [Figure 1]. The accessory cusps were projecting from the cementoenamel junction to the incisal edge of the affected teeth and separated from the rest of the enamel by a developmental groove. Radiographic examination exhibited a V-shaped radiopaque structure superimposed on the image of double teeth [Figure 2]. A periapical radiograph also showed a large pulp chamber and a large single root of the double teeth. Based on the clinical and radiographic observations, we arrived at a diagnosis of facial and lingual talon cusps on double teeth.
Figure 1: Labial and lingual talon cusps projecting from double teeth

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Figure 2: Periapical view of taloned double teeth

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The patient had a carious lesion in tooth #65, which was extracted under local anesthesia. The patient and his parents were not concerned about the anomalous teeth. It was not that the anomalous teeth did not pose any significant clinical problems. Oral prophylaxis was performed. Then we decided to apply fluoride varnish on the anomalous tooth and keep the patient under observation.


  Discussion Top


Both talon cusp and double teeth are dental anomalies of shape; they arise during the morphodifferentiation stage of tooth development. These two anomalies have multifactorial etiology involving both genetic and environmental factors. Talon cusps may develop as a result of an outward folding of the inner enamel epithelial cells and a transient focal hyperplasia of mesenchymal dental papilla.[1],[2],[3],[4],[5] Double teeth may arise due to pressure or physical forces producing close contact of developing tooth germs.[11],[12],[13]

Talon cusp may appear as an isolated anomaly, or present with various other dental anomalies such as supernumerary teeth, peg-shaped lateral incisors, Carabelli cusp, complex odontome, shovel-shaped incisors, and agenesis or impacted canine.[4] Here, we have described talon cusps on double teeth.

Double teeth are the most common developmental anomaly in primary dentition. Although various investigators have attempted to differentiate gemination from fusion, clinical significances of these two anomalies are the same.[11],[12],[13] Clinical complications associated with double teeth are carious lesions in the incisogingival developmental groove and unsightly appearance of the anomalous teeth.[4],[5],[9],[10],[11],[17] In our case, the double teeth were well-aligned in the dental arch and its developmental grooves were caries-free.

Complications of talon cusps are occlusal interferences, cusp fracture, caries in the developmental grooves, unaesthetic appearance, pulp exposure resulting from cusp fracture, and irritation of the tongue during speech and mastication.[1],[2],[3],[4],[5],[6],[7],[8],[17],[18],[19],[20] In this case, the talon cusps appeared asymptomatic and fused with the labial and lingual surfaces of double teeth.

Double teeth in primary dentition in many instances require no treatment except for periodic observation. In permanent dentition, sometimes periodic disking of teeth is necessary if their mesiodistal diameter is excessively large.[14] During the course of treatment, root canal therapy is indicated if pulp exposure occurs. Treatment of talon cusp requires periodic grinding when it interferes with occlusion or irritates the tongue during speech and mastication.[2],[3],[4],[5],[6],[7],[8]

Various treatment modalities for talon cusp are a) periodic reduction of the cusp, b) application of fluoride or desensitizing agents, restoring tooth morphology, or complete removal of the tooth depending on the severity of the problem.[3],[4],[5],[6],[7],[8],[9] If pulp exposure occurs during reduction of the talon cusp, endodontic therapy should be instituted. The anomalous teeth in our case did not cause any significant complications and its appearance was satisfactory. Thus, we performed only preventive treatment by performing oral prophylaxis and fluoride application.

Almost 92% of talon cusps in permanent dentition occurred in the maxilla.[7] In the present case, the affected teeth were present in the mandible. Reports of lingual talon cusp are many but accessory cusps projecting from the palatal and labial surfaces of teeth are few. Abott,[18] Patil et al .,[19] Dunn,[20] and Sashikiran et al .[11] reported facial and lingual talon cusps affecting permanent maxillary incisors. Cubukcu et al . described a case of palatal and lingual talon cusps on geminated permanent maxillary central incisors.[16] Ekambaram et al . reported a very rare case of facial and lingual talon cusps projecting from double teeth involving mandibular permanent central incisors.[15] Here, we described a similar case of labial and lingual talon cusps on double teeth involving mandibular central incisors.


  Conclusion Top


Talon cusps and double teeth are both rare dental anomalies that pose clinical and aesthetic problems. Their management varies, depending on the types of complications present. Pedodontists should be very careful of the prominent talons that often possess developmental grooves that may be exposed due to carious exposure and thereby complicate the operative procedure.

Acknowledgement

Dr. Santanu Mukhopadhyay, Associate Professor, Department of Pedodontics and Preventive Dentistry, Dr. R. Ahmed Dental College and Hospital, Kolkata, West Bengal, India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Shafer WG, Hine MK, Levy BM. A Textbook of Oral Pathology. 4th ed. Philadelphia: WB Saunders; 1983. p. 41.  Back to cited text no. 1
    
2.
Mitchell WH. Case report. Dent Cosmos 1892;34:1036.  Back to cited text no. 2
    
3.
Mellor JK, Ripa LW. Talon cusp: A clinically significant anomaly. Oral Surg Oral Med Oral Pathol 1970;29:225-8.  Back to cited text no. 3
    
4.
Mader CL. Talon cusp. J Am Dent Assoc 1981;103:244-6.  Back to cited text no. 4
    
5.
Sumer AP, Zengin AZ. An unusual presentation of talon cusp: A case report. Br Dent J 2005;199:429-30.  Back to cited text no. 5
    
6.
Kulkarni VK, Choudhary P, Bansal AV, Deshmukh J, Duddu MK, Shashikiran ND. Facial talon cusp: A rarity, report of a case with one year follow up and flashback on reported cases. Contemp Clin Dent 2012;3(Suppl 1): S125-9.  Back to cited text no. 6
    
7.
Hattab FN, Hazza'a AM. An unusual case of talon cusp on geminated tooth. J Can Dent Assoc 2001;67:263-6.  Back to cited text no. 7
    
8.
Gupta S, Tandon A, Chandra A, Gupta OP. Syndontia with talon cusp. J Oral Maxillofac Pathol 2012;16:266-71.  Back to cited text no. 8
[PUBMED]  Medknow Journal  
9.
Rao PK, Mascarenhas R, Shetty SR. Facial talon in mandibular incisor: An unusual occurrence. Dent Res J (Isfahan) 2011;8:229-31.  Back to cited text no. 9
    
10.
Oredugba FA. Mandibular facial talon cusps: Case report. BMC Oral Health 2005;5:9.  Back to cited text no. 10
    
11.
Shashikiran ND, Babaji P, Reddy VV. Double facial and a lingual trace talon cusps: A case report. J Indian Soc Pedod Prev Dent 2005;23:89-91.  Back to cited text no. 11
[PUBMED]  Medknow Journal  
12.
Brook AH, Winter GB. Double teeth. A retrospective study of 'geminated' and 'fused' teeth in children. Br Dent J 1970;129:123-30.  Back to cited text no. 12
    
13.
Schuurs AH, van Loveren C. Double teeth: Review of the literature. ASDC J Dent Child 2000;67:313-25.  Back to cited text no. 13
    
14.
Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and Maxillofacial Pathology. 3rd ed. Philadelphia: WB Saunders; 2009. p. 79.  Back to cited text no. 14
    
15.
Ekambaram M, Yiu CK, King NM. An unusual case of double teeth with facial and lingual talon cusps. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:e63-7.  Back to cited text no. 15
    
16.
Cubukcu CE, Sonmez A, Gultekin V. Labial and palatal talon cusps on geminated tooth associated with dental root shape abnormality: A case report. J Clin Pediatr Dent 2006; 31:21-4.  Back to cited text no. 16
    
17.
Mc Donald RE, Avery DR, Dean JA. Dentistry for the Child and Adolescent. 8th ed. St Louis: Mosby; 2009. p. 107-8.  Back to cited text no. 17
    
18.
Abbott 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.  Back to cited text no. 18
    
19.
Patil R, Singh S, Subba Reddy VV. Labial talon cusp on permanent central incisor: A case report. J Indian Soc Pedod Prev Dent 2004;22:30-2.  Back to cited text no. 19
[PUBMED]    
20.
Dunn WJ. Unusual case of labial and lingual talon cusps. Mil Med 2004;169:108-10.  Back to cited text no. 20
    


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