Archives of Medicine and Health Sciences

CASE REPORT
Year
: 2022  |  Volume : 10  |  Issue : 1  |  Page : 95--98

True talon cusp associated with cleft lip and palate: A rare case report


Bhavana Inderchand, Bhavna Dave, Prateek Kariya, Lipsa Shah 
 Department of Pediatrics and Preventive Dentistry, K M Shah Dental College and Hospital, Sumandeep Vidyapeeth (Deemed to be University), Vadodara, Gujarat, India

Correspondence Address:
Dr. Lipsa Shah
Department of Pediatrics and Preventive Dentistry, K M Shah Dental College and Hospital, Sumandeep Vidyapeeth (Deemed to be University), Vadodara - 391 760, Gujarat
India

Abstract

Talon cusp is a rare dental anomaly in which a cusp-like structure projects from the cingulum area or cementoenamel junction of the maxillary or mandibular anterior teeth. This unusual cusp resembles the talon of an eagle. It can be found in both the primary and permanent dentitions. A comprehensive literature study reveals that only 37 examples of talon cusps in the primary dentition have been described, with only 3 cases reporting this anomaly on the primary maxillary lateral incisor. We present a male patient with cleft lip and palate having primary lateral incisor talon cusp. The clinical implications of this anomaly, as well as the dispute over its etiology, are reviewed.



How to cite this article:
Inderchand B, Dave B, Kariya P, Shah L. True talon cusp associated with cleft lip and palate: A rare case report.Arch Med Health Sci 2022;10:95-98


How to cite this URL:
Inderchand B, Dave B, Kariya P, Shah L. True talon cusp associated with cleft lip and palate: A rare case report. Arch Med Health Sci [serial online] 2022 [cited 2022 Oct 1 ];10:95-98
Available from: https://www.amhsjournal.org/text.asp?2022/10/1/95/347971


Full Text

 Introduction



Mellor and Ripa coined the term “talon cusp” in 1970. It is defined as a supernumerary accessory talon-shaped cusp projecting from the lingual or facial surface of the crown of a tooth and extending for at least half the distance from the cementoenamel junction to the incisal edge.[1] Talon cusp was first recorded by Mitchell in 1892. She described this accessory cusp on the lingual surface of a maxillary central incisor as “a process of a horn-like shape curving from the base downward to the cutting edge.” Various names have been given by different authors for the same phenomenon – accessory cusp, cusped cingulum, dens evaginatus, evaginated odontome, hyperplastic cingulum, and supernumerary lingual tubercle.[2]

Talon cusp is usually unilateral, but one-fifth of the cases show bilateral occurrence.[3] With regard to tooth affinity, central incisors are involved in the primary dentition, and the maxillary lateral incisor is most often affected in the permanent dentition (67%), and both sexes are affected, with males with a higher incidence than females.[4] It consists of normal enamel, dentin, and pulpal tissue that may or may not be present.[5] The cusp often demonstrates a deep developmental groove where the cusp joins the lingual surface of the incisor. After the first report of a talon cusp on a primary incisor of a 4-year-old Filipino girl 35 years ago, the majority of cases reported thereafter were in Asian children. The prevalence of talon cusps in permanent teeth was 7%, whereas 0.04% in primary teeth.[6] [Table 1] represents the prevalence of talon cusps on primary teeth reported in the English literature.{Table 1}

 Case Report



A 2-year-old male child reported to the department of pediatric and preventive dentistry for a regular dental visit. He was an apparently healthy child born to nonconsanguineous parents at full term. The examination of the oral cavity revealed previously treated cleft lip and palate and normal development of the primary dentition. An anomalous cusp-like structure was detected on the palatal surface of the primary maxillary left lateral incisor that extended from the cervical margin of the tooth toward the incisal edge forming a triangular spike-like projection [Figure 1]. The cusp tip was pointed and coincided with the midline of the long axis of the tooth, forming a Y-shaped crown outline. The cusp measured 4.5 mm in length (incisocervically), 4.0 mm in width (mesiodistally), and 3.5 mm in thickness (labiolingually). Noncarious developmental grooves were observed laterally. An intraoral periapical radiograph of this tooth revealed the additional cusp with its pulpal extension and V-shaped radiopacity superimposed over the normal image of the crown irt 62 is noted to be suggestive of true talon [Figure 2]. The cusps neither irritated the tongue during speech and mastication nor interfered with occlusion, and the patient had no symptoms.{Figure 1}{Figure 2}

 Discussion



Talon cusp is a rare dental anomaly in which a cusp-like structure projects from the cingulum area or cementoenamel junction of the maxillary or mandibular anterior teeth.

The exact etiology of the talon cusp remains unknown. Various hypotheses regarding its etiology have been put forward.[7] According to Hattab et al., it is thought to arise during the morphodifferentiation stage of tooth development as a result of outfolding of the enamel organ or hyperproductivity of the dental lamina. Developmentally, it may arise as a result of outfolding of inner enamel epithelial cells (precursors of ameloblasts) and transient focal hyperplasia of the mesenchymal dental papilla (precursors of odontoblasts).[4] Thirumalaisamy et al. stated another hypothesis suggesting genetics to be a causative factor of talon cusp based on its occurrence in a family.[8] Shafer et al. said trauma and other localized forces on tooth germ have also been held responsible for talon cusp.[9] Occurrences of talon cusp on the labial surface of a mandibular central incisor and both labial and palatal talon cusps on the same tooth have been first reported by Abbott.[9]

The accessory cusp has been seen in association with other dental anomalies such as supernumerary teeth, odontomas, impacted teeth, peg-shaped lateral incisors, and dens invaginatus. Individuals born with oral clefts have a higher frequency of developmental defects of enamel. On the other hand, talon cusps may be associated with other dental anomalies, suggesting a genetic association. This could probably be explained by Rantanen's theory of hyperactivity of the anterior part of the dental lamina.[10]

[Table 2] represents syndromes associated with odontogenic anomaly and cleft lip and palate.[6]{Table 2}

The prevalence of talons cusp in primary dentition: [Table 3] represents the prevalence of talon cusp in primary dentition from 1977 to 2021. Till date, 53 cases of talon's cusp in primary dentition have been reported from all over the world, out of which only three cases reported in maxillary left lateral incisor till date.{Table 3}

Hattab's et al.[11] classified talon's cusp based on the degree of formation and extension into three categories:

Type 1 (True talon): A well-delineated additional cusp that predominantly projects from the palatal or lingual surface of an anterior tooth and extends halfway from the cementoenamel junction to the incisal edgeType 2 (Semi talon): An additional cusp of a millimeter or more but extending less than half the distance from cementoenamel junction to incisal edge. It may blend with the palatal surface or strand away from the crownType 3 (Trace talon): Enlarged cingulum may present as conical bifid or tubercle-shaped.

Chin-Ying described the variations in talon cusps as:

Major talons: Well-delineated cusps that project from an anterior tooth's facial or palatal/lingual surface and extend at least half the distance from the cementoenamel junction to the incisal edgeMinor talons: Which occur on the same surfaces but extend more than one-fourth and less than half the distance from the cementoenamel junction to the incisal edgeTrace talons: Enlarged prominent cingula and their variations, which occupy less than one-fourth the distance from the cementoenamel junction to the incisal edge.

The radiographic appearance of the talon cusp varies with the morphology of the cusp and the angle at which the radiograph is taken. V-shaped radiopacity superimposed over the normal image of the crown of the tooth is noted radiographically in cases of true talon or semi talon. Trace talon appears as a tubercle-like radiopacity originating from the cervical third of the root. The apex of the “V” is inverted in mandibular cases.[16]

Clinical complications of talon cusps include compromised esthetics, attrition, temporomandibular joint pain, trauma to the tongue and lip during speech and mastication, displacement of the affected tooth, problems in breastfeeding, accidental cusp fracture, and occlusal interferences all of which may require treatment, but in our case, the patient did not have any discomfort or complication, so we have kept him on regular follow-up. The deep grooves that unite this cusp to the tooth act as stagnation areas for plaque and debris which may lead to periodontal and periapical pathosis. The various treatment options for talon cusp are gradual, periodic reduction of the cusp, application of fluoride or desensitizing agents, and restoring tooth morphology or complete removal of tooth.[17]

The severity of the dental anomalies seems to be directly related to the severity of the cleft, suggesting that the embryological development of the lip, palate, and tooth is controlled by common genetic factors. There is, however, a gap in the knowledge regarding the reason why there is a correlation between the type of cleft and the severity of the dental abnormalities found. Many studies attribute the phenotype of oral clefts simply to “affected” or “unaffected” status, while evidence increasingly indicates that other clinical markers, such as the presence of dental anomalies, should be considered, defining broader phenotypes that help to unravel the genetic basis of the condition.[18]

 Conclusion



In this article, we have reviewed the literature regarding the talon cusp and have documented our case report according to the classification of Hattab's et al.[11] as type-1 (True talon) and Chin-Ying variations as major talon cusp. We should be extra alert when such anomalies are present since they are frequently connected with other dental anomalies; therefore, clinicians should constantly be aware of developmental anomalies, clinical problems, and their variations to manage the same.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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