|Year : 2015 | Volume
| Issue : 3 | Page : 145-149
Facial talon cusp in a mesiodens: A rare occurrence
Department of Pediatric and Preventive Dentistry, Institute of Dental Sciences, SOA University, Bhubaneswar, Odisha, India
|Date of Web Publication||21-Aug-2015|
Department of Pediatric and Preventive Dentistry, Institute of Dental Sciences, SOA University, Bhubaneswar - 751 030, Odisha
Source of Support: None, Conflict of Interest: None
Supernumerary teeth are the ones which are extra in comparison to the normal dentition. The most common type of supernumerary, which is reported is mesiodens which is seen between maxillary central incisors. The supernumerary teeth may be associated with a syndrome or can be seen in nonsyndromic cases too. Talon cusp also known as Eagle's Talon is an accessory cusp like structure or an extra cusp on an anterior tooth, which is usually present in the palatal aspect of teeth. The association of mesiodens with a talon cusp is a rare occurrence itself. Here, we report a case of a facial talon cusp in a mesiodens in an 8-year-old male child, which is quite rare.
Keywords: Facial, mesiodens, talon cusp
|How to cite this article:|
Acharya S. Facial talon cusp in a mesiodens: A rare occurrence. Eur J Gen Dent 2015;4:145-9
| Introduction|| |
Supernumerary teeth are the extra teeth present apart from the normal dentition. The most common supernumerary tooth to be reported is mesiodens present between the maxillary central incisors.  The term mesiodens refers to supernumerary tooth present in the midline of maxilla between the two central incisors.  The mesiodens may erupt normally, stay impacted, appear inverted or take a horizontal position. The term mesiodens was coined by Balk  in 1917 to denote a supernumerary tooth located mesial to both central incisor appearing as peg-shaped crown in normal or inverted position. Asymptomatic unerupted mesiodens may be discovered during the radiological examination of the premaxillary area.  Single supernumerary teeth accounts for 76-86%, in pair accounts for 12-23%, and <1% cases with three or more extra teeth.  Some syndromes such as Gardiner's syndrome, cleidocranial dysostosis, cleft lip, and palate may show mesiodens, but mesiodens may also be seen in nonsyndromic cases too.  Both dentitions may be affected, but a higher incidence of this anomaly is noted in permanent dentition.  The talon cusp, an anomalous structure resembling an Eagle's claw, projects lingually from the cingulum areas of a maxillary or mandibular permanent incisor. This cusp blends smoothly with the tooth except that there is a deep developmental groove where the cusp blends with the sloping lingual tooth surface. It is composed of normal enamel and dentin and contains a horn of pulp tissue. It is more frequent in permanent than in primary dentition. 
Fortunately, this anomaly is quite uncommon among the general population. However, it has been reported that it appears to be more prevalent in persons with the Rubinstein-Taybi syndrome, Mohr syndrome, Sturge-Weber syndrome and incontinentia pigmenti. The occurrence of talon cusp in the supernumerary tooth is an extremely rare phenomenon with only countable number of case reports till now and its occurrence on facial aspect is still infrequent.  Here, we report an unusual and rare case of a facial talon cusp in a mesiodens in an 8-year-old male child.
| Case Report|| |
An 8-year-old male patient presented to the outpatient department with a complaint of unusual looking tooth in the upper anterior region of the jaw. The patient did not complain of any pain in any of the tooth. The child was the first child and was nonsyndromic. Family history was noncontributory. No abnormalities were found on extra-oral examination. On intraoral examination, completely erupted tooth was noticed between two central incisors which seemed to be a supernumerary tooth [Figure 1]. Patient was in a mixed stage of the dentition with a palatally erupting lateral incisor on the left side and an unerupted lateral incisor on the right side. On examination of mesiodens, it had two lobes with a developmental groove running between the two lobes. On further examination on a study model, it was found that mesiodens had a facial talon cusp, giving inverted "T" shape [Figure 2] and [Figure 3] as talon was located on the facial aspect. Since the patient was in mixed dentition stage, extraction of mesiodens was advised for better alignment of the permanent anteriors. Unfortunately, the patient did not turn up and we could not meet the treatment plan as advised.
| Discussion|| |
Mesiodens is the most common supernumerary tooth in the palatal midline between the two maxillary central incisors. The prevalence of mesiodens varied from 0.15% to 1.9% in different reported cases with a higher prevalence to be found in the permanent than in the primary dentition.  Mesiodens is a clinically significant anomaly which is associated with various complications such as failure of eruption, midline diastema, displacement of incisors, root resorption of adjacent teeth, and cyst formation.  In our case, the unesthetic appearance was the only complaint by the patient. The size, shape, location, and the structure of the accessory cusp show wide variation. Hattab and Hazza'a classified talon cusp into three types. They are type 1 or major talon, type 2 or minor talon, and type 3 or trace talon.  Major talon is a morphologically well-defined additional cusp extending at least half the distance from the cementoenamel junction (CEJ) to the incisal edge of the tooth, whereas minor talon extends more than one-fourth, but less than half the distance from the CEJ to the incisal edge. Trace talon is a prominent cingulum occupying less than one-fourth the distances from the CEJ to the incisal edge of the tooth. In the present case, the talon cusp was of type 1 or major talon. Complications associated with talon cusps are interference with occlusion, cusp fracture, pulp exposure, open bite, periodontal problems due to excessive occlusal force, poor esthetics, and caries at the developmental grooves.  Early diagnosis of talon cusp is important, and a definitive treatment such as sealing of developmental grooves, and grinding of accessory cusps in multiple appointments are required. The etiology of both mesiodens and talon cusp are not clearly understood. Various theories such as dichotomy of tooth bud, genetic factors, atavism, and hyperactivity of dental lamina have been proposed for supernumerary tooth formation.  Talon cusps may develop as a result of an outward folding of inner enamel epithelial cells and a transient focal hyperplasia of mesenchymal dental papilla.  Occurrence of talon cusp on supernumeraries is extremely rare [Table 1] and [Table 2]. Reports describing treatments of talon cusp on supernumerary teeth are few because the condition is not usual. , Most of the cases have reported extraction of these teeth, and some also stated the patients not reporting for treatment. , In our case too, the patient did not turn up for further treatment.
| Conclusion|| |
As the occurrence of both these anomalies together is very rare, we have to diagnose the cases correctly and intervene timely so that major complications do not occur. It is always advisable to start with conservative treatment modality giving the tooth sufficient time to recover and respond by reparative dentin formation, so that pulp vitality can be maintained and invasive intervention can be avoided if at all possible. This case is very rare as can be seen from the tables which have been provided so identification and management plays a major role here.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]