Talon cusp

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Talon cusp
Other namesEagle's talon, dens evaginatus, interstitial cusp, tuberculated premolar, evaginated odontoma, supernumerary cusp [1]
Talon cusp.png
Periapical radiograph of talon cusp on a partially erupted upper left permanent maxillary incisor in an 8 year-old male of Arabic descent
Specialty Dentistry

Talon cusp is a rare dental anomaly [2] resulting in an extra cusp or cusp-like projection on an anterior tooth, located on the inside surface of the affected tooth. Sometimes it can also be found on the facial surface of the anterior tooth. [3]

Contents

The term 'talon cusp' refers to the same condition as dens evaginatus; however, talon cusp is more specifically the manifestation of dens evaginatus on the anterior teeth. Talon cusp can be simply defined as hyperplasia of the cingulum of an anterior tooth.

Although talon cusp may not appear serious, and in some people may be completely benign, it can cause clinical, diagnostic and functional problems, and alters the appearance of a person's teeth. The condition was first described by W.H. Mitchell in 1982 and named by J. Kimball Mellor B.S., D.D.S. and Louis W. Ripa, D.D.S., M.S. [4] due to its similar appearance to an eagle's talon. Some sources define a talon cusp as an extra cusp which extends at least half the distance between the cementoenamel junction and the incisal edge of the tooth. [5] Other sources classify all enlarged cingula as talon cusps, and classify them according to the degree of enlargement. [5]

The incidence of talon cusp has been found to range from 1% to 6% of the population.[ vague ] [6] Talon cusp tends to occur on permanent teeth only, [5] being very rare in deciduous teeth. [5] In most cases, the involved teeth are the permanent maxillary lateral incisors (55%), followed by maxillary central incisors (33%), mandibular incisors (6%), and maxillary canines (4%). [5]

Signs and symptoms

Talon cusp will show physical signs of the irregular dental formation of the teeth and cause other symptoms of the disease that could possibly lead to dental problems in the future, depending on severity of the deformity.

Most commonly, the extra cusp is located on the lingual surface, giving a three-pronged appearance. [5] Rarely, however, the extra cusp may be situated on the facial surface, or there may be extra cusps on both lingual and facial surfaces. [5] There may be a deep groove between the talon cusp and the rest of the tooth. The extra cusp typically contains pulp tissue. [5] When viewing talon cusp from the occlusal, the projection will appear "x-shaped", as well as appears conical, and mimic the shape of an eagle's talon. [2]

Symptoms of talon cusp include:

Cause

The cause of talon cusp is unknown. The anomaly can occur due to genetic and environmental factors but the onset can be spontaneous. Prevention is difficult because the occurrence happens during the development of teeth.

Talon cusp affects men and women equally, however the majority of reported cases are of the male gender. [5] Individuals of Asian, Arabic, Native American and Inuit descent are affected more commonly. [5] Talon cusp is also highly observed in patients with orofacial digital II syndrome and Rubinstein Taybi syndrome. Other anomalies that occur with talon cusp can include peg laterals, supernumerary teeth, dens envaginatus, agenesis and impaction. [5] A person belonging to one of these particular demographics or one who has any of these deformities or syndromes may have a higher risk of having a talon cusp.

Mechanism

The exact mechanism of the formation of dens evaginatus and talon cusp is unknown.[ citation needed ] It has been suggested that the anomaly is caused by an evagination. The formation of the "cusp" is due to excess layering of the internal enamel epithelium and dental papilla into the stellate reticulum. This occurs during the morphological differentiation stage of tooth development.[ citation needed ] During the developmental stages of tooth formation, certain dental follicle cells were differentiated incorrectly which formed the excess enamel and incorrect morphology of the affected tooth.

Talon cusp can progress into severe dental problems if the severity of the cusp affects the person's hygiene and oral functions.

Talon cusp may occur on its own or associated with other dental anomalies such as mesiodens, odontome, unerupted or impacted teeth, peg-shaped maxillary incisor, dens invaginatus, cleft lip, bilateral gemination, fusion, and supernumerary teeth. [8]

Diagnosis

This anomaly is large enough to be seen with the naked eye. One can see the projection on the incisal edge of a tooth looking into the mouth of the affected person. The structure is described to be "T'shaped" or "X-shaped" however will differ depending on its shape, size, structure, location and site of origin. [9] X-rays and radiographs can also show evidence of the abnormality. The digital images would show a tooth with talon cusp as if it were "double teeth". [5]

When looking at a radiograph some features to look for would be location, edge, shape and number. The location would be on an anterior tooth, the edge would be clear and well defined and can be seen even by the naked eye, and the shape would appear "talon-like" over the top portion or crown of the affected tooth. There could potentially be one, two or multiple protrusions depending on the type of cusp.

Talon cusp can fall under three categories: Type I, Type II and Type III. They are created based on the cusp formation shape and length of extension.

Since many cases of Talon cusp go unreported, it is hard to draw linkage maps but it is safe to assume that dental formation is influenced by genetic factors. [5] Talon cusp is also seen in association with conditions such as Rubinstein-Taybi syndrome,Mohr syndrome,Ellis–van Creveld syndrome,Incontinentia pigmenti achromians,Berardinelli-Seip syndrome, and Sturge–Weber syndrome. [5]

Treatment

Treatment is only required if the occlusion or bite of the person is compromised and causing other dental problems. Multiple long-term clinical problems can arise such as occlusal interferences, aesthetic disturbances, loss of pulp vitality, irritation of tongue during mastication and speech, caries and displacement of the affected tooth. Most people with talon cusp will live their normal lives unless the case is severe and causes a cascade of other dental issues that lead to additional health problems. Generally talon cusps on lower teeth require no treatment, but talon cusps on upper teeth may interfere with the bite mechanics and may need to be removed or reduced. [5]

Small talon cusps that produce no symptoms or complication for a person can remain untreated. However large talon cusps should not.

Some common treatments include:

The condition is usually benign, but it can cause mild irritation to soft tissues around the teeth and the tongue, and if large enough, may pose an aesthetic problem. Talon cusps that are too large are filed down with a motorized file, and then endodontic therapy is administered.

In order to prevent any future dental complications, when talon cusp is present due to an early diagnosis it would be best to see a dentist regularly every six months for routine dental checkups, remain under observation, brush and floss properly and undergo regular topical applications of fluoride gel to prevent caries and to promote enamel strength.

Recent research

Future studies will look further into the relationship of talon cusp and Rubinstein-Taybi syndrome and other oral-facial-digital syndromes. A former study showed a direct correlation in which 45 affected patients with Rubinstein-Taybi syndrome, 92% of these patients had talon cusp. [5] [11] Other researchers are attempting to trace talon cusp to ancestors and comparing dentition to modern humans. Another study done in 2007 examined the dentition of 301 Native American Indian skeletons for the presence or absence of talon cusp. The results showed five skeletons (2 percent) in the population had the trait. [12]

In 2011, only 21 cases of talon cusp have been reported and are in literature. [1] It appears that as of 2014 and 2015, [13] additional research continues in hopes of finding the cause and mechanism of talon cusp. With the majority of cases of talon cusp being unreported, it remains difficult to conduct tests, come up with conclusions, conduct surgery and perform research with small numbers.

Related Research Articles

<span class="mw-page-title-main">Human tooth</span> Calcified whitish structure in humans mouths used to break down food

Human teeth function to mechanically break down items of food by cutting and crushing them in preparation for swallowing and digesting. As such, they are considered part of the human digestive system. Humans have four types of teeth: incisors, canines, premolars, and molars, which each have a specific function. The incisors cut the food, the canines tear the food and the molars and premolars crush the food. The roots of teeth are embedded in the maxilla or the mandible and are covered by gums. Teeth are made of multiple tissues of varying density and hardness.

<span class="mw-page-title-main">Canine tooth</span> Long pointed tooth in mammals

In mammalian oral anatomy, the canine teeth, also called cuspids, dog teeth, eye teeth, vampire teeth, or vampire fangs, are the relatively long, pointed teeth. In the context of the upper jaw, they are also known as fangs. They can appear more flattened however, causing them to resemble incisors and leading them to be called incisiform. They developed and are used primarily for firmly holding food in order to tear it apart, and occasionally as weapons. They are often the largest teeth in a mammal's mouth. Individuals of most species that develop them normally have four, two in the upper jaw and two in the lower, separated within each jaw by incisors; humans and dogs are examples. In most species, canines are the anterior-most teeth in the maxillary bone. The four canines in humans are the two upper maxillary canines and the two lower mandibular canines. They are specially prominent in dogs (canidae), hence the name.

<span class="mw-page-title-main">Hyperdontia</span> Condition of having extra teeth beyond the regular number of teeth

Hyperdontia is the condition of having supernumerary teeth, or teeth that appear in addition to the regular number of teeth. They can appear in any area of the dental arch and can affect any dental organ. The opposite of hyperdontia is hypodontia, where there is a congenital lack of teeth, which is a condition seen more commonly than hyperdontia. The scientific definition of hyperdontia is "any tooth or odontogenic structure that is formed from tooth germ in excess of usual number for any given region of the dental arch." The additional teeth, which may be few or many, can occur on any place in the dental arch. Their arrangement may be symmetrical or non-symmetrical.

Hypodontia is defined as the developmental absence of one or more teeth excluding the third molars. It is one of the most common dental anomalies, and can have a negative impact on function, and also appearance. It rarely occurs in primary teeth and the most commonly affected are the adult second premolars and the upper lateral incisors. It usually occurs as part of a syndrome that involves other abnormalities and requires multidisciplinary treatment.

<span class="mw-page-title-main">Human tooth development</span> Process by which teeth form

Tooth development or odontogenesis is the complex process by which teeth form from embryonic cells, grow, and erupt into the mouth. For human teeth to have a healthy oral environment, all parts of the tooth must develop during appropriate stages of fetal development. Primary (baby) teeth start to form between the sixth and eighth week of prenatal development, and permanent teeth begin to form in the twentieth week. If teeth do not start to develop at or near these times, they will not develop at all, resulting in hypodontia or anodontia.

<span class="mw-page-title-main">Malocclusion</span> Medical condition

In orthodontics, a malocclusion is a misalignment or incorrect relation between the teeth of the upper and lower dental arches when they approach each other as the jaws close. The English-language term dates from 1864; Edward Angle (1855-1930), the "father of modern orthodontics", popularised it. The word "malocclusion" derives from occlusion, and refers to the manner in which opposing teeth meet.

<span class="mw-page-title-main">Maxillary central incisor</span> Tooth

The maxillary central incisor is a human tooth in the front upper jaw, or maxilla, and is usually the most visible of all teeth in the mouth. It is located mesial to the maxillary lateral incisor. As with all incisors, their function is for shearing or cutting food during mastication (chewing). There is typically a single cusp on each tooth, called an incisal ridge or incisal edge. Formation of these teeth begins at 14 weeks in utero for the deciduous (baby) set and 3–4 months of age for the permanent set.

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Dens invaginatus (DI), also known as tooth within a tooth, is a rare dental malformation where there is an infolding of enamel into dentine. The prevalence of condition is 0.3 - 10%, affecting more males than females. The condition is presented in two forms, coronal and radicular, with the coronal form being more common.

Dens evaginatus is a rare odontogenic developmental anomaly that is found in teeth where the outer surface appears to form an extra bump or cusp.

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Occlusion, in a dental context, means simply the contact between teeth. More technically, it is the relationship between the maxillary (upper) and mandibular (lower) teeth when they approach each other, as occurs during chewing or at rest.

<span class="mw-page-title-main">Crossbite</span> Medical condition

Crossbite is a form of malocclusion where a tooth has a more buccal or lingual position than its corresponding antagonist tooth in the upper or lower dental arch. In other words, crossbite is a lateral misalignment of the dental arches.

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<span class="mw-page-title-main">Enamel hypoplasia</span> Medical condition

Enamel hypoplasia is a defect of the teeth in which the enamel is deficient in quantity, caused by defective enamel matrix formation during enamel development, as a result of inherited and acquired systemic condition(s). It can be identified as missing tooth structure and may manifest as pits or grooves in the crown of the affected teeth, and in extreme cases, some portions of the crown of the tooth may have no enamel, exposing the dentin. It may be generalized across the dentition or localized to a few teeth. Defects are categorized by shape or location. Common categories are pit-form, plane-form, linear-form, and localised enamel hypoplasia. Hypoplastic lesions are found in areas of the teeth where the enamel was being actively formed during a systemic or local disturbance. Since the formation of enamel extends over a long period of time, defects may be confined to one well-defined area of the affected teeth. Knowledge of chronological development of deciduous and permanent teeth makes it possible to determine the approximate time at which the developmental disturbance occurred. Enamel hypoplasia varies substantially among populations and can be used to infer health and behavioural impacts from the past. Defects have also been found in a variety of non-human animals.

Serial extraction is the planned extraction of certain deciduous teeth and specific permanent teeth in an orderly sequence and predetermined pattern to guide the erupting permanent teeth into a more favorable position.

<span class="mw-page-title-main">Tricho–dento–osseous syndrome</span> Medical condition

Tricho–dento–osseous syndrome (TDO) is a rare, systemic, autosomal dominant genetic disorder that causes defects in hair, teeth, and bones respectively. This disease is present at birth. TDO has been shown to occur in areas of close geographic proximity and within families; most recent documented cases are in Virginia, Tennessee, and North Carolina. The cause of this disease is a mutation in the DLX3 gene, which controls hair follicle differentiation and induction of bone formation. All patients with TDO have two co-existing conditions called enamel hypoplasia and taurodontism in which the abnormal growth patterns of the teeth result in severe external and internal defects. The hair defects are characterized as being rough, course, with profuse shedding. Hair is curly and kinky at infancy but later straightens. Dental defects are characterized by dark-yellow/brownish colored teeth, thin and/or possibly pitted enamel, that is malformed. The teeth can also look normal in color, but also have a physical impression of extreme fragility and thinness in appearance. Additionally, severe underbites where the top and bottom teeth fail to correctly align may be present; it is common for the affected individual to have a larger, more pronounced lower jaw and longer bones. The physical deformities that TDO causes become more noticeable with age, and emotional support for the family as well as the affected individual is frequently recommended. Adequate treatment for TDO is a team based approach, mostly involving physical therapists, dentists, and oromaxillofacial surgeons. Genetic counseling is also recommended.

Open bite is a type of orthodontic malocclusion which has been estimated to occur in 0.6% of the people in the United States. This type of malocclusion has no vertical overlap or contact between the anterior incisors. The term "open bite" was coined by Carevelli in 1842 2 as a distinct classification of malocclusion. Different authors have described the open bite in a variety of ways. Some authors have suggested that open bite often arises when overbite is less than the usual amount. Additionally, others have contended that open bite is identified by end-on incisal relationships. Lastly, some researchers have stated that a lack of incisal contact must be present to diagnose an open bite.

Orthodontic indices are one of the tools that are available for orthodontists to grade and assess malocclusion. Orthodontic indices can be useful for an epidemiologist to analyse prevalence and severity of malocclusion in any population.

Anterior teeth are one of the most scrutinized teeth, the size and shape and color of the anterior upper teeth plays an important role in dental aesthetics and smile aesthetics. A few aesthetic anterior problems could be solved with composite restorations. For example, dental caries, tooth fracture, enamel defects and diastemas. Composite restoration can also improve aesthetic by changing shape, color, length and alignment of teeth.

References

  1. 1 2 Praveen, P (February 2011). "Talon Cusp in a Primary Tooth" (PDF). Journal of Dental Sciences and Research. 2 (1): 35–40. Retrieved November 1, 2015.
  2. 1 2 3 4 5 Ozcelik, Bahar; Atila, Burcu (2011-01-01). "Bilateral Palatal Talon Cusps on Permanent Maxillary Lateral Incisors: A Case Report". European Journal of Dentistry. 5 (1): 113–116. doi:10.1055/s-0039-1698866. ISSN   1305-7456. PMC   3019756 . PMID   21228961.
  3. ↑ Shirolkar S, Das M, Gayen K, Mukhopadhayay S, Sarkar S, Roychowdhury S. Managing a facial talon: A rare morphological variation on maxillary permanent central incisor. J Dent Res Rev [serial online] 2021 [cited 2021 Sep 5];8:217-20. Available from: https://www.jdrr.org/text.asp?2021/8/3/217/324411
  4. ↑ Mellor, J. Kimball; Ripa, Louis W. (1970-02-01). "Talon cusp: A clinically significant anomaly". Oral Surgery, Oral Medicine, Oral Pathology. 29 (2): 225–228. doi:10.1016/0030-4220(70)90089-7. PMID   5262843.
  5. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Neville BW; Chi AC; Damm DD; Allen CA (13 May 2015). Oral and Maxillofacial Pathology. pp. 80–81. doi:10.1007/s12105-007-0007-4. ISBN   978-1-4557-7052-6. PMC   2807501 . PMID   20614286.{{cite book}}: |journal= ignored (help)
  6. ↑ Neville, B.W., D. Damm, C. Allen, J. Bouquot. Oral & Maxillofacial Pathology. Second edition. 2002. Page 78. ISBN   0-7216-9003-3.
  7. 1 2 3 "Presentation and Management of Talon Cusp". www.jpma.org.pk. Retrieved 2015-11-02.
  8. ↑ Sharma, Gaurav; Nagpal, Archna (2014). "Talon Cusp: A Prevalence Study of Its Types in Permanent Dentition and Report of a Rare Case of Its Association with Fusion in Mandibular Incisor". Journal of Oral Diseases. 2014: 1–6. doi: 10.1155/2014/595189 .
  9. ↑ Sumer, A. P.; Zengin, A. Z. (2005-10-08). "An unusual presentation of talon cusp: A case report". British Dental Journal. 199 (7): 429–430. doi:10.1038/sj.bdj.4812741. ISSN   0007-0610. PMID   16215568. S2CID   30334582.
  10. 1 2 Oredugba, Folakemi A. (2005-12-08). "Mandibular facial talon cusp: Case report". BMC Oral Health. 5 (1): 9. doi: 10.1186/1472-6831-5-9 . ISSN   1472-6831. PMC   1334182 . PMID   16336661.
  11. ↑ Hennekam, R. C.; Van Doorne, J. M. (1990-01-01). "Oral aspects of Rubinstein-Taybi syndrome". American Journal of Medical Genetics. Supplement. 6: 42–47. doi:10.1002/ajmg.1320370607. ISSN   1040-3787. PMID   2118777.
  12. ↑ Mayes, A. T. (2007). "Labial talon cusp - The Journal of the American Dental Association". Journal of the American Dental Association. 138 (4): 515–8. doi:10.14219/jada.archive.2007.0205. PMID   17403743 . Retrieved 2015-12-10.
  13. ↑ Mallineni, Sreekanth-Kumar; Panampally, George-Kurian; Chen, Yong; Tian, Tian (2014-10-01). "Mandibular talon cusps: A Systematic review and data analysis". Journal of Clinical and Experimental Dentistry. 6 (4): e408–e413. doi:10.4317/jced.51476. ISSN   1989-5488. PMC   4282910 . PMID   25593665.
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