SHORT COMMUNICATION
Year : 2014 | Volume
: 25 | Issue : 2 | Page : 272--274
Non-syndromic multiple talon cusps in siblings
Gaurav Sharma1, Anudeep R Mutneja2, Archna Nagpal3, Puneet Mutneja4,
1 Department of Oral Medicine and Radiology, Sudha Rustagi College of Dental Sciences, Faridabad, Haryana, India
2 Saraswati Dhanwantari Dental College and Hospital and Postgraduate Research Institute, Parbhani, Maharashtra, India
3 P.D.M. Dental College and Research Institute, Bahadurgarh, Haryana, India
4 Department of Prosthodontics and Crown and Bridge, Saraswati Dhanwantari Dental College and Hospital and Postgraduate Research Institute, Parbhani, Maharashtra, India
Correspondence Address:
Anudeep R Mutneja
Saraswati Dhanwantari Dental College and Hospital and Postgraduate Research Institute, Parbhani, Maharashtra
India
Abstract
Talon«SQ»s cusp is an anomalous structure that projects palatally from the cingulum areas of maxillary or mandibular anterior teeth. This dental anomaly may pose several pathological, functional and esthetic problems. Talon cusps usually affect a single tooth, but may rarely affect an entire sextant. Such multiple talon cusps may not always occur in association with a syndrome. Furthermore, they may exhibit a genetic pattern of inheritance. This article emphasizes rare occurrence of such nonsyndromic multiple talon cusps in two siblings.
How to cite this article:
Sharma G, Mutneja AR, Nagpal A, Mutneja P. Non-syndromic multiple talon cusps in siblings.Indian J Dent Res 2014;25:272-274
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How to cite this URL:
Sharma G, Mutneja AR, Nagpal A, Mutneja P. Non-syndromic multiple talon cusps in siblings. Indian J Dent Res [serial online] 2014 [cited 2023 Mar 20 ];25:272-274
Available from: https://www.ijdr.in/text.asp?2014/25/2/272/135943 |
Full Text
Introduction
A Talon cusp is a well-demarcated structure situated on the surface of an anterior tooth. In a vast majority of cases, this accessory cusp projects from the lingual surface of the afflicted permanent tooth in a three-pronged pattern that resembles an eagle's talon. Talon's cusp may rarely affect multiple teeth even in the absence of an underlying syndrome. This article reports such rare non-syndromic occurrence of multiple Talon's cusp in two siblings.
CASE REPORT
An 18-year-old male patient visited our department with a chief complaint of deposits on his teeth since 6 months. There was no history of bleeding from the gingiva/mobility of teeth. No significant past dental/medical/family history was recorded. Patient claimed no deleterious/abusive habits. General physical examination revealed no abnormalities. Extraoral examination also divulged no abnormalities.
Intraoral examination revealed extrinsic stains over teeth predominantly on the lingual aspect of mandibular anteriors. Incidentally also noted were prominent elevated cusp like structures from the cingulum region of 11, 12, 13, 21, 22, and 23 (true talon) [Figure 1]. There were no occlusal interferences.
A positive vital response was elicited with respect to 11, 12, 13, 21, 22, and 23. Radiographic examination (intraoral periapical radiographs) showed a dense V-shaped radiopacity with respect to the maxillary anteriors. The exact distinction between enamel, dentin, and presence of a pulp chamber in relation to the anomalous cusp like structures was not very well-appreciable on the radiograph [Figure 2].{Figure 1}{Figure 2}
Based on the above findings (a normal physical and skin examination and absence of any significant systemic history), a diagnosis of nonsyndromic multiple talon cusps was made. Examination of the patient's 15-year-old sister also revealed multiple talons cusp with respect to maxillary anteriors. The cusps were prominent on 13, 12, and 23 (semi talon) [Figure 3]. Radiographic examination (intraoral periapical radiographs) showed a dense V-shaped radiopacity with respect to all the maxillary anteriors including 11, 21, and 22 though they were clinically only mildly discernible [Figure 4].{Figure 3}{Figure 4}
As the cusps did not cause any noticeable changes in function/occlusion no further treatment was instituted. Patients were educated about the same with a study cast [Figure 5] and were referred to Department of Periodontology for thorough oral prophylaxis.{Figure 5}
DISCUSSION
Talon cusp refers to dental anomaly that manifests as an accessory cusp-like structure from the palatal/lingual cusp and rarely facial surface of anterior teeth. [1] This anomalous cusp composed of normal enamel; dentin may or may not contain pulpal tissue. [2] Although first described by W H Mitchell in 1892, the term "talon cusp" was coined by Ripa and Mellor in 1970 due to its resemblance with an Eagle's talon. [1] The exact etiology of talon cusps remains unknown with environmental and genetic factors playing a role during morphodifferentiation stage of odontogenesis. [2],[3],[4] The occurrence of talon cusps has been reported to be 3 times greater in the permanent dentition rather than in deciduous dentition. [2]
Maxillary lateral incisors are the most commonly affected permanent teeth, [5] whereas maxillary canines (4%) are rarely affected. [3] However in both our cases, there was the involvement of talon cusp in maxillary canines. Both genders may be equally affected and the cusp may occur either unilaterally or bilaterally. [5] Although this odontogenic anomaly may not be a part of any specific syndrome, those associated with talon cusp include, Sturge-Weber syndrome, Rubinstein-Taybi syndrome, Mohr syndrome, incontinentia pigmenti achromans, Ellis-Van Creveld syndrome, Berardinelli-Seip syndrome. [2],[4],[6],[7] A thorough clinical and systemic examination in both our cases revealed none of associated features of syndromes. Talon cusp may be coupled with other dental anomalies such as shovel shaped maxillary incisors, odontome, bifid cingula, dens invaginatus, impacted teeth and fusion. [8] The sibling of the case presented exhibited shovel shaped maxillary central incisors.
Talon cusps have been classified into three types by Hattab et al. as true talon, semi talon, and trace talon. Type I (true talon) refers to an accessory cusp that project toward the palatal surface of an anterior tooth and extends at least half the length of the cementoenamel junction to the incisal edge. Type II (semi talon) is an anomalous cusp 1 mm or more in length that extends less than half the length of the cementoenamel junction to the incisal edge. Type III (trace talon) is an augmented manifestation, a protruding cingulum with variations such as conical, bifid, or tubercle-like. [3],[4]
Talon cusps in a 10-year-old boy and his 12-year-old sister was reported by Meon in 1990. [7] Segura and Jimenez-Rubio have reported two cases of talon cusps afflicting consanguineous first cousins and suggested genetics as a probable major etiological factor for talons cusp in 1999. [7] Sarraf-Shirazi, Minoo Rezaiefar, and Maryam Forghani reported multiple talon cusps in three siblings in 2010. [7] In the present case, true talon was noted with respect to 11 and 21, while semi talon was noted in relation to 12, 13, 22, and 23. His sister exhibited semi talon with respect to 13, 12, and 23, while 11, 21, and 22 depicted trace talon. The presence of multiple talon cusps in these siblings suggest a genetic pattern of occurrence of talon cusps. [7],[8] However, patients refused genetic examination because of financial constraints and they were also asymptomatic and not concerned with esthetics.
The radiographic appearance of talon cusp varies with the morphology of the cusp and the angle at which the radiograph is taken. [6] A 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. [6] Trace talon appears as a tubercle-like radiopacity originating from the cervical third of the root. [6] The apex of the "V" is inverted in mandibular cases. [6] Similar findings were noted in the presented cases.
Clinical complications of talon cusps include compromised esthetics, attrition, temporomandibular joint pain, trauma to tongue and lip during speech and mastication, displacement of the affected tooth, problems in breastfeeding, accidental cusp fracture and occlusal interferences. [1],[6] The deep grooves that unite this cusp to the tooth act as stagnation areas for plaque and debris leading to periodontal and periapical pathosis. [1],[6] Talon cusp may present diagnostic problems if it is unerupted and bears resemblance to a compound odontoma or a supernumerary tooth that may lead to unnecessary surgical procedures. [1],[6]
Small asymptomatic talon cusps require no therapeutic intervention. [1],[6] Orthodontic correction may be essential when there is tooth displacement or malalignment of affected or opposing teeth. [1],[6] Certain cases require complete cusp reduction followed by endodontic therapy. [1],[6] Full crown coverage and extraction of the offending tooth may be required in some cases. [1],[6]
CONCLUSION
The occurrence of multiple talon cusps is rare and is even rarer in siblings. Genetic studies need to be conducted to ascertain the mode of genetic transmission of talon cusps. Talon cusps in siblings should be suspected when a patient has multiple talon cusps and intraoral examination should be conducted for siblings.
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