Dental Management of a Talon Cusp on a Primary Incisor

Resident’s Name: Jessica Wilson

Program: Lutheran Medical Center -Providence

Article title: Dental Management of a Talon Cusp on a Primary Incisor

Author(s): Yoon & Chussid.

Journal: Pediatric Dentistry

Year. Volume (number). Page #’s: 2007. 29:1. 51-55.

Major topic: Talon Cusp Management

Overview of method of research: Case Report

Background:
The cause of the talon cusp has been suggested to be disturbances in morphodifferentiation. Radiographically, a talon cusp appears as two radiopaque lines converging from the cervical region to the incisal edge. The talon cusp is composed of normal enamel and dentin and may or may not include pulpal tissue. Different populations experience different frequency of talon cusps and range anywhere from 1-8%. Patients with orofacial digital II syndrome as well as Rubinstein-Taybi syndrome have a higher incidence of talon cusps and they have also been linked to peg laterals, supernumerary teeth, dens evaginatus, agenesis and impactions. The male to female ratio is 16:9 and talon cusps are 3 times more likely in the permanent dentition, 92% being in the maxilla. There 20 cases of talon cusps in the primary dentition have been reported in literature.

Clinical complications include:
1. Occlusal interferences
2. Problems with esthetics
3. Possible cusp fracture that leads to pulpal necrosis
4. Tongue irritation
5. Problems breastfeeding
6. Caries
7. Tooth displacement

Treatment Modalities:
1. Observation
2. Periodic reduction
3. Pulpectomies
4. Sealing of susceptible grooves/fissures
5. Resin crowns
6. Extractions

Case Report:
A 14-month-old patient presented for an initial exam. The parent reported a chief concern of “unaesthetic appearance and abnormal shape” of central maxillary incisor. Upon clinical exam, the patient demonstrated 100% overbite and a talon cusp was revealed on the lingual surface of the right central incisor displacing the tooth approximately 4mm anteriorly. The talon cusp extended half the distance from the CEJ to the incisal edge and grooves were present on both sides of the talon cusp. Although the tooth was asymptomatic, it interfered with occlusion. The authors decided to gradually reduce the size of the cusp to eliminate the occlusal interference as well as the increased risk of the anteriorly displaced incisor.
A total of 2mm of tooth structure was removed over 4 visits. These visits were spaced about 6 weeks apart to allow the deposition of tertiary dentition. 5% sodium fluoride varnish was applied to reduce sensitivity. It was estimated that approximately 3mm of dentin remained after treatment. The tooth remained asymptomatic at the one month post-op and the incisor appeared to move back into the arch without occlusal interference and 2mm overjet. The authors report the prognosis of this tooth to be guarded.

Discussion:
The rate of tertiary dentin formation is about 1.49µm/day and doesn’t begin until 19 days after an operative procedure. Other materials that may be used to protect the dentin include bonding agents and restorations (composites, compomers or resin modified glass ionomers). Although the authors chose to treat the tooth in this article, the majority of small talon cusps are asymptomatic and require no treatment.

Assessment of Article:
Good background information, but nothing too exciting.