Journal of Advanced Clinical and Research Insights

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Twin talon cusp - A case report with review of literature
Twin talon cusp - A case report with review of literature
A.H. Harini Priya, Natraj Priyadarshini
Department of Oral Pathology, SRM Dental College, Chennai, Tamil Nadu, India
Correspondence: A.H. Harini Priya, Department of Oral Pathology, SRM Dental College, Chennai, Tamil Nadu, India.
Phone: +91-9884130803.
Received 01 December 2017;
Accepted 08 January 2017
doi: 10.15713/ins.jcri.195
Talons cusp is one developmental anomaly of the tooth that shows varied presentation as mentioned in the literature. The occurrence of talons cusp in the palatal aspect of the maxillary teeth has been the most common of all. These cases tend to occur due to hyperactivity of the enamel organ. The occurrence of this developmental defect in turn can lead to alteration in normal structure and function of the tooth. Hereby, we are reporting a rare occurrence of twin Talon's cusp involving the palatal aspect of maxillary central incisor.
Keywords:Accessory cusp,dens evaginatus, maxilla,permanent incisor,talon, tooth anomaly
How to cite this article: Priya AHH, Priyadarshini N. Twintalon cusp - A case report with review of literature. J Adv ClinRes Insights 2018;5:6-8.


Developmental anomalies involving the structure of the teeth have long been a debate as of its occurrence along with various syndromic conditions. Talons cusp is one such anomaly that is easy to diagnose due to its structural prominence. It was first described by Mitchell in 1892 and was named as Talon's cusp by Mellor and Ripa.[1] It is usually visualized as an accessory cusp from the cingulum area of an anterior tooth resembling an eagle's talon which resembles that of an eagle's claw as seen when hooked on to a prey.[2] The occurrence of twins Talons cusp involving two maxillary incisors is a rarity and is much less reported so far.

Case Report

A 11-year-old girl reported with the chief complaint of decayed teeth. Extraoral findings showed no abnormality. Intraoral finding revealed a mixed dentition along with the presence of dental caries in relation to 54, 75, and 46. The patient had a proclined maxillary anteriors, along with the presence of Talon cusp in 11 and 21. The cusp projected from the cementoenamel junction and curved toward the incisal edge of both the incisors [Figure 1] A periapical radiograph revealed an inverted V-shaped radiopaque structure on the maxillary right and left central incisors [Figure 2]. With the above findings, a diagnosis of Type I Talon cusp in 11 and Type II talon cusp in 21 was given. The extent of pulp tissue into the cusp could not be determined on the radiograph. With the consent of the parents, after oral prophylaxis, pit and fissure sealant was applied, and the patient was recalled for follow-up.


Talon cusp is a rare entity more frequently affecting the maxillary permanent incisors and rarely affecting the mandibular and primary incisors.[3] This condition resembles the same as that of Dens Evaginatus as seen in posterior teeth.[4] The exact etiology of this condition is not known, while various genetic factors seem to have an interplay in the occurrence of this condition which in turn can lead to alteration in the morphodifferentiation stage of tooth development, resulting in out folding of enamel organ or hyperactivity of Dental Lamina.[5] It has been stated that any disturbance in the morphodifferentiation due to associated endocrine abnormality can lead to structural abnormalities of the tooth as the function of ameloblast and odontoblasts remain unaffected.[6] Thus, Talon cusp can occur in isolation or along with other associated dental anomalies such as mesiodens, odontome, unerupted or impacted teeth, peg-shaped maxillary incisors, dens invaginatus, cleft lip and distorted nasal alae, fusion, gemination, supernumerary teeth, and enamel clefts. A strong correlation between the occurrence of talons cusp and associated gene defect has also been stated where it is found associated with systemic conditions such as Sturge-Weber Syndrome, Ellis-van Creveld Syndrome, Incontinentia Pigmenti, Oro-facial Digital II, and Rubinstein-Taybi Syndrome.[3,7-9]

As described earlier, this lesion usually presents similar to that of a eagle's Talon. It is composed of enamel and dentinwhile a few states the presence of small amount of pulp tissuealso within the cusp, the extent of which is difficult to determinedue to superimposition of the tooth structure as in radiographicexamination.[10] Radhika et al.[6] reported a male-to-female ratio of47:26 among 73 cases reported in the literature.[11] Most reportedcases of Talon cusp are located in the permanent dentition.Usually, it occurs unilaterally, but bilateral cases, includingmultiple and double Talon cusps, have also been reported.[5] Inthe present case, no other associated anomaly was appreciate

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A report on TWIN TALON CUSP with review of literature Priya and Priyadarshini

Twin talon cusp - A case report with review of literature
Figure 1: Type I Talon cusp in 11 and Type II Talon cusp in 21

Twin talon cusp - A case report with review of literature
Figure 2: IOPA showing prominent Talons cusp in 11 and Talonscusp in 21

Since Talon cusp tends to show a varied presentation withits size, shape, and location, Hattab et al. formulated diagnosticcriteria.
  • Type 1: Talon - refers to a morphologically well-delineatedadditional cusp that prominently projects from the palatal(or facial) aspect/surface of a primary or permanentanterior tooth and extends at least half the distance from thecementoenamel junction to the incisal edge.
  • Type 2: Semi talon - refers to an additional cusp of a fewmillimeter extending less than half of the distance from thecementoenamel junction up to the incisal edge. It may blendwith the palatal surface or stand away from the rest of thecrown.
  • Type 3: Trace talon - an enlarged or prominent cingulum andtheir variations, i.e. conical, bifid, or tubercle-like.

Radiographically, it may appear typically as a V-shapedradiopaque structure, as in case of true talon or semi-talon,or can be tubercle-like, as in trace talon, originating from thecervical third of the root. The radiopaque V-shaped structure issuperimposed over the normal image of the crown of the tooth.This appearance varies in accordance with the shape and size ofthe cusp, and the angle at which the radiograph is taken.[12] Ourcase consists of Type I Talon in relation to 11 and Type II talonin relation to 21.

Smaller Talon cusps are usually asymptomatic and does notcause much dental problems compared to that of large Taloncusps which can lead to problems in occlusion, developmentof dental caries, speech, and esthetics.[13] As mentioned earlier,these Talon cusps can be associated with syndromic conditions,thereby a proper record of family history is essential to rule outfuture complications.

Further, treatment of associated dental complication isinclusive of esthetic management involving grinding of theTalons cusp, fissure sealing and composite resin restoration maybe necessary. Orthodontic management may be necessary in caseof tooth displacement or malalignment of the same or oppositetooth.[5,14,15] The treatment modalities and preventive strategiesso planned should revolve around the future complications orassociated systemic diseases.


Any minor dental anomaly might be a mirror of a syndromiccondition; Overall study of a characteristic clinical sign can thusprovide a wider view. Therefore, revolving around the sameancient concept of treating, only the clinical condition so presentshould be ruled out. Talons cusp is one such dental entityassociated with various syndromic conditions, and therefore,careful speculation is essential.

  1. Mellor JK, Ripa LW. Talon cusp: A clinically significant anomaly.Oral Surg Oral Med Oral Pathol 1970;29:225-8.
  2. Kapur A, Goyal A, Bhatia S. Talon cusp in a primary incisor:A rare entity. J Indian Soc Pedod Prev Dent 2011;29:248-50.
  3. Gupta R, Thakur N, Thakur S, Gupta B, Gupta M. Talon cusp :A case report with management guidelines for practicingdentists. Dent Hypotheses 2013;4:2013-5.
  4. Rajendran R, Sivapathasundharam B. Shafer, Hine, Levy. Shafer'sTextbook of Oral Pathology. 7th ed. India: Elsevier Publishers;2012. p. 42.
  5. Ozcelik B, Atila B. Bilateral palatal talon cusps on permanentmaxillary lateral incisors: A case report. Eur J Dent 2011;5:113-6.
  6. Radhika MB, Paremala K, Sudhakara M, Soumya M. Talonscusp: A report of seven cases and review of literature. World JDent 2014;5:76-9.
  7. Kalaskar R, Kalaskar AR. Oral manifestations of ellis-vancreveld syndrome. Contemp Clin Dent 2012;3:S55-9.

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Priya and Priyadarshini A report on TWIN TALON CUSP with review of literature

  1. Stalin A, Varma BR, Jayanthi. Rubinstein taybi syndrome.J Indian Soc Pedod Prev Dent 2006;24 Suppl 1:S27-30.
  2. Gosselin ML, Doyle T, MacLellan J, Anderson RD, Dyment H.A talon cusp mistaken for a mesiodens: Case report. J Can DentAssoc 2012;78:c6.
  3. Sumer AP, Zengin AZ. An unusual presentation of talon cusp:A case report. Br Dent J 2005;199:429-30.
  4. Hattab FN, Yassin OM, al-Nimri KS. Talon cusp-clinical significanceand management: Case reports. Quintessence Int 1995;26:115-20.
  5. Oredugba FA. Mandibular facial talon cusp: Case report. BMCOral Health 2005;5:9.

  1. Pushpalatha C, Sowmiya SV, Umapathy T, Sowbhagya MB. Casereport semi-talon cusps on maxillary anterior teeth : A rareentity. Int J Oral Care Res 2014;2:91-3.
  2. Thakur S, Gupta R, Thakur N, Gupta M. Facial talon cusp onpermanent maxillary canine: A rare dental anomaly. J Gen Dent2013;2:324-7.
  3. Prabhu RV, Rao PK, Veena K, Shetty P, Chatra L, Shenai P, et al.Prevalence of talon cusp in Indian population. J Clin Exp Dent2012;4:e23-7.

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