Management of a Facial Talon Cusp on a Maxillary Permanent Central Incisor: A Case Report and Review of the Literature

Corrections of Dental Anomalies in the Maxillary Incisors and Their Influence on Perceived Smile Esthetics: A Systematic Review

INTRODUCTION

Dental anomalies present a significant challenge to clinicians due to their impact on both dental function and esthetics. The correction of these anomalies plays a critical role in improving the quality of life of our patients, highlighting the importance of this restorative work.

OBJECTIVE

The purpose of this systematic review is to assess the techniques used to restore various dental anomalies, and their subsequent esthetic impact on the overall dentition.

METHODS

Inclusion criteria consisted of restorative rehabilitations of the permanent dentition in non-syndromic patients with dental anomalies of morphology, structure, size, and number in the maxillary incisors. Exclusion criteria included surgical rehabilitation techniques, endodontic treatments, and anomalies of the primary dentition. The medical literature was systematically searched (Pubmed, PMC, Embase, Cochrane Central Register of Controlled Clinical trials, Scopus and Google Scholar) to identify all relevant articles reporting data regarding the chosen anomalies. ROBINS-I was used to assess the risk of bias tool, and the results were tabulate due to data heterogeneity.

RESULTS

Of the 1821 analyzed articles, 46 articles met the inclusion criteria, and were chosen to go through the final review procedure. Of the selected articles, 3 investigated amelogenesis imperfecta and dentinogenesis imperfecta, 1 analyzed conoid teeth, 1 considered hypodontia (other than MLIA), 3 concerned microdontia (excluding peg laterals and conoid teeth), 10 evaluated peg-shaped laterals, 2 investigated talon cusps and geminated teeth, 15 were regarding maxillary lateral incisor agenesis, and 11 papers were related to the perception of anomalies.

CONCLUSIONS

Pre-visualization using Digital Smile Design, a treatment plan encompassing minimally invasive restorations, and using a multidisciplinary approach among practitioners helps the anomalous patient achieve the best possible esthetic result.

Conservative Management of Facial Talon Cusp in a Permanent Maxillary Central Incisor: A Case Report

Facial talon cusp is a rare developmental dental anomaly with unknown etiology. This case report is about an 11-year-old boy who presented with discomfort associated with tooth #11. After clinical and radiographical examination, the diagnosis of facial talon cusp (stage 1) was established. Treatment options and steps were discussed in detail. To the best of our knowledge, this is the first reported case of facial talon cusp in Saudi Arabia. The management of facial talon cusp is highly dependent on the individual patients. There are cases that only require fissure sealants; on the other hand, some cases need more aggressive treatment such as removal of the cusp, root canal treatment, or extraction. Dentists should be aware of the different treatment modalities in order to deliver the correct treatment for the patients. Clinical and radiographic examinations are important to rule out other dental anomalies. A standardized classification should be followed in classifying facial talon cusp in order to link each stage with its treatment.

Endodontic management of maxillary first molar with protostylid: a rare case report

BACKGROUND

A protostylid is a relatively rare dental developmental aberration characterized as an extra cusp located on the mesial half of the buccal surface of the molars. A protostylid is rarely to be reported due to its low rate of occurrence. This case report describes a patient referred for endodontic treatment due to the presence of a protostylid on the buccal surface of the maxillary first molar that induced apical periodontitis.

CASE PRESENTATION

A 53-year-old female reported a 3-month history of pain of chewing with her upper left posterior teeth over 3 months. In the clinical examination, an abraded anomalous cusp-like structure was found on the buccal surface of tooth 26, Cone beam computed tomography (CBCT) revealed a supernumerary cusp with an intact root canal inside, which was fused with the mesiobuccal (MB) root canal in the middle of the root. In addition, extensive periapical radiolucency was observed around tooth 26. The tooth was diagnosed as apical periodontitis, and endodontic treatment was performed. The initial lesion in tooth 26 gradually healed over 1 year of observation.

CONCLUSIONS

To our knowledge, this case is the first to describe the endodontic management of a maxillary first molar with a protostylid and advances our understanding of supernumerary cusps. This case provides a reference for the treatment of protostylid.

Rare variant of dens invaginatus with accessory root and labial talon cusp in maxillary lateral incisor-Case report

Dens invaginatus (DI) often causes dysmorphic changes in both the crown and root. This case report presents a complicated type 3a DI in a maxillary lateral incisor with labial talon cusp and root bifurcation. Although lingual talon cusp is common in maxillary lateral incisor, labial talon cusp is rare. An auxiliary palatal root in maxillary lateral incisor is also unusual. No such case involving all three variations has been described in the literature. The DI was classified as type B4 according to Schulze and Brand, as it involved division of pulp and root. DI was managed by orthograde MTA, radisectomy and periodontal regeneration was done for the palatal root. Labial talon associated with DI and can lead to early periodontal/pulpal involvement. Type 3 DI can affect the root with marked dilatation and division. Additional palatal root should be carefully detected in type 3a DI and managed with the aid of CBCT.

Prevalence of talon cusp: Systematic literature review, meta-analysis and new scoring system

OBJECTIVES

Talon cusp is a developmental anomaly consisting of a vertical ridge or cusp projecting labially or lingually from an anterior permanent or primary tooth. A range of prevalence between 0.06 % and 40.8 % has been reported in the literature. Although many epidemiological studies have been conducted, no synthesis of these data has been performed to date. The aim of this paper was to determine the prevalence of talon cusp and to investigate the link between sex and talon cusp.

SOURCE

A systematic search was undertaken using the PubMed/Medline, Embase and Cochrane Library electronic databases for publications from 1981 to 2020 investigating the prevalence of talon cusp and the link between talon cusp and sex.

STUDY SELECTION

Three reviewers selected the studies independently, extracted the data in accordance with the PRISMA statement, and assessed the risk of bias via the GRADE & Cochrane approaches.

RESULTS

From 39 potentially eligible studies, 9 were selected for full text analysis and 8 were included in the meta-analysis, representing 35,224 participants. The meta-analyses were performed with a random model, calculating a weighted-mean prevalence (at least one talon cusp per individual) of 1.67 %. Sex and talon cusp were not statistically significantly associated in our study (OR = 1.10; 95 % CI [0.82-1.47]; p > 0.05).

DISCUSSION

We report the first prevalence of talon cusp provided by meta-analysis in a non-syndromic sample. A non-statistically significant association between sex and talon cusp is relevant in terms of genetic etiology. In order to improve the homogeneity and accuracy of the results of further studies, we propose a new universal scoring system for talon cusp.

CLINICAL SIGNIFICANCE

Talon cusp is a developmental anomaly with various clinical implications. Therapeutics may vary from simple monitoring to extraction of the supporting tooth. This condition occurs in approximately 1.67 % of the population.

Management of non-syndromic dens evaginatus affecting permanent maxillary central incisors: a systematic review

To assess management of non-syndromic dens evaginatus affecting permanent maxillary central incisor, we performed a systematic review and also present a case report. We searched PubMed via MEDLINE and the reference lists of included reports. Eligible studies were any type of clinical studies describing the management of non-syndromic dens evaginatus affecting the crown of a permanent maxillary central incisor. We included 31 studies corresponding to 34 relevant case reports. Therapeutic options were complete reduction of the talon cusp in a single appointment (56%), periodic and gradual reduction of the cusp (26%), abstention (13%) or extraction (5%). We report an 8-year-old girl with unusual two-talon cusp, labial and lingual, on a right maxillary double central incisor. A multidisciplinary approach is key to management of permanent maxillary central incisors affected by coronary anomalies.