Extra Cusp Research Articles

An atypical presentation of talon cusp: Double talon cusps

Talon cusp is an uncommon developmental anomaly resulting in an extra cusp or cuspal projection on an anterior tooth consisting of normal enamel, dentin, and varying degrees of pulp tissue. Talon cusp shows varied presentations of which the palatal talon cusp has been the most common of all. The management requires an extensive understanding of this clinical entity and the complications associated with its occurrence. In this case series, we are reporting double talon cusps which is a rarity itself, involving the palatal aspect of maxillary central incisors.

Rare Occurrence of ‘Tuberculum Sextum’ (Cusp 6 or Entoconulid) in the Permanent Mandibular First Molar-A Case Report

Morphology of the human tooth with variation in cusp numbers and patterns are of great interest to the anthropologist, morphologist, and the clinical dentist. Very rarely an extra cusp known as Cusp 6 can be seen in the permanent or primary mandibular molars particularly the first molars. Cusp 6 is a supernumerary cusp seen at the distal margin of the crown, lingual to the distobuccal cusp. Cusp 6 is also known by other names like “Tuberculum Sextum” or “Entoconulid” which are anthropologic terms as evident from the existing literature. The present article reports the occurrence of such a rare cusp in the permanent mandibular first molar of an 8-year-old Indian boy

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

BackgroundA 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 presentationA 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.ConclusionsTo 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.

Dens Evaginatus of Bilateral Permanent Mandibular Premolars with Pulpal Involvement: A Case Report

Dens evaginatus (DE) is a rare developmental anomaly resulting in an extra cusp in teeth. This odontogenic malformation occurs during morphodifferentiation before the mineralization of hard tissue. We report an interesting case of an 11-yearold Asian boy who presented with acute pain and tooth mobility on permanent mandibular premolars due to bilateral DE. Radiographic evaluation revealed acute periapical radiolucency indicative of an abscess. Permanent mandibular right first premolar (an immature apex tooth) was treated with apexification while permanent mandibular left second premolar (a mature apex tooth) was treated with conventional root canal treatment. The differential treatments based on the degree of root formation led to favorable outcomes of preserving the teeth. Appropriate DE diagnosis is vital to timely treatments and positive prognosis while avoiding unnecessary extractions.

Parastyle – A case series

Human teeth show a large number of morphological variations and cuspal variations are one among them. A parastyle is a paramolar cusp that appears on the buccal surface of the maxillary molars. The exact cause of occurrence of parastyle is not clear but primarily it is found to be polygenetic in origin with some environmental influence. It is found to be rare in occurrence with prevalence of 0–0.1% in first molars, 0.4–2.8% in the upper second molar, and 0–4.7% in the maxillary third molars. Various dental problems like caries, sensitivity, interference with cementation of brackets, bands gingivitis, have been found to be associated with these extra cusps. These morphological findings are important for anthropologist and forensic experts. Few case reports are there in literature. The present article mentions the four cases of this rare morphologic variation. Keywords: Extra cusp, Parastyle, Protostylid, Maxillary molar, Paramolar tubercle.

Developmental dental anomalies and their potential role in establishing identity in post-mortem cases: a review.

Teeth may provide useful forensic evidence owing to features like uniqueness, stability and comparability. Moreover, the human dentition is heterodont, i.e. all the teeth have different morphology - incisors, canines, premolars and molars. There are sometimes deviations from normal morphology, such as the presence of extra teeth, variation in their shape and size eg the presence of an extra cusp, fractured crown/root, Carabelli's cusp, peg laterals, transpositions, fusion, etc. These differences can help forensic personnel identify bodies, especially where other methods of identification like facial features, fingerprints or DNA typing cannot yield satisfactory results as in cases of badly decomposed bodies, burnt remains, mass disasters, etc. Identification from dentition is based on the direct comparison of post-mortem dental profiles with ante-mortem dental records of the deceased. This article aims to review these developmental and morphological dental traits and their role in post-mortem identification.

The Islamic Perspective of Lingual Dens Evaginatus in a Mandibular Left Second Premolar: A Case Report

Dens evaginatus (DE) is a developmental anomaly. It is an extra cusp or tubercle that protrudes from the occlusal surface of posterior teeth, as well as the lingual surface of anterior teeth. Tubercles are susceptible to pulp exposure from wear or fracture because of malocclusion;leading to pulpal complications early after eruption.DE may also complicate the process of daily routine oral health care. A 13-year-old girl presented to our polyclinic with sinus track at the posterior lower left buccal gingiva forthe past1 year. All 35 teeth were sound. At the lingual side, there was an accessory tooth in close relation to tooth 35 covered with supra-gingival inflammation. Electric pulp test (EPT) showed that tooth 35 was already non-vital. Intraoral periapical (IOPA) radiograph and cone beam computed tomography (CBCT) scan showed an abnormalappearing root which shows DE with radiolucency at the periapical area. Root canal treatment was performed using crown down pressureless (CDP) technique and obturation was done using lateral condensation technique. The tooth was restored using composite restoration. DE is a rare condition. It is quite a challenge for dental practitioner since the diagnosis is difficult and the treatment options are limited. In the case of DE with necrotic pulp and periapical abscess, root canal treatment is a treatment of choice. We have to accept and appreciate any gift from Allah SWT whether it is good or bad, no equal divine creation except from Allah SWT.Therefore we need to take care of our oral hygiene to prevent diseases. In every disease, there is a cure; we thus need to try to do the best to find the cure and to not easily get rid of the tooth and replace it with a denture. Early diagnosis of DE can lead to proper treatment which can result in high success rate if it is followed by adequate restoration.

Regenerative Endodontic Treatment with Orthodontic Treatment in a Tooth with Dens Evaginatus: A Case Report with a 4-year Follow-up

Dens evaginatus is a developmental tooth anomaly in which an extra cusp or tubercle protrudes on the occlusal surface of the tooth along with some pulpal tissue. Because of the fragile nature of the protrusion, these teeth are often at risk of pulpal exposure. When this occurs in an immature tooth, regenerative endodontic treatment may be a good treatment approach to promote root formation. There is limited literature that documents the occurrence of orthodontic treatment in teeth that have undergone regenerative endodontic therapy using triple antibiotic paste. Here we present a case of an immature premolar tooth with dens evaginatus that was diagnosed with pulp necrosis and chronic apical abscess. The tooth was treated with regenerative endodontic treatment; after which, the patient received orthodontic treatment with fixed appliances for 2 years. The tooth responded favorably to the regenerative endodontic treatment and orthodontic tooth movement. Clinically and radiographically, all the follow-up examinations revealed an asymptomatic tooth with evidence of periapical healing with stunted root development. The tooth remained asymptomatic even after 4 years. The regenerative endodontic procedure (REP) was successful in treating an immature permanent premolar with pulp necrosis and apical periodontitis with dens evaginatus. In this case, the tooth treated with an REP responded to orthodontic treatment similar to the nonendodontically treated teeth. Further studies are recommended to clarify the precise effects of orthodontic treatment on teeth treated with an REP.

Talon cusp on palatally erupted mesiodens

Talon cusp is an accessory cusp-like structure or an extra cusp on an anterior tooth arising as a result of evagination on the surface of the crown before calcification has occurred. The cusp is composed of normal enamel and dentin containing varying extensions of pulp tissue. It is associated with few developmental anomalies such as peg laterals, dens invaginatus, and mesiodens. Mesiodens is a supernumerary tooth located in the premaxillary central incisor region which is supplemental or rudimentary type. Association of mesiodens with talon cusp is a rare occurrence with 25 cases reported. The presence of Talon cusp or a supernumerary tooth – mesiodens – leads to clinical implications such as poor esthetics, crowding, rotations, and also occlusal discrepancies. In this report, we present a case report of an 18-year-old male having a talon cusp on palatally erupted mesiodens.

CBCT Guided Endodontic Management of A Mandibular First Molar With Radix Entomolaris: A Case Report

Knowledge about the possible existence and the racial prevalence is mandatory for successful endodontic treatment of cases ofRadix Entomolaris (RE). Factors such as an extra cusp usually buccal (protostylid), prominent distolingual lobe, complexity of the external contour of the furcation and convexity in the cervical region help to diagnose the presence of an RE. Radiographically, double periodontal ligament images or outline of the distal root contour can hint the presence of an RE. An angled radiograph (25-30°) can be more useful in this regard. Three-dimensional imaging techniques based on computed tomography (CT) and cone beam computed tomography (CBCT) have been able to predict the exact morphology of an RE non- invasively. This is a case report of a successful endodontic treatment of an 11 years old female patient with

Variation in Cuspal Morphology in Maxillary First Permanent Molar with Report of 3 Cusp Molar- A Prevalence Study.

Human teeth has always been known for morphological variations in both the crown and root structures. The corono-morphological variations can be in the form of extra cusp or missing cusp. Permanent maxillary first molars are the biggest teeth in maxillary arch and have a high anchorage value and are known for their four cusp and five cusp patterns, if present with cusp of Carebelli. The aim of this study was to determine the prevalence of cuspal variations and quantification of cusps of permanent maxillary first molar in Malwa population. A total of 1249 individuals were studied at Government College of Dentistry, Indore, Madhya Pradesh, India, to evaluate the number of cusps in permanent maxillary first molars. Of the studied 1249 individuals, permanent maxillary first molars had five cusps in 407 (32.6%) cases while 838 (67.08%) cases had four cusp and four (0.32%) cases had three cusps. The four cases having three cusp permanent maxillary first molars were present unilaterally and only in females. This article emphasizes the presence of permanent maxillary first molar with only three cusps in the Malwa population of India. It also reviews the literature in respect to this rare anomaly and calls for continuous and close monitoring to report such cases in the future.

Facial talon cusp in a mesiodens: A rare occurrence

AbstractSupernumerary teeth are the ones which are extra in comparison to the normal dentition. The most common type of supernumerary, which is reported is mesiodens which is seen between maxillary central incisors. The supernumerary teeth may be associated with a syndrome or can be seen in nonsyndromic cases too. Talon cusp also known as Eagle′s Talon is an accessory cusp like structure or an extra cusp on an anterior tooth, which is usually present in the palatal aspect of teeth. The association of mesiodens with a talon cusp is a rare occurrence itself. Here, we report a case of a facial talon cusp in a mesiodens in an 8-year-old male child, which is quite rare.

Anatomical abnormalities in multiple permanent teeth.

Anatomical abnormalities in multiple permanent teeth.

Paramolar tubercle (Parastyle) in primary molars of Davangere (India) children: A retrospective study

Aim: To estimate the prevalence of paramolar tubercle (extra cusp) in primary molars of Indian children. Materials and Methods: A survey was conducted in children aged 2-8 years reporting during the period from 2006 to 2008. For recording paramolar tubercle, the definition given by Scott and Turner was employed. Subjects found with paramolar structure were further subjected to radiographic examination and impressions were made for further analysis of the paramolar tubercle. Results: Paramolar tubercle was noticed in eight patients (five boys and three girls). Among the eight patients, one patient had bilateral presence of paramolar tubercle. In seven patients, it was found on the right side and in two patients, it was found on the left side. We found type I in one case, type II in one case, type III in four cases, type IV in two cases and type V in one patient. Based on the different morphological patterns of paramolar tubercle observed during this study, we propose a new diagnostic classification system for better grading and understanding this rare dental trait, particularly for primary molars. Conclusion: As the frequency of paramolar tubercle is very rare, more studies involving different races have to be performed, rather involving individual cases, to show its unilateral/bilateral presence, sexual predominance and also to analyze the size and pattern of the paramolar tubercle.

Maxillary and Mandibular First Premolars Showing Three-Cusp Pattern: An Unusual Presentation

Dental anatomy is the study of morphology of various teeth in human dentitions. The application of dental anatomy in clinical practice is important, and dentist should have a thorough knowledge regarding the morphology of the teeth. At times as a result of genetic variation, environmental factors, diet of an individual and race, variations in the morphology of the teeth can be observed. These variations have been extensively studied by the researcher in the field of anthropology to define a particular race. The most commonly observed changes include peg-shaped laterals, shovel-shaped incisors, and extra cusp on molar. Common variations documented with regard to maxillary and mandibular first premolars are the variation in the number of roots. But the variations with respect to crown morphology are few. We report a first documented unusual presentation of maxillary and mandibular first premolars with three-cusps pattern in a female patient.

Talons Cusp in Mandibular Anteriors – An Unusual Presentation in A Child Patient

Talon’s cusp is a dental anomaly also known as an eagle’s talon. It is an extra cusp on an anterior tooth which arises as a result of evagination on the surface of a crown before calcification has occurred. The exact etiology is unknown. The incidence is less than 6%. Commonly involved is maxillary lateral incisors, with some instances of bilateral involvement. The anomaly has been reported to be rare in the mandible. This article reports unusual case of talon’s cusp, which affecting permanent mandibular central incisors. DOI: http://dx.doi.org/10.3329/bjch.v36i1.13041 Bangladesh J Child Health 2012; Vol 36 (1): 51-52

Bilateral maxillary fused second and third molars: a rare occurrence

This case report describes the diagnosis and endodontic therapy of maxillary fused second and third molars, using cone-beam computed tomography (CBCT). A 31-year-old Chinese male, with no contributory medical or family/social history, presented with throbbing pain in the maxillary right molar area following an unsuccessful attempted tooth extraction. Clinical examination revealed what appeared initially to be a damaged large extra cusp on the buccal aspect of the distobuccal cusp of the second molar. However, CBCT revealed that a third molar was fused to the second molar. Unexpectedly, the maxillary left third molar also was fused to the second molar, and the crown of an unerupted supernumerary fourth molar was possibly also fused to the apical root region of the second molar. Operative procedures should not be attempted without adequate radiographic investigation. CBCT allowed the precise location of the root canals of the right maxillary fused molar teeth to permit successful endodontic therapy, confirmed after 6 months.

Facial talon in mandibular incisor: An unusual occurrence

Talon cusp, also known as an eagle's talon, is a dental anomaly that occurs on the lingual aspect of teeth commonly, but occurrence on the facial aspect has rarely been reported. It is an extra cusp on an anterior tooth, which arises as a result of evagination on the surface of a crown before calcification has occurred. The incidence of talon cusp on lingual side is less than 6% and is even lesser on the facial aspect. Commonly involved teeth are maxillary incisors, usually unilateral but in some instances bilateral. The classical radiographical feature of talon cusp is double teeth appearance. The anomaly has been reported to be unusual in the mandibular dentition and extremely rare on the facial aspect. We report one such extremely rare case of facial talon cusp in mandibular central incisor.

Talon cusps in mandibular incisors: an unusual presentation in a child patient.

Talon cusp is a dental anomaly also known as an eagle’s talon. It is an extra cusp on an anterior tooth which arises as a result of evagination on the surface of a crown before calcification has occurred. The exact etiology is unknown. The inci-dence of talon cusp is less than 6%. Commonly involved teeth are maxillary incisors, usually unilateral but in some instanc-es bilateral. The classical radiographical feature of talon cusp is double teeth appearance. The anomaly has been reported to be unusual in the mandibular dentition. This article reports an unusual case of talon cusp of permanent mandibular central incisors.

Bilateral Six Cusped and Three Rooted Mandibular First Molars

ABSTRACT Teeth are vertebrate organs that arise from complex and progressive interactions between an ectoderm, the oral epithelium and an underlying mesenchyme. A significant amount of research has focused on determining the processes that initiate tooth development. It is widely accepted that there is a factor (multiple signaling molecules, including BMPs, FGFs, Shh and Wnt proteins) within the tissues of the first branchial arch that is necessary for the development of teeth. A 9-year-old reported to our department with the chief complaint of pain in the lower right back teeth region. On clinical examination, mandibular molars revealed the presence of an extra cusp on the lingual surface. Occurrence of six cusps in permanent mandibular molar is a rare phenomenon, and number of cases reported is very few.