Maksiller Santral Kesici Dişte Talon Tüberkülü: Klinik ve Radyolojik Bulguları ve Tedavisi ile bir Vaka Sunumu

Year 2022, Volume: 6 Issue: 2, 109 - 113, 31.12.2022

Tuğçe Güngör Ezgi Tüter Bayraktar Bilge Tarçın Birsay Gümrü

https://doi.org/10.29228/erd.34

Abstract

Dens evaginatus (DE) gelişimsel bir dental anomali olup, mine ve dentin dokusunun yanı sıra pulpa dokusunu da içerebilen tüberkül benzeri yapı olarak tanımlanmaktadır. Genellikle premolar dişlerle ilişkilendirilmekle birlikte, kesici dişlerde de görülmektedir (talon tüberkülü). Asya kökenlilerde daha sık rastlanan bu anomali, her iki cinsiyeti de etkileyebilmekte ve unilateral veya bilateral olarak izlenebilmektedir. Klinik olarak; çürük, maloklüzyon, oklüzal travma ve pulpa nekrozu gibi komplikasyonlara sebep olabilir. Radyolojik olarak, etkilenen kuron üzerine süperpoze olan “V” şeklindeki radyo-opak yapı mesiodens, kompound odontoma veya sürnumerer diş görüntüsünü taklit edebilir.
Estetik kaygılar ve çürük dişlerinin tedavisi için kliniğimize başvuran 16 yaşındaki erkek hastanın klinik ve radyolojik muayenesi gerçekleştirilmiştir. İntra-oral muayenede, sol maksiller santral kesici dişin lingual yüzeyinde konik şekilli aksesuar tüberkül saptanmıştır. İlgili bölgeden alınan periapikal radyografide, etkilenen kuron üzerine süperpoze olmuş tipik “V” şekilli radyo-opak yapı izlenmiştir. İlgili tüberküldeki pulpa uzantısının incelenmesi ve restoratif tedavilerin bu doğrultuda şekillendirilmesi için konik ışınlı bilgisayarlı tomografi (KIBT) görüntülemeye başvurulmuştur. Hasta, retantif alanların ve çürüklerin restorasyonu için Restoratif Diş Tedavisi Anabilim Dalı’na sevk edilmiştir.
Nadir rastlanan bir anomali olan DE, klinik ve radyolojik bulgularla birlikte değerlendirilmelidir. Genetik aktarımın göz önünde bulundurulması erken tanı açısından oldukça önemlidir. Koruyucu/önleyici ve minimal invaziv uygulamaların KIBT görüntüleme ile desteklenmesi klinisyene önemli avantaj sağlayacaktır.

Keywords

dens evaginatus, talon tüberkülü, aksesuar tüberkül, konik ışınlı bilgisayarlı tomografi, tedavi

Talon Cusp on a Maxillary Central Incisor: A Case Report with Clinical and Radiological Findings, and Management

Abstract

Dens evaginatus (DE) is a developmental dental anomaly and is defined as a tubercle-like structure that may contain pulp tissue as well as enamel and dentin. Although it is usually associated with premolars, it is also seen in incisors (talon cusp). This anomaly, which is more common among Asians, may affect both genders and may be observed unilaterally or bilaterally. Clinically, it may cause complications such as caries, malocclusion, occlusal trauma, and pulp necrosis. Radiologically, the V-shaped radiopaque structure superimposed over the affected crown may mimic the appearance of a mesiodens, compound odontoma, or supernumerary tooth.
Clinical and radiological examination of a 16-year-old male patient who admitted to our clinic with aesthetic concerns and treatment of decayed teeth was performed. In the intra-oral examination, a conical accessory cusp was noted on the lingual surface of the left maxillary central incisor. A typical V-shaped radiopaque structure superimposed on the affected crown was observed on the periapical radiograph taken from the relevant area. Cone beam computed tomography (CBCT) imaging was used to evaluate the restorative treatment options by examining the pulp extension in the relevant tubercle. The patient was referred to the Department of Restorative Dentistry for restoration of the retentive areas and caries.
DE, which is a rare anomaly, should be evaluated together with clinical and radiological findings. Consideration of genetic transmission is quite important for early diagnosis. CBCT imaging will provide significant advantage to the clinician in preventive and minimally invasive applications.

Keywords

dens evaginatus, talon cusp, accessory cusp, cone beam computed tomography, management

References

• Al-Omari MA, Hattab FN, Darwazeh AM, Dummer PM. Clinical problems associated with unusual cases of talon cusp. Int Endod J. 1999;32(3):183-190.
• Almandey AH, Anthonappa RP, King NM, Fung CW. KBG syndrome: clinical features and specific dental findings. Pediatr Dent. 2010;32(5):439-444.
• Babaji P. Bilateral supplemental maxillary incisors with both dens invaginatus and dens evaginatus in a non syndromic patient: a rare case report. J Clin Diagn Res. 2015;9(1):ZJ01-02.
• Babaji P, Sanadi F, Melkundi M. Unusual case of a talon cusp on a supernumerary tooth in association with a mesiodens. J Dent Res Dent Clin Dent Prospects. 2010;4(2):60-63.
• Bargale S, Sagari S, Purohit S, Kiran S. Labial and palatal talon cusp on the maxillary supernumerary tooth in a deciduous dentition. BMJ Case Rep. 2014;2014:bcr2013202300.
• Chatterjee M, Mason C. Talon cusps presenting in a child with Alagille’s syndrome-a case report. J Clin Pediatr Dent. 2007;32(1):61-63.
• Chen RJ, Chen HS. Talon cusp in primary dentition. Oral Surg Oral Med Oral Pathol. 1986;62(1):67-72.
• Cubukcu CE, Sonmez A, Gultekin V. Labial and palatal talon cusps on geminated tooth associated with dental root shape abnormality: a case report. J Clin Pediatr Dent. 2006;31(1):21-24.
• Danesh G, Schrijnemakers T, Lippold C, Schäfer E. A fused maxillary central incisor with dens evaginatus as a talon cusp. Angle Orthod. 2007;77(1):176-180.
• Davis PJ, Brook AH. The presentation of talon cusp: diagnosis, clinical features, associations and possible aetiology. Br Dent J. 1986;160(3):84-88.
• Decaup PH, Garot E, Rouas P. Prevalence of talon cusp: Systematic literature review, meta-analysis and new scoring system. Arch Oral Biol. 2021;125:105112.
• Dinesh Rao B, Hegde S. A talon cusp on fused teeth associated with hypodontia: report of a unique case. Eur J Dent. 2010;4(1):75-80.
• Elmubarak NA. Genetic risk of talon cusp: Talon cusp in five siblings. Case Rep Dent. 2019;2019:3080769.
• Gardner DG, Girgis SS. Talon cusps: a dental anomaly in the Rubinstein-Taybi syndrome. Oral Surg Oral Med Oral Pathol. 1979;47(6):519-521.
• Goldstein E, Medina JL. Mohr syndrome or oral-facial-digital II: report of two cases. J Am Dent Assoc. 1974;89(2):377-382.
• Gündüz K, Açikgõz A. An unusual case of talon cusp on a geminated tooth. Braz Dent J. 2006;17(4):343-346.
• Hattab FN. Double talon cusps on supernumerary tooth fused to maxillary central incisor: Review of literature and report of case. J Clin Exp Dent. 2014;6(4):e400-407.
• Hattab FN, Yassin OM, al-Nimri KS. Talon cusp - clinical significance and management: case reports. Quintessence Int. 1995;26(2):115-120.
• Hattab FN, Yassin OM, al-Nimri KS. Talon cusp in permanent dentition associated with other dental anomalies: review of literature and reports of seven cases. ASDC J Dent Child. 1996;63(5):368-376.
• Hattab FN, Yassin OM, Sasa IS. Oral manifestations of Ellis-van Creveld syndrome: report of two siblings with unusual dental anomalies. J Clin Pediatr Dent. 1998;22(2):159-165.
• Jaya R, Mohan Kumar RS, Srinivasan R. A rare case of dilated invaginated odontome with talon cusp in a permanent maxillary central incisor diagnosed by cone beam computed tomography. Imaging Sci Dent. 2013;43(3):209-213.
• Levitan ME, Himel VT. Dens evaginatus: literature review, pathophysiology, and comprehensive treatment regimen. J Endod. 2006;32(1):1-9.
• Liu JF, Chen LR. Talon cusp affecting the primary maxillary central incisors in two sets of female twins: report of two cases. Pediatr Dent. 1995;17(5):362-364.
• Lozić B, Ljubković J, Pandurić DG, Saltvig I, Kutsche K, Krželj V, Zemunik T. Oculo-facio-cardio-dental syndrome in three succeeding generations: genotypic data and phenotypic features. Braz J Med Biol Res. 2012;45(12):1315-1319.
• Mellor JK, Ripa LW. Talon cusp: a clinically significant anomaly. Oral Surg Oral Med Oral Pathol. 1970;29(2):225-228.
• Mitchell WH. Case report. Dent Cosmos. 1892;34:1036.
• Nagaveni NB, Umashankara KV, Sreedevi, Reddy BP, Radhika NB, Satisha TS. Multi-lobed mesiodens with a palatal talon cusp: a rare case report. Braz Dent J. 2010;21(4):375-378.
• Özkan G, Toptaş A, Güneri P. The characteristics and occurrence of the talon cusps in Turkish population: a retrospective sample study. Surg Radiol Anat. 2016;38(9):1105-1110.
• Tsutsumi T, Oguchi H. Labial talon cusp in a child with incontinentia pigmenti achromians: case report. Pediatr Dent. 1991;13(4):236-237.