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Braz Dent J (2001) 12(2): 132-134 J.A.B. Ferraz et al. ISSN 0103-6440

Dental Anomaly: Dens evaginatus (Talon Cusp)

José Antônio Brufato FERRAZ1

Jacy Ribeiro de CARVALHO JÚNIOR1
Paulo César SAQUY1
Jesus Djalma PÉCORA2
Manoel D. SOUSA-NETO1

1Faculty of Dentistry, University of Ribeirão Preto (UNAERP), Ribeirão Preto, SP, Brazil
2Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil

Dens evaginatus is a developmental anomaly characterized by the occurrence of an extra cusp shaped as a tubercle projecting from the
palatal or buccal surfaces (talon cusp). In the anterior dentition, dens evaginatus is more commonly found in the maxilla and on the
palatal surface of the tooth. The authors present a case of dens evaginatus in a maxillary central incisor, in which the evagination was
removed and routine endodontic treatment was performed.

Key Words: dens evaginatus, evaginated odontoma, talon cusps, endodontic therapy.

INTRODUCTION (11) reported two rare cases of talon cusps in mandibu-

Dens evaginatus or evaginated odontoma is a
developmental anomaly that occurs more frequently in
mandibular premolars (1); however, it can also affect
other teeth, including supranumerary teeth (2). It occurs
in both primary and permanent dentitions (3,4). In
canines and incisors, dens evaginatus originates in the
palatal cingulus, often being bilateral. The nodule, also
known as “talon cusp”, can result from the abnormal
proliferation of enamel epithelium from the interior of
the stellate reticulum of the enamel organ (5). Its etiol-
ogy is unknown.
Segura and Jimenez-Rubio (6) reported the pres-
ence of talon cusp in two members of the same family,
suggesting that genetic inheritance may be a causative
factor. The incidence is calculated between 1 to 2% in
many Asian communities (7) and between 3 to 4% in
Eskimos and North American Indians (8). There are
few reports of this anomaly in Caucasians (9). Dankner
et al. (10), in a radiographic study of 15,000 anterior
teeth, found that dens evaginatus was present in 1% of
the cases, being more frequently found in the maxilla,
particularly in the lateral incisor. Hedge and Kumar
lar incisors. One of them was seen on a mandibular
primary lateral incisor and the other one was observed
on the mandibular left permanent central incisor. De
Sousa et al. (12) described an unusual case of bilateral
talon cusp associated with dens invaginatus. Abbott
(13) reported labial and palatal talon cusps on the same
tooth.
This evagination is often described as a nodule
or tubercle, shaped as a cylindrical cone with a sharp
point or a raindrop. Merril (14) divides the various
kinds of evagination into two groups: 1) the nodule
originates from the lingual crest of the buccal cusp, and
2) the nodule originates from the middle of the occlusal
surface and commonly obliterates the central sulcus.
Composed of normal enamel and dentin, a talon
cusp may or may not contain pulp tissue (3,4). Shay (7)
reported that pulp tissue can extend to the center of the
tubercle and, once fractured, the pulp is exposed. Güngör
et al. (15), in a histologic evaluation, reported the
existence of pulp tissue in the bilateral talon cusps of
primary maxillary central incisors.
According to Al-Omari et al. (2), a talon cusp is
not an innocuous defect, because of substantial diag-

Correspondence: Prof. Dr. Manoel D. Sousa-Neto, Rua Cav. Torquato Rizzi, 1638, ap. 43, 14020-300 Ribeirão Preto, SP, Brasil. e-mail:
sousanet@unaerp.br

Braz Dent J 12(2) 2001

 Dens evaginatus: case report
nostic, treatment planning and procedural difficulties.
Early diagnosis and management are important to avoid
complications.
The objective of this article is to report a case of
dens evaginatus (talon cusp) in a permanent maxillary
central incisor that required endodontic treatment.
CASE REPORT
A 13 year old, Caucasian, female patient was
referred to the clinic with pain in element number 11.
The patient was undergoing orthodontic treatment at
this time. On clinical examination, dens evaginatus was
detected in element number 11, with the presence of
wearing of the cusp (Figures 1 and 2). The orthodontist
reported an occlusal adjustment by grinding the palatal
projection, with subsequent application of fluoride.
After the adjustment the patient complained of moder-
ate pain, which was monitored with vitality tests for 7
months, not responding after this period.
Figure 1. The wearing made of the dens evaginatus in order to
eliminate the occlusal interference.
Figure 2. Occlusal view of the wearing done in the palatal cusp of
the element 11.
133
X-rays showed the presence of enamel, dentin
and pulp horn in the palatal cuspid of the dens evaginatus
(talon cusp) (Figure 3). The diagnosis was pulp necro-
sis. Disinfection with 1% sodium hypochlorite was
performed at the first session, and a calcium hydroxide
dressing was placed in the root canal. After 10 days, the
root canal was sealed using a hybrid thermomechanic
technique (Figure 4), and the patient was able to con-
tinue with orthodontic therapy.
DISCUSSION
Dens evaginatus is an anomaly of great clinical
significance, sometimes causing occlusal interference.
The cleaning of the area between the nodule and the
tooth is difficult, and caries are often found.
According to Pécora et al. (16) and Shay (7),
when the evagination is worn or fractured, pulp exposi-
tion can occur, leading to pulp necrosis. In the present
case, there was a wearing of the enamel surface of the
Figure 3. Diagnostic x-ray showing the presence of enamel,
dentin and pulp horn in the palatal cusp of the dens evaginatus.
Figure 4. X-ray after nodule removal and endodontic treatment.
Braz Dent J 12(2) 2001
134 J.A.B. Ferraz et al.
nodule, probably causing exposure of the dentin-pulp
complex and, consequently, pulp necrosis.
The incidence of dens evaginatus is predomi-
nant in Asians, but this condition can also be found in
Caucasians, as observed in this case. Today, with greater
migratory movements, communities are mixing, thus
the professional must be aware of this clinical condition
in order to provide information to the patient regarding
correct hygiene, the need for occlusal adjustment or
even removal and the necessity of endodontic treat-
ment.
McCulloch et al. (17,18) report that the orth-
odontist must carefully evaluate patients with dens
evaginatus, because movement can change the patient’s
bite, making an occlusal adjustment necessary that can
lead to dentin-pulp complex exposure.
In the present case there was occlusal wearing
that led to pulp necrosis. Pulp capping or partial pulpo-
tomy has been postulated to be one of the most reliable
forms of vital tooth treatment when pulp exposure is
encountered following the sterile removal of the tu-
bercle. When pulp exposure is not encountered,
preventive resin composite sealing of the dentin or class
I amalgam cavity preparation would be the treatment of
choice.
It is important that the dentist be well prepared to
carefully plan treatment of dens evaginatus, to avoid
future problems.
RESUMO
Ferraz JAB, de Carvalho Júnior JR, Saquy PC, Pécora JD,
Sousa-Neto MD. Dens evaginatus: relato de um caso clínico.
Braz Dent J 2001;12(2):132-134.
Dens evaginatus é uma anomalia de desenvolvimento caracterizada
pela ocorrência de uma cúspide extra, como uma projeção de um
tubérculo nas superfícies palatina e vestibular. Na dentição ante-
rior, o dens evaginatus é mais comumente encontrado na maxila e
na superfície palatina do dente. Os autores apresentam um relato de
um caso de tratamento endodôntico de um dens evaginatus em um
incisivo central superior. Depois de um correto diagnóstico e
planejamento, a evaginação foi removida e o tratamento endodôntico
de rotina foi realizado.
Braz Dent J 12(2) 2001
Unitermos: dens evaginatus, odontoma evaginado, cúspide talão,
terapia endodôntica.
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Accepted February 3, 2001