Accessory Cusps in Dentistry

Accessory Cusps

• Variations in cusp morphology exist between different populations.
• There are three main types of accessory cusps: Cusp of Carabelli, Talon cusp, and Dens evaginatus.
• When an accessory cusp is present, the other permanent teeth often demonstrate increased tooth size.
• Cusp of Carabelli
  • Located on the palatal surface of the mesiolingual cusp of a maxillary molar.
  • May occur in permanent or deciduous dentitions, ranging from a distinct cusp to a small pit.
  • Most prominent on the first molar, becoming less obvious on the second and third molars.
• Talon Cusp
  • A well-defined extra cusp situated on the surface of an anterior tooth, extending halfway from the cementoenamel junction to the incisal edge.
  • Primarily found on permanent maxillary lateral or central incisors, less frequently on mandibular incisors and maxillary canines.
  • Rare in deciduous dentition.
  • Usually projects from the lingual surface of the affected tooth, forming a three-pronged pattern resembling an eagle's talon.
  • May project from the facial surface or both surfaces of a single tooth.
  • A deep developmental groove may be present where the cusp fuses with the underlying tooth surface.
  • Contains a pulpal extension in most cases.
  • Radiographically, the cusp appears overlying the crown's central portion, including enamel and dentin.
  • Only a few cases show visible pulpal extensions on radiographs.
  • Genetic influences, including racial variation, occurrence in twins, and association with several syndromes.
  • Both sexes are affected, and the occurrence can be unilateral or bilateral.
• Dens Evaginatus
  • A cusp-like enamel elevation in the central groove or lingual ridge of the buccal cusp of premolar teeth.
  • While reported on molars, it typically occurs on premolar teeth.
  • Usually bilateral, with a strong emphasis on the mandible.
  • Deciduous molars are rarely affected.
  • The accessory cusp usually comprises enamel and dentin, with pulp present in about half the cases.
  • Most frequent in Asians, Inuits, and Native Americans, but rare in white populations.
  • Radiographically, the occlusal surface appears tuberculated, often showing a pulpal extension in the cusp.
  • The accessory cusp frequently leads to occlusal interferences, causing clinical problems:
    • Pulpal necrosis can occur due to direct exposure from wear or fracture, or bacterial invasion of immature dentinal tubules.
    • Dilaceration, displacement, tilting, or rotation of the tooth may also result.
  • Often found alongside another coronal anatomy variation, shovel-shaped incisors, especially maxillary incisors, in the same racial groups.

Accessory Cusps: Treatment and Prognosis

• Patients with cusps of Carabelli usually don't require therapy, unless a deep groove is present between the accessory cusp and the tooth surface.
• Deep grooves should be sealed to prevent decay.
• Patients with talon cusps on mandibular teeth often require no therapy.
• Talon cusps on maxillary teeth commonly interfere with occlusion and should be removed.
• Other potential complications include compromised aesthetics, tooth displacement, caries, periodontal issues, and tongue or labial mucosa irritation.

Explore the variations and types of accessory cusps in dental anatomy through this informative quiz. Learn about the Cusp of Carabelli, Talon cusp, and Dens evaginatus, as well as their characteristics and occurrence. Perfect for dental students and professionals alike.