Management of a permanent maxillary central incisor with a talon cusp: A case of misdiagnosis and treatment delay

Background: The presence of talon cusp is important for differential diagnosis as it can be confused with other dental anomalies, such as fusion of teeth. Misdiagnosis can lead to delayed or inappropriate treatment, which may cause further complications. Case presentation: A healthy 7-year-old girl was previously referred to an oral surgeon to be treated for an extra tooth-like structure in the maxillary anterior region. Fusion of the right maxillary central incisor with a mesiodens was diagnosed, but definitive treatment was deferred until root development was complete. On a cone-beam computed tomography (CBCT) scan, made at a follow-up two years later, the observed tooth anatomy did not match the initial diagnosis. The patient was referred first to an endodontic office and later to the University Dental Clinic, where she was examined at the age of 11 years. The right maxillary central incisor exhibited a pronounced, well-demarcated accessory cusp on the palatal surface extending to the level of the incisal edge, on first sight, resembling a fused mesiodens. The accessory cusp had created occlusal interference with labial displacement of the affected tooth, resulting in compromised dental esthetics and an increased risk for dental trauma. Results: A diagnosis of free true palatal talon with a pulp horn inside was made. Accordingly, the talon cusp was almost completely eliminated in four visits over a period of six months, giving the crown a normal morphology. This allowed adequate space for orthodontic retraction of the tooth. Conclusion: Dentists should be aware of the clinical features of talon cusp and its radiographic appearance to make an accurate diagnosis and provide appropriate treatment.