Endodontic Treatment and Esthetic Management of a Geminated Central Incisor Bearing a Talon Cusp

Gemination with talon cusps is an uncommon morphologic dental anomaly, characterized by the formation of clinically wide tooth that can cause significant aesthetic and clinical problems including esthetic impairment, pain, caries susceptibility, and tooth crowding. These morphological dental anomalies have specific treatment needs due to the abnormal morphology and need virtuous radiologic diagnosis. Multidisciplinary approach can supply success of the treatment plan that can provide esthetic and occlusal requirements. In this case report, the multidisciplinary approach for the treatment of geminated tooth with talon cusp is presented with the clinical and radiographic findings. 1. Introduction Gemination is a rare morphological dental anomaly that develops when the single tooth bud attempts to divide to form two teeth. The anomalous tooth usually has totally or partially separated two crowns, with a single and large and maybe partially divided pulp chamber. In rare cases, division through the crown and root can be seen. Primary dentition is more frequently affected than the permanent dentition, usually in the incisor region [1]. The prevalence of gemination is variable and it generally ranges from 0.1 to 1% [2]. The etiology of gemination is unclear but there are several hypotheses like heredity, local metabolic interferences during morphodifferentiation of the tooth germ, environmental factors such as thalidomide embryopathy, fetal alcohol exposure, or hypervitaminosis A of the pregnant mother, and trauma [3]. Talon cusp is also a rare morphological dental anomaly of hyperplasia of the maxillary or mandibular incisor’s cingulum, which is characterized by the presence of an accessory cusp-like structure. Talon cusp is usually seen in the cingulum area or cementoenamel junction of the mandibular or maxillary incisors both primary and permanent dentition and contains enamel, dentin, and also pulp tissue [4]. There is no predilection of sex and can be seen unilateral or bilateral. Its prevalence range is found to be 0.04–10% in various studies [5]. Talon cusp generally may occur isolated, but it can be very rarely associated with gemination. In the literature only six cases of geminated teeth with talon cusp have been reported [6]. The aim of this case report is to present the multidisciplinary approach for the treatment of geminated tooth with talon cusp with the clinical and radiographic findings. 2. Case Report A 17-year old boy referred to our clinic with the complaints of pain and aesthetic problems. His medical history was noncontributory. On