Unusual occurrence of accessory central cusp in the maxillary second primary molar

Abstract

Accessory cusp present on the occlusal surface may seldom pose problems. While its presence may not be a cause for alarm in most instances, it can sometimes lead to serious consequences if it is damaged. This case presents a rare finding of unilateral central accessory cusp seen on the occlusal surface of the maxillary left second primary molar and discusses the need for continuous dental surveillance and preventive measures.

Accessory Central Cusp in the Maxillary Second Primary Molars: A Rare Entity among the Rare

“…According to the best of our knowledge, there are only two reported cases of dens evaginatus in primary second molars. 2 15…”

“… 1 The frequency of occurrence of these variations differ depending on their type; Talon's cusp (between 1 and 7.7%) and Carabelli's cusp (68%) and Leong's tubercle (8%). 2 …”

Dens Evaginatus in Proximal Surface of Mandibular Premolar: A Rare Presentation

“…Mutations in the human EDA1, EDAR, and EDARADD genes often result in more severe phenotypes resulting in tooth loss and malformation [ 4 ]. During the bell stage of tooth formation, this anomaly is caused by internal enamel epithelium and the adjacent odontogenic mesenchyme evaginating into the stellate reticulum of the enamel organ [ 5 ]. Reports have shown that the enamel knots were found to act as central regulators of tooth development since they link cell differentiation to morphogenesis [ 3 , 4 , 6 , 7 ].…”

“…The primary enamel knot regulates the advancing cuspal morphogenesis of the crown through expression of molecules such as fibroblast growth factors (FGF-4, FGF-9), transforming growth factor β , and bone morphogenic proteins (BMP-2, 4 and 7). The accumulation of these molecules is thought to induce the initiation of the secondary enamel knots at the sites that mark cusp formation during the tooth development [ 3 , 5 ].…”

Maxillary and Mandibular First Premolars Showing Three-Cusp Pattern: An Unusual Presentation

“…But now it is believed that PAX and MSX genes are responsible for variation in shape of the teeth [8]. Extra cusps develop due to abnormal proliferation and folding of a portion of inner enamel epithelium (IEE) along with adjacent ectomesenchymal cells of the dental papilla into the stellate reticulum of the enamel organ during bell stage of tooth formation.The resultant formation is defined as either tubercle or supplemental solid elevation on some portion of the crown surface [9]. …”