Aim: To present a case report of concomitant occurrence of dens invaginatus and talon cusp in a single tooth with clinical management using cone-beam computed tomography (CBCT). Background: Developmental dental anomalies are an important category of dental morphogenic variants. Developmental anomalies of the permanent dentition are most frequently encountered in the maxillary lateral incisor. Talon cusp is an additional cusp that projects predominately from the lingual or occasionally from the labial surface of anterior teeth. This accessory crown structure is composed of enamel, dentine, and varying degrees of pulp tissue. Dens invaginatus is defined as a deep surface invagination of the crown or root that is lined by the enamel. Case description: A 12-year-old female patient reported with complaint of small swelling in the upper front region of gums. Clinical examination revealed presence of the sinus tract with respect to the permanent maxillary left lateral incisor with morphologic alteration with associated talon cusp. Intraoral periapical radiographic and CBCT examination revealed malformation of the root with the enamel-lined tract mesial to and separate from the main root canal. Large periapical radiolucency approximately sized 1–1.5 cm was associated with the tract. Root canal treatment of the main root canal as well as of dens invagination followed by apicectomy and cyst enucleation was done. Conclusion: Co-occurrence of a talon cusp and double dens invaginatus is an extremely rare developmental dental anomaly. This case report represents a talon cusp with dens invaginatus on the maxillary left lateral incisor with associated cyst. Early identification is needed for prevention of potential problems on the affected or opposing tooth. Clinical significance: This case report presents a management of unusual clinical case of dens invaginatus and talon cusp associated with periapical cyst because of deep infected dens invaginatus using CBCT examination.
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