An atypical survey in a cluster headache patient: A case report.

Cluster headache is a rare, severe headache associated with hypothalamic dysfunction or sleep cycles. It is classified in the primary headache group in The International Classification of Headache Disorders-3-2018 (ICHD-3-2018). In this case report, we present a 62-year-old male patient whose cluster headache showed a five times longer remission interval after dental implant treatment and ceased for more than two years following cardiac stent therapy.

Evaluation of sex dimorphism of the mandible with geometric morphometric analysis: conventional and reconstructed panoramic radiography study.

PURPOSE: The purpose of the study was to investigate the mandible shape dimorphism between males and females both on conventional panoramic radiographs (cPR) and reconstructed panoramic radiographs obtained from cone beam computed tomography (rPR) with geometric morphometric method. METHODS: Panoramic radiographs and cone beam computed tomography scans were performed on 33 males and 35 females with median age 23.0 (13.0-57.0) years old. The mandibular shape comparisons between genders were examined with Procrustes analysis, mandible shape classification analysis was made with principal component analysis and shape deformations were concluded from thin plate spline (TPS) analysis. RESULTS: Age had no statistically significant difference between gender (p = 0.580). For the shape of mandible on cPR and rPR, there were statistically significant differences between males and females (p = 0.002, p = 0.032, respectively). The shape variabilities of mandible on cPR for females were 0.054 and for males 0.053. The shape variabilities of mandible on rPR for females were 0.051 and for males 0.049. Both on cPR and rPR, the shape variability of the females' mandible was similar within their group, the shape variability of the males' mandible was similar within their group. In the examination of mandibular dimorphism in cPR, maximal deformations were seen in the region between the mandibular notch, posterior ramus, anterior ramus, gonion, in both sides, in TPS graphs. On the other hand, a high level of deformations was observed in all landmarks that define the mandibular shape on rPR. CONCLUSIONS: The mandible dimorphism can be detected in the examination performed with geometric morphometric methods on cPR and rPR. While mandible shape differences according to gender are seen most in the ramus region in cPR, differences can be detected in all landmarks in rRP.

Ultrasonographic Evaluation of Soft Tissue Calcifications in the Head and Neck Region Detected on Panoramic Radiographs.

OBJECTIVE: The aim of this study is to present a comparison between panoramic radiographs and USG imaging with a focus on revealing the advantages of USG over radiographs, and to show the distribution of calcifications detected in USG by considering the age and gender. METHODS: A total of 148 patients with soft tissue calcifications as seen on panoramic radiographs were examined with USG imaging. Sialoliths, carotid artery calcifications, tonsilloliths, phleboliths and lymph node calcifications were examined in terms of anatomical localization, distribution and shape. RESULTS: In the USG evaluation of these 148 patients, soft tissue calcifications were observed in 113 (76.4%) patients. The mean age of the patients with calcification was 55.6 ± 13.1 (min: 22-max: 77). Bilateral calcifications were detected in 25 (22.1%) patients, whereas unilateral calcifications were found in 88 (77.9%) patients. While the rates of tonsilloliths, sialoliths, phleboliths, and lymph node calcifications were statistically similar in male and female patients, the rate of carotid artery calcifications was found to be higher in men than in women (P = 0.017). No statistical significance was found between age groups in terms of the formation of soft tissue calcifications (P = 0.117). CONCLUSIONS: Panoramic radiographs may mislead clinicians in the diagnosis and differential diagnosis of soft tissue calcifications in the head and neck region due to the presence of distortion, superpositions, metal artefacts, and ghost images. USG is an important diagnostic tool in determining the localization of soft tissue calcifications that can be confused on two-dimensional radiographs, their relationship with neighboring structures, and defining calcification. It can be used safely in the detection of soft tissue calcifications as it provides dynamic imaging without the use of radiation or contrast material compared to other advanced imaging methods.

Validation of the Turkish version of the Obstetric Quality-of-Recovery score 11 (ObsQoR-11T) after cesarean delivery.

BACKGROUND: To translate and validate the psychometric characteristics of a Turkish version of the Obstetric Quality-of-Recovery score 11 tool used to measure post-cesarean delivery recovery in Turkish-speaking patients. METHODS: After the original English version of the Obstetric Quality-of-Recovery score 11 tool was translated into Turkish; it was psychometrically validated to assess the post-cesarean delivery quality of recovery. Validity, reliability, and feasibility were investigated. The Obstetric Quality-of-Recovery score 11 tool was administered to Turkish-speaking patients on postoperative day 1. On postoperative day 1, a global health visual analog scale was used to assess the patient's perceived global recovery. RESULTS: One hundred and eighty-six patients completed their questionnaires, providing a completion rate of 97.38%. The Spearman rho (ρ) correlation coefficient between the Obstetric Quality-of-Recovery score and global health visual analog scale (0-100 points) was 0.850 at postoperative day 1 following surgery (P < 0.001). Internal consistency, measured using Cronbach's alpha, was 0.822. The split-half coefficient was 0.708. The Obstetric Quality-of-Recovery score differed significantly between the emergency and elective cesarean delivery groups (80 (41-104) vs. 83.3 (51-102); P < 0.05). The test-retest reliability of the Obstetric Quality-of-Recovery score items was more than 0.6 in 82% of cases, indicating good repeatability and reliability. CONCLUSION: The Obstetric Quality-of-Recovery score 11 is a valid and reliable tool to measure the post-cesarean quality of recovery in Turkish-speaking patients. The psychometric properties of the Turkish version of the scale to measure the post-cesarean quality of recovery were similar to those of the seminal English version.

Linguistic validation of a widely used recovery score: quality of recovery-15 (QoR-15).

BACKGROUND: The quality of recovery-15 (QoR-15) is a patient reported outcome questionnaire that measures the quality of recovery after surgery and anesthesia. The QoR-15 has been validated in many languages; Turkish version of the QoR-15 has not yet been established. The aims of this study were to translate the QoR-15 questionnaire into Turkish and to perform a full psychometric evaluation of the Turkish version. METHODS: After translating the original English version of the QoR-15 scale into Turkish, the QoR-15T scale was psychometrically validated. This process included validity, reliability, responsiveness, feasibility. The QoR-15T was evaluated before the surgery and 24 h after surgery. RESULTS: A total of 210 patients completed the pre- and postoperative questionnaires, providing a completion rate of 93.75%. The correlation coefficient between QoR-15T score and VAS score was 0.644 on postoperative day 1 (p < 0.001). Inter item Cronbach's alpha was 0.863. Global test-retest concordance coefficient was 0.98 (95% CI: 0.94-1.00). DISCUSSION: The QoR-15T scale is a reliable and valid instrument for evaluating postoperative quality of recovery in Turkish speaking patients. The psychometric characteristics used to assess postoperative quality of recovery were similar to those in the English version.

Do carboxyhaemoglobin and methaemoglobin levels predict the return of spontaneous circulation and prognosis of cardiac arrest patients?

BACKGROUND: Early prediction of return of spontaneous circulation (ROSC) for cardiac arrest (CA) patients is a major challenge. Different biomarkers have been studied as an early predictor for ROSC, but a consensus has not been achieved in this regard. This study's goal was to investigate the value of the carboxyhaemoglobin (COHb) and methaemoglobin (MetHb) levels as a predictive marker for ROSC and prognostic marker for patients who achieve ROSC. METHODS: A total of 241 adult patients (109 female, 132 male) diagnosed as non-traumatic CA were included in the study. The patients were divided into two groups based on whether they achieved ROSC. The ROSC group was divided into two sub-groups: survivors and non-survivors. Complete blood count parameters, routine biochemistry measurements, coagulation parameters, and blood gas analysis, and cardiac markers values were compared between the groups. RESULTS: COHb levels were significantly lower in the non-ROSC group than in the ROSC group (P = .002). Urea, creatinine, potassium and cTn (cardiac troponin) levels in the non-ROSC group were significantly higher than in the ROSC group (P < .001, .001, .014, and .005, respectively). COHb levels were significantly lower in the non-survivor group than in the survivor group (P = .022). Urea, creatinine, potassium, lactate dehydrogenase, and cTn levels were significantly higher in the non-survivor group than the survivor group (P = .001, .005, .001, .010 and .008, respectively). There was no significant difference between the ROSC and non-ROSC groups and survivor group and non-survivor groups in terms of MetHb levels (P = .769 and .668, respectively). Moreover, CPR duration is significantly shorter in the survivor group than the non-survivor group (P Ë‚ .001). CONCLUSION: COHb levels in the blood gas analysis at the time of admission could be used as a predictive marker for ROSC and prognostic marker for the patients who achieved ROSC.

Cardiopulmonary resuscitation is more effective for in-hospital cardiac arrest when performed on a stretcher. A manikin study.

OBJECTIVES: To compare the efficacies of various chest compression procedures performed on a stretcher during dynamic transport of patients with in-hospital cardiac arrest. Methods: This prospective and randomized cross-over study used manikins. Practitioners were asked to perform chest compressions on a manikin placed on a moving stretcher for 2 minutes. Cardiopulmonary resuscitation (CPR)  procedures were included the following 3 types: i) CPR-walking (CPR-W) ii) CPR-straddling (CPR-S), and iii) CPR-mechanical chest compression device (CPR-MCCD). Demographic data of the participants, CPR quality indicators, the time between the start command and first compression, level of difficulty, and the distance covered by the stretcher for the duration of each application were recorded. RESULTS: Thirty-two physicians (9 female, 23 male), participated in this study. The CPR-MCCD procedure was the most effective for all parameters, except the time between the start command and first compression. On the other hand, the compression rate at optimal depth, CPR success score, distance covered, and level of difficulty parameters were significantly favored in the CPR-S group, when compared to the CPR-W group (p less than 0.001, all comparisons). CONCLUSIONS: It is possible to perform high-quality chest compressions during patient transport using the CPR-MCCD method. The CPR-S method allowed practitioners to perform higher-quality chest compressions compared to CPR-W.

Analytic Hierarchy Process (AHP)-Based Aggregation Mechanism for Resilience Measurement: NATO Aggregated Resilience Decision Support Model.

Resilience is a complex system that represents dynamic behaviours through its complicated structure with various nodes, interrelations, and information flows. Like other international organizations NATO has also been dealing with the measurement of this complex phenomenon in order to have a comprehensive understanding of the civil environment and its impact on military operations. With this ultimate purpose, NATO had developed and executed a prototype model with the system dynamics modelling and simulation paradigm. NATO has created an aggregated resilience model as an upgrade of the prototype one, as discussed within this study. The structure of the model, aggregation mechanism and shock parametrization methodologies used in the development of the model comprise the scope of this study. Analytic Hierarchy Process (AHP), which is a multi-criteria decision-making technique is the methodology that is used for the development of the aggregation mechanism. The main idea of selecting the AHP methodology is its power and usefulness in mitigating bias in the decision-making process, its capability to increase the number of what-if scenarios to be created, and its contribution to the quality of causal explanations with the granularity it provides. The parametrized strategic shock input page, AHP-based weighted resilience and risk parameters input pages, one more country insertion to the model, and the decision support system page enhance the capacity of the prototype model. As part of the model, the decision support system page stands out as the strategic level cockpit where the colour codes give a clear idea at first about the overall situational picture and country-wise resilience and risk status. At the validation workshop, users not only validated the model but also discussed further development opportunities, such as adding more strategic shocks into the model and introduction of new parameters that will be determined by a big data analysis on relevant open source databases. The developed model has the potential to inspire high-level decision-makers dealing with resilience management in other international organizations, such as the United Nations.

Anesthesia management for robotic assisted radical prostatectomy. Single center experince.

AIM: The aim of this study was to present our experiences for anesthesia management in patients undergoing robot-assisted radical prostatectomy (RARP) in light of current literature data. MATERIAL AND METHODS: This clinical retrospective study included 103 patients who underwent robot-assisted radical prostatectomy. All patient data were obtained from the patient files and anesthesia follow-up forms. Demographic datas, intraoperative fluids, blood products requirement and blood gas parameters were recorded. RESULTS: A total 15 of 103 patients data were lack, the remaining 88 patients were evaluated. Combination of crystalloid and colloid was used for intravenous fluid management. About 11% of patients required transfusion during surgery. The mean pH and pO2 values of the patients were observed to decrease whereas pCO2 and lactate values increased. DISCUSSION: Radical Prostatectomy can be performed either using open technique as a traditional approach or laparoscopic or robot-assisted technique as a minimally invasive approach. Today, minimally invasive approaches have replaced traditional open prostatectomy. Anaesthesia management of these minimally invasive techniques is very different and challenging from open technique in many aspects. CONCLUSION: Although minimally invasive techniques have good surgical outcomes such as less blood loss, smaller surgical incision, and shorter hospitalization, these techniques bring new problems that anesthesiologists have to deal with. Increased RARP operations has led to the anesthesiologists more likely to encounter perioperative problems. KEY WORDS: Anesthesia, Minimally invasive techniques, Radical prostatectomy.

Analgesic Effectiveness of Ultrasound-Guided Pecs II Block in Central Venous Port Catheter Implantation.

BACKGROUND AND AIM: In oncology patients, central venous port catheter (CVPC) implantation is generally preferred for venous route. However, in this procedure, postoperative pain is often observed. This study aimed to investigate the effectiveness of ultrasound-guided Pecs II block in the management of pain after CVPC placement. METHODS: One hundred and eighty-seven patients who underwent CVPC implantation between January 2017 and August 2018 were included in the study. Patients who underwent Pecs II block under ultrasound guidance were called as the Pecs group, and those who underwent local anesthesia (LA) were referred as the LA group. All procedural parameters were analyzed, including demographic characteristics of patients, visual analogue scores (VAS) at 2nd and 24th hours, and postoperative opioid, and non-steroidal anti-inflammatory drug (NSAID) consumption. RESULTS: The postoperative 2nd hour VAS scores were similar in both groups and were lower than the 24th hour VAS scores. VAS scores at the 24th hour in the Pecs group were significantly lower than the LA group (P = 0.001). While the number of fentanyl rescue doses administered in PACU was similar, the total NSAID consumption in the first 24 hours was higher in the LA group than in the Pecs group. CONCLUSION: In CVPC placement, ultrasound-guided Pecs II block is a more reliable, easily applicable and longer-acting approach than LA infiltration for postoperative analgesia.

Perioperative anesthetic management in a patient with factor XI deficiency undergoing coronary artery bypass graft surgery.

Spontaneous bleeding is rare in patients with factor XI deficiency and significant bleeding usually occurs after a trauma or a surgical procedure. It is difficult to maintain hemostatic balance in these patients. In the present case report, a 68-year-old male patient with no chronic disease was scheduled for elective cardiopulmonary bypass surgery. Eight units of fresh-frozen plasma (FFP) were slowly infused and the operation was initiated with the activated partial thromboplastin time (aPTT) of 34.5, which was 108.7 in the preoperative period. Tranexamic acid bolus was administered before the skin incision and continued throughout the operation. Intraoperative aPTT was measured intermittently and a total of six units of FFP were administered. After 76 minutes of cross-clamp time, the patient was separated from cardiopulmonary bypass without any problem. There is no consensus regarding the management of bleeding during cardiac surgery in patients with factor XI deficiency. The common approach includes normalizing the factor levels via FFP infusion or factor concentrates in the preoperative period, proceeding with surgery following the replacement, and close monitoring of perioperative factor levels and aPTT values.

Complications and pitfalls of central venous port catheters: experience with 782 patients with cancer.

BACKGROUND: The clinical use of port catheters has become widespread because they provide a safe and easy vascular route. Such widespread use of vascular port catheters has revealed early and late complications. AIM: This study was evaluated the early and late noninfectious complications and present precautions and pitfalls to handle these complications. METHODS: The retrospective observational study comprised 801 vascular port catheters inserted into 782 adult patients for various reasons between 2010 and 2018. Patient demographic, indications for port catheter implantation, port catheter types, and insertion sides were noted. Port catheter implantation related early and late complications were recorded. RESULTS: The subclavian vein was selected as a target vein in almost all of the interventions (98.9%). Similarly, right-sided veins were used in about 90% of patients. The most common problem was technical issues related to the interventions. If venous cannulation was challenging, ultrasonography and fluoroscopy guidance roadmap technique were used. Most serious complication was pneumothorax in 7 patients. In the late period, the most common problem was thrombotic occlusion of the catheter. In two-thirds of these patients, thrombolytic therapy for thrombosed port catheters may rescue some catheters and avoid secondary port catheter insertions. CONCLUSIONS: Despite these benefits, port catheters are associated with various complications. However, most of these complications can be effectively prevented by proper techniques and easily applied precautions.

Endotracheal Intubation by Paramedics Using Neodymium Magnet and Modified Stylet in Simulated Difficult Airway: A Prospective, Randomized, Crossover Manikin Study.

BACKGROUND: The present study evaluates the success and efficacy of endotracheal intubation (ETI) using a modified intubation stylet and a magnet system to direct the stylet into the trachea. The system was developed by the researchers in an attempt to increase the success and efficacy of ETI. METHODS: ETI procedures were performed on an airway management manikin by emergency medical technicians with at least four years of experience in ETI. The technicians used a stylet modified with an iron ball affixed to the tip and a neodymium magnet, designed specifically for the study. The intention was to guide the endotracheal tube into the trachea at the level of the thyroid and cricoid cartilages on the manikin with the aid of the modified stylet and the magnetic force of the neodymium magnet. The success rate, completion time, and degree of difficulty of two procedures were compared: magnetic endotracheal intubation (METI) and classic ETI (CETI). RESULTS: The success rate was 100% in both groups. The mean completion times for the METI and CETI procedures were 18.31 ± 2.46 s and 20.01 ± 1.95 s, respectively. There were significant differences in completion time and degree of difficulty between the METI and CETI procedures (both p=0.001). CONCLUSIONS: We found the use of a neodymium magnet and modified stylet to be an effective method to guide the endotracheal tube into the trachea. The present study may provide a basis for future studies.

A Novel Technique: Ultrasound-Guided Serratus Anterior Plane Block for the Treatment of Posttraumatic Intercostal Neuralgia.

Serratus anterior plane block has been used for pain management during the acute period of conditions affecting the thorax, such as postthoracotomy recovery, rib fracture, and breast surgery recovery. Here, we report the use of serratus anterior plane block in posttraumatic chronic pain treatment. We describe a case of posttraumatic chronic intercostal neuralgia, in which successful pain relief was achieved via repeated injections of local anesthetic and steroid combinations in the serratus anterior plane under ultrasonographic guidance. This novel technique is easy to administer, reliable, and warrants further investigation with regard to its use for rehabilitation of patients who are experiencing posttraumatic chronic neuropathies of the chest wall.

Efficacy of Two Different Nickel-Titanium Rotary Systems in Retreatment Procedure With or Without Laser-Activated Irrigation: An In Vitro Study.

Objective: The aim of this study was to compare the efficacy of HyFlex EDM (Coltene/Whaledent, Altstätten, Switzerland) and ProTaper Universal Retreatment Nickel-Titanium (NiTi) Systems [The ProTaper Universal Retreatment (PTR), Dentsply Maillefer, Ballaigues, Switzerland] in the removal of the root canal filling materials with or without laser activated irrigation. Materials and methods: The root canals of 60 human mandibular premolars were instrumented with K files up to size 35 at a working length; the step-back procedure was performed in 1 mm increments up to size 50. Next, the teeth were obturated using the lateral compaction technique with gutta-percha and resin-based sealer, and they were randomly divided into two groups (n = 30) according to the retreatment systems: PTR and HyFlex EDM NiTi rotary files. Then, each group was divided into two subgroups (n = 15), laser [photon-induced photo-acoustic streaming (PIPS); Fotona, Ljubljana, Slovenia] activated irrigation and conventional needle irrigation group. Following these procedures, the specimens were evaluated using micro-computed tomography. Results: There was no significant difference between the instrumentation systems regarding the cleaning efficacy (χ2 = 0.754; p = 0.86). Additionally, PIPS method did not have a significant effect on the removal of the filling material compared to conventional needle irrigation. Conclusions: Both instrumentation systems were effective in removing the filling material, but neither was able to remove the filling material completely. PIPS method did not show a significant additional effect regarding the removal of filling material.

Accuracy of the use of radiographic visibility of root pulp in the mandibular third molar as a maturity marker at age thresholds of 18 and 21.

Evaluation of the radiographic visibility of root pulp in mandibular third molars has been suggested as an alternative method for estimation of legal age threshold in living individuals when the root apices are mature. Here, we assessed the accuracy of this method for age thresholds of 18 and 21 years. A sample of 463 panoramic radiographs of individuals aged between 16 and 34 years was examined. The root pulp visibility of the mandibular third molars was scored; the stages ranged from 0 to 3. A receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC) were used to select optimal cut-offs for 18- and 21-year-old thresholds. As prognostic predictors, the selected cut-offs were stages 1 and 2 for the 18- and 21-year-old thresholds of both sexes, respectively. For the 18-year-old threshold, the AUC, sensitivity and specificity were 0.829, 83.1% and 66.7% in females; and 0.930, 89.4% and 90.9% in males, respectively. For the 21-year-old threshold, the AUC, sensitivity and specificity were 0.874, 72.8% and 92.0% in females; and 0.906, 85.5% and 88.2% in males, respectively. The accuracy of the method for estimating the 18- and 21-year-old thresholds ranged from moderate to high. Therefore, the method must be used in conjunction with other age estimation methods, especially to predict whether a female has reached 18 years of age.

A comparative study of cone-beam computed tomography and periapical radiographs in decision-making after endodontic instrument fractures.

PURPOSE: This study aimed to compare the diagnostic efficacies of periapical radiographs (PRs) and cone-beam computed tomography (CBCT) scans on clinicians' decision-making in diagnosing and providing treatment of fractured instruments in root canals during glide path preparation. METHODS: 40 maxillary molar teeth were selected and randomly divided into 4 groups. In each experimental group (n = 10), Hedstroem stainless steel instruments were fractured in mesiobuccal (MB) or distobuccal (DB) root canals. In group 1 (#0.06), group 2 (#0.08), group 3 (#0.10), and group 4 (#0.15), instruments were forced to fracture. PRs and CBCT scans were evaluated and compared. Observers were asked to use the following scoring system to decide whether to: 1. remove the fragment; 2. leave the fragment in situ; 3. bypass the fragment; or 4. use a surgical approach for removing the fragment. RESULTS: CBCT observers mostly decided on removing and bypassing the fractured fragment, while radiograph observers mostly decided to leave fragments in situ. However, there was no significant difference between these parameters when CBCT scans were compared to PRs for decision-making of the fractured instruments (p≥0.05) regarding different sizes of root canal instruments. CONCLUSIONS: In decision-making regarding fractured instruments during glide path preparation, clinicians should strategize treatment options based on variables using high-resolution images that reflect accurate scenarios through PRs or CBCT scans that also take into account low radiation dosage in situ PRs have precedence for a diagnostic approach.

Clinical evaluation of near-infrared light transillumination in approximal dentin caries detection.

The objective of this clinical study was to compare conventional caries detection techniques, pen-type laser fluorescence device, and near-infrared light transillumination method in approximal dentin caries lesions. The study included 157 patients, aged 12-18, without any cavity in the posterior teeth. Two calibrated examiners carried out the assessments of selected approximal caries sites independently. After the assessments, the unopened sites were excluded and a total of 161 approximal sites were included in the study. When both the examiners arrived at a consensus regarding the presence of dentin caries, the detected lesions were opened with a conical diamond burr, the cavity extent was examined and validated (gold standard). Sensitivity, specificity, negative predictive value, positive predictive value, accuracy, and area under the ROC curve (Az) values among the caries detection methods were calculated. Bitewing radiography and near-infrared (NIR) light transillumination methods showed the highest sensitivity (0.83-0.82) and accuracy (0.82-0.80) among the methods. Visual inspection showed the lowest sensitivity (0.54). Laser fluorescence device and visual inspection showed nearly equal performance. Near-infrared light transillumination can be used as an alternative method to approximal dentin caries detection. Visual inspection and laser fluorescence device alone should not be used for approximal dentin caries.

The characteristics and occurrence of the talon cusps in Turkish population: a retrospective sample study.

PURPOSE: The purpose of this study was to figure out the characteristics and occurrence of talon cusps in a sample of Turkish population. METHODS: In this retrospective study, talon cusps in permanent dentition were evaluated on radiographs and intraoral photographs which were obtained from patients who were referred to Oral and Maxillofacial Radiology Department, Faculty of Dentistry, Adnan Menderes University, Aydin, Turkey between January 2013 and January 2014. RESULTS: Talon cusps were observed in 365 of 4116 patients, with a frequency of 8.86 %. There were 208 (57 %) females and 157 (43 %) males with this variation. Maxillary canines were the most affected anterior teeth (40.83 %), followed by lateral incisors (39.60 %) and central incisors (19.55 %). Of the patients, 81 (22.19 %) had type I talon cusp with two periapical pathologies, 114 (31.23 %) had type II talon cusp with four periapical pathologies and 226 (61.91 %) had type III talon cusp with also four periapical pathologies. CONCLUSIONS: The occurrence of talon cusps was higher than other studies reported in the literature, with an exception of the study in Alaskan Eskimos. The most commonly detected type of talon cusp was type III (61.91 %), and dens invaginatus was the most frequent variation observed with talon cusps.