Radicular Aberrations of Mandibular Third Molars: Relevance for Oral Surgery—A Comprehensive Narrative Review

Background: Mandibular third molars (MTMs) are the most frequently impacted teeth and a common indication for oral surgery. Anatomical root variations can complicate extractions and increase intra- and postoperative risks. Methods: This narrative review analyzes the most frequent MTM root anomalies—supernumerary roots, fusion, taurodontism, C-shaped canals, hypercementosis, and apical dilacerations—focusing on their clinical implications and the diagnostic role of cone-beam computed tomography (CBCT). Results: Root anomalies markedly influence surgical complexity. Supernumerary roots and fusions may hinder elevator use and require modified sectioning. Taurodontism and hypercementosis prolong procedures and increase incomplete extraction risk. C-shaped canals and severe apical curvatures raise the likelihood of root fracture, displacement, or nerve injury. Panoramic radiographs, though common, provide limited two-dimensional detail and may underestimate anomalies. CBCT, by contrast, offers three-dimensional visualization, enhancing diagnosis, planning, and safety. Conclusions: Knowledge of MTM root anomalies, combined with selective CBCT use, is essential for optimizing surgical strategies, minimizing complications, and improving outcomes.