Root and canal morphology of mandibular molars with radix variants in a Pakistani subpopulation- a cone beam computed tomographic study

Dental anatomy is inherently diverse, with mandibular molars often exhibiting variations such as presence of three roots presented either as Radix Entomolaris (RE) or Radix Paramolaris (RP). RE manifests an additional root distolingually, while RP denotes an extra root mesiobuccally, both potentially housing supplementary root canals. Recognizing and understanding these anatomical intricacies may contribute to improved diagnosis and endodontic treatment outcomes. Therefore, the aim of this study is to evaluate the root and canal morphology of mandibular molars with radix variant in Pakistani subpopulation using cone beam computed tomography. This analytical cross-sectional study was conducted from January 2021 to January 2024 at Oral Biology department of Dr. Ishrat ul Ebad Khan Institute of Oral Health Sciences. The sample was comprised of CBCT scans of 250 participants and analyzed for 1000 mandibular first and second molars. Radiographs of patients from both genders ranging between 16 and 45 years were included. CBCT images which were clearly and adequately captured and free from motion artifacts or other significant image distortions were included in the study. Teeth with previous endodontic treatment, structural defects, developmental anomalies, or inadequate CBCT image quality were excluded. A non-probability convenient sampling technique was used to select the study population. The statistical analysis, using SPSS version 21, analyzed percentages, frequencies, and the Fisher’s exact test to ascertain the significance of radix molars concerning gender and sides of the mandible. Out of the 250 CBCT scans examined; 14 molars were identified as radix variant in mandibular first molars (13 RE, 1 RP), and 4 were observed in mandibular second molars (all RP). The prevalence of RE was higher in mandibular first molars, while RP was prevalent in mandibular second molars, with statistical significance of p = 0.002. According to De Moor’s classification of external root morphology, most RE were Type 1. No statistically significant difference was found between the left and right sides of the mandible, as indicated by p = 0.27. Whereas all radix roots exhibited Vertucci Type I canal configuration, Radix molars were observed more frequently in males. Within the studied Pakistani subpopulation, radix entomolaris (RE) was more frequently observed in mandibular first molars, whereas radix paramolaris (RP) was more commonly identified in mandibular second molars. In all examined radix molars, most prevalent morphology was type I and least was type III as per De Moor classification whereas all the radix roots contained a single root canal configuration for Vertucci’s classification.