Cone-Beam Computed Tomography Assessment of Mandibular Molar Root and Canal Morphology in a North African Population

##plugins.themes.academic_pro.article.sidebar##

Published Apr 1, 2026
https://doi.org/10.62438/tunismed.v104i02.6316
Download
PDF
Vol. 104 No. 02 (2026): Tunis Med Fev 2026

##plugins.themes.academic_pro.article.main##

Aymen Ben Hadj Khalifa
Laboratory of Biological, Clinical and Dento-Facial Approach, Dental Anatomy Department, Faculty of Dental Medicine, University of Monastir, Monastir, Tunisia
https://orcid.org/0000-0001-5080-4179
Ghada Ayari
Department of Endodontics, Tahar Sfar Hospital, Mahdia, Tunisia
Malek Abidi
Dental Anatomy Department, Faculty of Dental Medicine, University of Monastir, Monastir, Tunisia
Hana Moalla
Dental Anatomy Department, Faculty of Dental Medicine, University of Monastir, Monastir, Tunisia
Rim Kallala
Dental Anatomy Department, Faculty of Dental Medicine, University of Monastir, Monastir, Tunisia
Soumaya Touzi
Dental Anatomy Department, Faculty of Dental Medicine, University of Monastir, Monastir, Tunisia
Chiraz Baccouche
Department of Endodontics, Tahar Sfar Hospital, Mahdia, Tunisia

Abstract

Aim: The aim of this study was to evaluate roots and root canal morphology of mandibular first and second permanent molars in a Tunisian
population using cone-beam computed tomography (CBCT), providing detailed anatomical data to support clinical endodontic practice.
Methods: This retrospective, descriptive study included 100 CBCT scans from patients referred to the University Dental Clinic of Monastir between
January and December 2024. A total of 400 mandibular molars (200 first and 200 second molars) were analyzed. Only teeth with fully developed roots and no prior endodontic treatment were included. Morphological features were assessed in axial, sagittal, and coronal CBCT views. The number of roots, number of canals per root, and canal configurations were recorded based on Vertucci’s classification. The presence of radix
entomolaris and radix paramolaris was also noted. Statistical analysis was performed using the Chi-square test (p ≤ 0.05).
Results: Mandibular first molars exhibited predominantly two-rooted anatomy (98%), with 2% presenting a third distolingual root (radix entomolaris). Second molars displayed more variation, with 5% showing a single root, 4% with three roots, and 1% with four roots. Canal configuration analysis revealed that the mesial root of first molars most commonly exhibited Vertucci Type IV (83.7%), while distal roots showed a predominance of Type
I (60.2%). In second molars, mesial roots also frequently presented Type IV (51.1%), whereas distal roots overwhelmingly exhibited Type I (94.4%). Three- and four-rooted molars were more commonly found in second molars. ....( abstract truncated at 250 words)

Keywords:

Dental Anatomy, Morphological Variations, Root canal configuration, Three-Dimensional Imaging, Tunisia

##plugins.themes.academic_pro.article.details##

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

  1. Demirbuga S, Sekerci AE, Dinçer AN, Cayabatmaz M, Zorba YOJMo, patologia oral y cirugia bucal. Use of cone-beam computed tomography to evaluate root and canal morphology of mandibular first and second molars in Turkish individuals. 2013;18(4):e737.
  2. Vertucci FJ. Root canal anatomy of the human permanent teeth. Oral Surgery, Oral Medicine, Oral Pathology. 1984;58(5):589-99.
  3. Ahmed H, Versiani M, De-Deus G, Dummer PJIej. A new system for classifying root and root canal morphology. 2017;50(8):761-70.
  4. Alazemi HS, Al-Nazhan SA, Aldosimani MA. Root and root canal morphology of permanent mandibular first and second molars in a Kuwaiti population: A retrospective cone-beam computed tomography study. Saudi Dent J. 2023;35(4):345-53.
  5. Vertucci FJJEt. Root canal morphology and its relationship to endodontic procedures. 2005;10(1):3-29.
  6. Touzi S AA, Kallala R, Riahi Z, Romdhane M, Hadyaoui D, et al. Canal Number and Configurations of the Permanent Mandibular First Molar in a Tunisian Population. International Journal of Health Sciences and Research. 2015;5:223-8.
  7. Song JS, Choi H-J, Jung I-Y, Jung H-S, Kim S-O. The Prevalence and Morphologic Classification of Distolingual Roots in the Mandibular Molars in a Korean Population. Journal of Endodontics. 2010;36(4):653-7.
  8. Celikten B, Tufenkci P, Aksoy U, Kalender A, Kermeoglu F, Dabaj P, et al. Cone beam CT evaluation of mandibular molar root canal morphology in a Turkish Cypriot population. Clin Oral Investig. 2016;20(8):2221-6.
  9. Almansour MI, Al-Zubaidi SM, Enizy AS, Madfa AA. Comprehensive evaluation of root and root canal morphology of mandibular second molars in a Saudi subpopulation evaluated by cone-beam computed tomography. BMC Oral Health. 2022;22(1):267.
  10. Saber SM, Seoud MAE, Sadat S, Nawar NN. Root and canal morphology of mandibular second molars in an Egyptian
  11. subpopulation: a cone-beam computed tomography study. BMC Oral Health. 2023;23(1):217.
  12. Mantovani VO, Gabriel AES, Silva RG, Savioli RN, Sousa-Neto MD, Cruz-Filho AM. Analysis of the mandibular molars root canals morphology. Study by computed tomography. Braz Dent J. 2022;33(5):1-8.
  13. Kantilieraki E, Delantoni A, Angelopoulos C, Beltes P. Evaluation of Root and Root Canal Morphology of Mandibular First and Second Molars in a Greek Population: A CBCT Study. Eur Endod J. 2019;4(2):62-8.
  14. Martins JN, Marques D, Mata A, Caramês JJIej. Root and root canal morphology of the permanent dentition in a Caucasian population: a cone-beam computed tomography study. 2017;50(11):1013-26.
  15. Torres A, Jacobs R, Lambrechts P, Brizuela C, Cabrera C, Concha G, et al. Characterization of mandibular molar root and canal morphology using cone beam computed tomography and its variability in Belgian and Chilean population samples. isd. 2015;45(2):95-101.
  16. Wang Y, Zheng QH, Zhou XD, Tang L, Wang Q, Zheng GN, et al. Evaluation of the root and canal morphology of mandibular first permanent molars in a western Chinese population by cone-beam computed tomography. J Endod. 2010;36(11):1786-9.
  17. Al-Alawi H, Al-Nazhan S, Al-Maflehi N, Aldosimani MA, Zahid MN, Shihabi GN. The prevalence of radix molaris in the mandibular first molars of a Saudi subpopulation based on cone-beam computed tomography. Restor Dent Endod. 2020;45(1):e1.
  18. al-Nazhan S. Incidence of four canals in root-canal-treated mandibular first molars in a Saudi Arabian sub-population. Int Endod J. 1999;32(1):49-52.
  19. Nur BG, Ok E, Altunsoy M, Aglarci OS, Colak M, Gungor E. Evaluation of the root and canal morphology of mandibular permanent molars in a south-eastern Turkish population using cone-beam computed
  20. tomography. European Journal of Dentistry. 2014;8(2):154-9.
  21. de Pablo ÓV, Estevez R, Sánchez MP, Heilborn C, Cohenca NJJoe. Root anatomy and canal configuration of the permanent mandibular first molar: a systematic review. 2010;36(12):1919-31.
  22. Nagaveni N, Umashankara KJJoISoP, Dentistry P. Radix entomolaris and paramolaris in children: A review of the literature. 2012;30(2):94-102.
  23. Bhatia S, Kohli S, Parolia A, Yap N, Lai C, Tan EJOHDM. Prevalence of radix molar in mandibular permanent molars: an observational study in Malaysian population. 2015;14:32-6.
  24. Gomez F, Brea G, Gomez-Sosa JF. Root canal morphology and variations in mandibular second molars: an in vivo cone-beam computed tomography analysis. BMC Oral Health. 2021;21(1):424.
  25. Tomaszewska IM, Skinningsrud B, Jarzębska A, Pękala JR, Tarasiuk J, Iwanaga JJCA. Internal and external morphology of mandibular molars: An original micro-CT study and meta-analysis with review of implications for endodontic therapy. 2018;31(6):797-811.
  26. Mukhaimer RHJIsrn. Evaluation of Root Canal Configuration of Mandibular First Molars in a Palestinian Population by Using Cone-Beam Computed Tomography: An Ex Vivo Study. 2014;2014(1):583621.
  27. Abarca J, Duran M, Parra D, Steinfort K, Zaror C, Monardes H. Root morphology of mandibular molars: a cone-beam computed tomography study. Folia Morphol (Warsz). 2020;79(2):327-32.
  28. Domark JD, Hatton JF, Benison RP, Hildebolt CFJJoe. An ex vivo comparison of digital radiography and cone-beam and micro computed tomography in the detection of the number of canals in the mesiobuccal roots of maxillary molars. 2013;39(7):901-5.
  29. Ahmed HMA, Dummer PMHJEEJ. Advantages and applications of a new system for classifying roots and canal systems in research and clinical practice. 2018;3(1):9-17.
  30. Wolf TG, Paqué F, Zeller M, Willershausen B, Briseño-Marroquín BJJoe. Root canal morphology and configuration of 118 mandibular first molars by means of micro–computed tomography: an ex vivo study. 2016;42(4):610-4.
  31. Madani ZS, Mehraban N, Moudi E, Bijani A. Root and Canal Morphology of Mandibular Molars in a Selected Iranian Population Using Cone-Beam Computed Tomography. Iran Endod J. 2017;12(2):143-8.
  32. Ni N, Cao S, Han L, Zhang L, Ye J, Zhang CJE-BE. Cone-beam computed tomography analysis of root canal morphology in mandibular first molars in a Chinese population: a clinical study. 2018;3:1-6.
  33. Akhlaghi NM, Khalilak Z, Vatanpour M, Mohammadi S, Pirmoradi S, Fazlyab M, et al. Root canal anatomy and morphology of mandibular first molars in a selected Iranian population: an in vitro study. 2017;12(1):87.
  34. Tassoker M, Sener S. Analysis of the root canal configuration and C-shaped canal frequency of mandibular second molars: a cone beam computed tomography study. Folia Morphol (Warsz). 2018;77(4):752-7.
  35. Aydın H, Harorlı H. Predictor factors of 1-rooted mandibular second molars on complicated root and canal anatomies of othermandibular teeth. Restor Dent Endod. 2024;49(1):e2.
  36. Aldosimani MA, Althumairy RI, Alzahrani A, Aljarbou FA, Alkatheeri MS, AlGhizzi MA, et al. The mid-mesial canal prevalence in mandibular molars of a Saudi population: a cone-beam computed tomography study. 2021;33(7):581-6.
  37. Varrela JJJodr. Effect of 45, X/46, XX mosaicism on root morphology of mandibular premolars. 1992;71(9):1604-6.
  38. Lahdesmaki RE, Alvesalo LJ. Root length in the permanent teeth of women with an additional X chromosome (47,XXX females). Acta Odontol Scand. 2010;68(4):223-7.
  39. Mashyakhy M, Gambarini G. Root and Root Canal Morphology Differences Between Genders: A Comprehensive in-vivo CBCT Study in a Saudi Population. Acta Stomatol Croat. 2019;53(3):213-46.
  40. Hoen MM, Pink FE. Contemporary endodontic retreatments: an analysis based on clinical treatment findings. J Endod. 2002;28(12):834-6.
  41. Şendişçi Gök R, Tercanlı H, Ekinci A. Evaluation of root and canal morphology of mandibular molar teeth by cone beam
  42. computed tomography: cross-sectional study. BMC Oral Health.
  43. ;25(1):798.