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Objectives <p>Mandibular molars exhibit considerable morphological variability in root and root canal anatomy among individuals and across populations. The aim of this study was to investigate whether an association exists between C-shaped root canal configuration (CSRC) in mandibular second molars (MSMs) and the presence of radix entomolaris (RE) in mandibular first molars (MFMs).</p> Materials and methods <p>This retrospective CBCT study included 1637 subjects (682 males and 955 females), involving 3274 MSMs and 3274 MFMs. CSRCs in MSMs were categorized using the Fan et al. categorization system (C1-C5). Whereas RE in MFMs were assessed according to American Association of Endodontists (AAE) in which RE identified as an extra distolingual root, both anatomical features were evaluated for frequency and bilateral symmetry. McNemar’s tests were used to evaluate bilateral symmetry. The chi-square test and Cramer’s V were used to examine the relationship between CSRCs and REs as well as the association between age and gender on the co-occurrence of these characteristics. Binary logistic regression analysis was used to assess if CSRCs might predict the existence of REs. The level of statistical significance was <i>P</i> &lt; 0.05.</p> Results <p>A total of 1637 patients and 6548 teeth were evaluated in this study. The prevalence of CSRC in MSMs was 46%, while radix RE in MFMs was observed in 31.6% of cases. CSRCs prevalence were slightly higher on the left side, whereas RE was more frequent on the right side. Bilateral symmetry of CSRCs was (86.6%) while was high (90.7%) for REs, A significant association was found between CSRC and RE (χ² = 4.884, <i>p</i> = 0.027). Logistic regression analysis demonstrated that the presence of CSRCs significantly increased the odds of REs by 1.27 times (OR = 1.265, 95% CI: 1.027–1.559, <i>p</i> = 0.027). No significant association was observed between age group and the coexistence of both variations (χ² (2) = 2.654, <i>p</i> = 0.265). In contrast, gender showed a significant association with both variation (χ² (1) = 20.431, <i>P</i> &lt; 0.001), with females demonstrating a higher prevalence compared to males.</p> Conclusions <p>RE in MFMs was associated with CSRC in MSMs. Both variations were more common in females, unaffected by age, and showed high bilateral symmetry, highlighting the importance of careful clinical and radiographic assessment for endodontic treatment planning.</p> Clinical relevance <p>The presence of C-shaped root canal configuration may indicate an increased likelihood of anatomical complexity in mandibular molars. Careful radiographic evaluation, preferably using CBCT, can improve the detection of root canal variations and support more accurate endodontic treatment planning.</p>

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Relationship between C-shaped root canal configuration in mandibular second molars and radix entomolaris in mandibular first molars: a CBCT-based study in a Western Chinese population

  • 期刊论文

  • 发表日期：

    2026年6月30日

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  • Hebah H. Al-awdi,
  • Eissa A. Al-shujaa,
  • Ahmed A. Madfa,
  • Li Peng

摘要

Objectives

Mandibular molars exhibit considerable morphological variability in root and root canal anatomy among individuals and across populations. The aim of this study was to investigate whether an association exists between C-shaped root canal configuration (CSRC) in mandibular second molars (MSMs) and the presence of radix entomolaris (RE) in mandibular first molars (MFMs).

Materials and methods

This retrospective CBCT study included 1637 subjects (682 males and 955 females), involving 3274 MSMs and 3274 MFMs. CSRCs in MSMs were categorized using the Fan et al. categorization system (C1-C5). Whereas RE in MFMs were assessed according to American Association of Endodontists (AAE) in which RE identified as an extra distolingual root, both anatomical features were evaluated for frequency and bilateral symmetry. McNemar’s tests were used to evaluate bilateral symmetry. The chi-square test and Cramer’s V were used to examine the relationship between CSRCs and REs as well as the association between age and gender on the co-occurrence of these characteristics. Binary logistic regression analysis was used to assess if CSRCs might predict the existence of REs. The level of statistical significance was P < 0.05.

Results

A total of 1637 patients and 6548 teeth were evaluated in this study. The prevalence of CSRC in MSMs was 46%, while radix RE in MFMs was observed in 31.6% of cases. CSRCs prevalence were slightly higher on the left side, whereas RE was more frequent on the right side. Bilateral symmetry of CSRCs was (86.6%) while was high (90.7%) for REs, A significant association was found between CSRC and RE (χ² = 4.884, p = 0.027). Logistic regression analysis demonstrated that the presence of CSRCs significantly increased the odds of REs by 1.27 times (OR = 1.265, 95% CI: 1.027–1.559, p = 0.027). No significant association was observed between age group and the coexistence of both variations (χ² (2) = 2.654, p = 0.265). In contrast, gender showed a significant association with both variation (χ² (1) = 20.431, P < 0.001), with females demonstrating a higher prevalence compared to males.

Conclusions

RE in MFMs was associated with CSRC in MSMs. Both variations were more common in females, unaffected by age, and showed high bilateral symmetry, highlighting the importance of careful clinical and radiographic assessment for endodontic treatment planning.

Clinical relevance

The presence of C-shaped root canal configuration may indicate an increased likelihood of anatomical complexity in mandibular molars. Careful radiographic evaluation, preferably using CBCT, can improve the detection of root canal variations and support more accurate endodontic treatment planning.