The association between complex root canal morphology of mandibular anteriors and distolingual roots in mandibular first molars in a Turkish population

Background: This study analyzes Cone Beam Computed Tomography (CBCT) images of mandibular anterior teeth (MATs) in the Turkish population to assess canal configurations, anatomical symmetry, and their correlation with distolingual roots (DLRs) in mandibular first molars (MFMs). Methods: In this retrospective study, CBCT images from 2000 patients were analyzed. A total of 12,000 mandibular teeth including six MATs and MFMs from each patient were evaluated using CBCT imaging. Images meeting inclusion criteria were categorized based on Vertucci's root canal morphology system. The data were classified by gender and symmetry patterns. The relationship between MAT root canal complexity and the presence of DLRs in MFMs was assessed. Results: Type I and Type III canal configurations were the most common in MATs. Complex canals appeared more often in females than in males. Among females, a small portion exhibited a unilateral group, while nearly half had a bilateral group. In males, about half showed a bilateral group, with no unilateral cases observed. More than half of MFMs had DLRs. Unilateral DLRs were seen in a notable number of females and a larger number of males. Bilateral DLRs were present in a smaller number of females and a slightly larger number of males. There was a clear link between DLRs and complex MAT canal configurations. Complications in bilateral MATs occurred more frequently in patients with bilateral DLRs. Conclusion: In the Turkish population, DLRs in MFMs are significantly associated with complex MATs canal configurations. CBCT imaging provides essential insights into root canal anatomy, aiding in the early detection of complex morphologies for optimal endodontic treatment.