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Maxillary First Premolars' Internal Morphology: A Systematic Review and Meta-Analysis
Thomas Gerhard Wolf1,2, Dilara Sare Ulugöl1, Richard Johannes Wierichs3
1Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, CH-3010 Bern, Switzerland.
Dentistry Journal
|November 26, 2025
Summary
This review found maxillary first premolars (Mx1Ps) most commonly have two roots and a 2-2-2/2 root canal configuration (RCC). Sex-specific differences in Mx1P morphology were identified, impacting endodontic treatment planning.
Area of Science:
- Endodontics
- Dental Anatomy
- Anthropology
Background:
- Understanding root canal morphology and configuration (RCC) is crucial for successful endodontic treatment.
- Maxillary first premolars (Mx1Ps) exhibit significant anatomical variations.
- Limited data exists on sex-specific differences in Mx1P RCC.
Purpose of the Study:
- To systematically review and analyze the root canal morphology and configuration (RCC) of maxillary first premolars (Mx1Ps).
- To investigate sex-specific differences in Mx1P RCC based on existing literature.
Main Methods:
- Systematic literature search conducted in five databases (Cochrane, Embase, LILACS, Scopus, MEDLINE via PubMed).
- PRISMA guidelines and AQUA tool were used for study selection and quality assessment.
- Data extraction focused on RCC prevalence, sex differences, root variations, and examination methods.
Main Results:
- 86 studies analyzing 31,325 teeth were included. The most common RCCs were 2-2-2/2 (IV) and 1-1-1/1 (I).
- Mx1Ps predominantly had two roots (7.1-96.2%) or one root (3.8-93.2%); three-rooted variants were rare (0.4-6.5%).
- Males showed higher frequencies of two- or three-rooted Mx1Ps with specific RCCs (e.g., 2-2-2/2, 1-1-3/3), while females had higher frequencies of others (e.g., 1-1-1/1, 2-2-1/1).
Conclusions:
- Maxillary first premolars predominantly feature two roots and a 2-2-2/2 (IV) root canal configuration.
- Cone-beam computed tomography (CBCT) was the most prevalent examination method.
- Clinicians must consider sex-specific and morphological variations in Mx1Ps for effective endodontic therapy.
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