CBCT-Based Epidemiological Study of Root and Root Canal Anatomy in Mandibular Second Molars in an Italian Clinical...

Background: Mandibular second molars show notable variability in root canal structures and C-shaped morphology, with possible differences among populations. Methods: This retrospective cross-sectional CBCT study included 500 patients attending the Department of Dentistry at IRCCS Ospedale San Raffaele (Milan, Italy) with bilateral mandibular second molars and was reported according to STROBE guidelines. CBCT scans (Hyperion X5; voxel size 0.125 mm) were assessed by two endodontists using standardized criteria. Root-based canal configurations were classified according to Vertucci in cases with complete bilateral coding of homologous mesial and distal roots; C-shaped morphology was classified using Fan's system and analyzed separately because Vertucci coding is not applicable to C-shaped systems. Categorical variables were analyzed using χ² or Fisher's exact test, continuous variables with parametric or non-parametric tests, and right-left comparisons with paired-sample tests (p < 0.05). Results: Complete bilateral Vertucci coding was feasible in 494/500 patients (98.8%), yielding 988 mesial and 988 distal roots for analysis. C-shaped canal configuration was detected in 1.2% of patients (6/500; 95% CI 0.44-2.59%); females showed a higher proportion than males (2.0% vs. 0.4%), with no evidence of a sex association (Fisher's exact test, p = 0.216). Fan subtype annotation was available for 5/6 patients and 7 teeth; C1, C3, and C4 patterns were observed. In the Vertucci dataset, mesial roots most frequently exhibited Types II (52.0%) and IV (26.5%), whereas distal roots were predominantly Type I (62.4%), followed by Type III (29.8%). Contralateral symmetry was observed in 27.3% of mesial roots (135/494; 95% CI 23.4-31.5%) and 59.1% of distal roots (292/494; 95% CI 54.6-63.5%). Mean pulp chamber roof-to-floor distance was 2.623 ± 0.263 mm on the right and 2.567 ± 0.343 mm on the left (paired p < 0.001; mean difference 0.056 mm; 95% CI 0.023-0.089 mm). Conclusions: In this cohort, C-shaped morphology was rare, and no evidence of a sex association was found, although the small number of cases limits statistical power. Mesial roots showed more variability than distal roots, and contralateral symmetry was moderate and greater for distal roots than for mesial roots, supporting contralateral anatomy as a helpful-rather than predictive-clinical reference.