Root and Root Canal Morphology of Mandibular Anterior Teeth in a Jordanian Subpopulation: A Cross-Sectional Cone-Beam Computed Tomography Study

Root and Root Canal Morphology of Mandibular Anterior Teeth in a Jordanian Subpopulation: A Cross-Sectional Cone-Beam Computed Tomography Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Root and Root Canal Morphology of Mandibular Anterior Teeth in a Jordanian Subpopulation: A Cross-Sectional Cone-Beam Computed Tomography Study Rawan Abu Zaghlan, Laith Abu Qdais, Farouq Mansour, Faisal Mansour, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7704890/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Numerous studies have explored root anatomy and root canal morphology variations across ethnic groups, but few have focused on the Jordanian population. This study, aimed to assess the prevalence of root anatomy and canal morphology in permanent teeth of a Jordanian subpopulation using cone-beam computed tomography (CBCT). This represents the second part of a four-part series focusing on mandibular anterior teeth. The first part examined mandibular molars, while subsequent parts will investigate the root anatomy and canal morphology of maxillary molars, as well as maxillary and mandibular premolars. CBCT scans of 728 mandibular anterior teeth from patients treated at The University of Jordan Hospital between June and December 2022 were analysed. Canal configurations were categorized according to Vertucci’s classification. Overall, 13.7% of teeth had two canals, most often in lateral incisors (18.3%) and least in canines (8%). Two canines were two-rooted with separate buccal and lingual roots. Vertucci Type I predominated (86.6%). No significant gender-related differences were found. A second canal, though uncommon, should be anticipated when treating mandibular anterior teeth in Jordanian patients. Health sciences/Anatomy Health sciences/Diseases Health sciences/Health care Health sciences/Medical research cone-beam computed tomography cross-sectional study prevalence root canal morphology root canal anatomy Figures Figure 1 Figure 2 Introduction Successful endodontic therapy depends on treatment of the entire root canal system and missed anatomy is a major cause of treatment failure [ 1 ]. Although mandibular anterior teeth are often assumed to have a single canal [ 2 ], clinical and in-vitro studies show frequent additional canals and substantial anatomical variability that can compromise outcomes when untreated [ 3 , 4 ]. Therefore, knowledge of possible root canal anatomy variations is essential for achieving success [ 5 ]. Beyond clinical care, root canal anatomy also informs anthropological reconstructions of human population histories [ 6 ]. Cone-beam computed tomography (CBCT) enhances anatomic assessment by producing undistorted three-dimensional images of teeth and surrounding tissues [ 7 ], and, when justified, has been validated as an accurate method for exploring root canal anatomy clinically [ 8 ]. In Jordan, root canal morphology research relied mainly on canal staining and clearing of extracted teeth [ 3 , 9 – 11 ], and only a small number of CBCT studies have been published [ 4 , 12 , 13 ]. Root and root-canal morphology vary across ethnic groups [ 14 ], yet Jordanian populations remain underrepresented. The Jordanian subpopulation has distinct genetic and environmental factors that may influence root and canal configuration [ 15 ]. Understanding these population-specific variations is critical for endodontic practitioners, as it allows them to deliver more effective care to patients in Jordan. Therefore, this study aims to assess the prevalence of root anatomy and root canal morphology in permanent mandibular anterior teeth of a Jordanian subpopulation using CBCT. Materials and methods This study was conducted in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines [ 16 , 17 ] and utilized the STROBE Checklist for Cross-sectional Studies to guide the study’s design and reporting of results. This study was approved by the Institutional Review Board at Jordan University Hospital/University of Jordan (IRB-JUH) and was conducted in full accordance with the World Medical Association Declaration of Helsinki. All Jordanian patients who were treated at the University of Jordan Hospital and had undergone CBCT scanning between June 2022 and December 2022 were identified. CBCT scans were consecutively selected from the hospital database to minimize selection bias. Patients were included if they had fully developed permanent mandibular anterior teeth, and if the CBCT scan quality was sufficient to assess the complete root canal morphology. CBCT scans were excluded if they showed: Root canal treatment that altered the native canal anatomy. Posts, crowns, or restorations causing artefacts. Internal or external root resorption. Poor image quality or limited field of view that impeded clear identification of the root canal anatomy. The scans were performed for various clinical purposes, including implant planning, assessment of maxillofacial pathology, and oral surgical, orthodontic and endodontic evaluations. As such, variations in field of view, voxel size, and diagnostic intent may have influence on the results, these methodological limitations are further elaborated upon in the discussion section. No patient underwent CBCT scanning solely for the purposes of this study. CBCT scans were acquired using a CS9300 scanner (Carestream health, Rochester, New York). The scanner offers a range of fields of view (5 x 5 cm to 17 x 13.5 cm), isotropic resolutions (90mm to 500 µm), and scan times between 12–20 seconds. Carestream 3D imaging software was used to view and analyse the images. Two examiners collaboratively: LAG, a specialist in dentomaxillofacial radiology, and RAZ, a specialist in endodontics analysed the CBCT images in a darkened room. Brightness, contrast, and sharpness settings were adjusted as necessary to enhance visualisation. The two examiners assessed the scans in the axial, coronal and sagittal planes. In cases of interexaminer disagreement, they reviewed the images together to reach a consensus. The canal configurations were categorised according to Vertucci’s classification [ 18 ], as shown in Table 1 . Table 1 Vertucci’s canal configuration classification (1984) Canal configuration Description Type I A single canal from the pulp chamber to the apex Type II Two separate canals leaving the pulp chamber but joining short of the apex to form one canal Type III One canal leaving the pulp chamber, dividing into two within the body of the root and merging again to exit as one canal Type IV Two separate and distinct canals from the pulp chamber to the apex Type V Single canal leaving the pulp chamber and dividing short of the apex into two separate and distinct canals with separate apical foramen Type VI Two separate canals leaving the pulp chamber, merging in the body of the root and redividing into two distinct canals short of the apex Type VII One canal leaving the pulp chamber, dividing then rejoining within the body of the root, and finally redividing into two separate canals short of the apex Type VIII Three separate and distinct canals from pulp chamber to the root apex The sample size for this study was determined to assess the anatomical features of mandibular anterior teeth, with a particular focus on the number and configuration of root canals as classified by Vertucci. To calculate the appropriate sample size, we employed a standard formula for estimating proportions with a 95% confidence level and a 5% margin of error. Given the variability in mandibular anterior teeth anatomy, particularly in root canal systems, we used an expected proportion (P) of 0.5, which represents the most conservative estimate when prior data are unavailable. A total of 728 mandibular anterior teeth were included in the study, comprising 120 left central incisors, 119 left lateral incisors, 124 left canines, 118 right central incisors, 122 right lateral incisors and 125 right canines, yielding a total of 730 roots. This sample size provides sufficient statistical power to analyse the anatomical variation of mandibular anterior teeth and to determine the distribution of root canal systems within a Jordanian population. Statistical analysis was performed using SPSS for Windows, version 16.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistics were generated to summarize the data. Group differences were analysed using the chi-square test for categorical variables when the assumptions of the test were met (i.e., all expected cell counts ≥ 5). When expected frequencies were small, Fisher’s exact test was applied. A significance level was set at P < 0.05. Results The sample consisted of 127 patients with 728 teeth, of which 440 teeth (60.4%) were from females and 288 (39.6%) from males. The 728 teeth had 730 roots, with only two cases of lower canines with two roots each: one in a male patient and one in a female patient. The teeth had 828 root canals; 86.3% (628 teeth) had a single root canal and 13.7% (100 teeth) with two root canals in each (Fig. 1 ). Significant differences in the number of root canals between the lower anterior teeth (P = 0.032) were found, Table 2 . The presence of two root canals was most prevalent in the lateral incisors (18.3%). Of the lower anterior teeth, the canines had the lowest prevalence of two root canals (8%). The differences in the number of root canals between males and females were not statistically significant. Table 2 The number of root canals of lower permanent anterior teeth in a sample of 728 teeth. Tooth No. of teeth Number of root canals (%, CI) One Two 31 120 101 (84.2, 76.5–90.2) 19 (15.8, 9.8–23.5) 32 119 95 (79.8, 71.4–86.7) 24 (20.2, 13.3–28.6) 33 124 114 (91.9, 85.5–96.2) 10 (8.1, 3.8–14.5) 41 118 101 (85.6, 78.0–91.3) 17 (14.4, 8.7–22.0) 42 122 102 (83.6, 75.9–89.8) 20 (16.4, 10.2–24.1) 43 125 115 (92, 85.7–96.2) 10 (8, 3.8–14.3) CI: Confidence Interval The Vertucci classification of the root canals of the lower anterior permanent teeth is shown in Table 3 , with statistically significant differences between the different teeth (P = 0.0051). Only types I-III were found. Most of the roots have type I (86.6%), followed by type III (8.4%), and type II (5%). The highest prevalence of type I was found in the lower canines (92.8%), while type II was most prevalent in mandibular canines (5.6%) and type III was most prevalent in the lower lateral incisors (13.3%). Type III was least prevalent in the canines, (1.6%). Table 3 The Vertucci classification of the root canals of the lower anterior teeth. Tooth Number of teeth Number of roots Vertucci classification n (%, CI) I II III 31 120 Single (n = 120) 101 (84.2, 76.5–90.2) 5 (4.2, 1.4–9.5) 14 (11.6, 6.5–18.7) 32 119 Single (n = 119) 95 (79.8, 71.4–86.7) 7 (5.9, 2.4–11.7) 17 (14.3, 8.6–21.8) 33 124 Single (n = 124) 114 (91.9, 85.5–96.2) 7 (5.7, 2.3–11.3) 3 (2.4, 0.5–6.9) 41 118 Single (n = 118) 101 (85.6, 78.0–91.3) 6 (5.1, 1.9–10.7) 11 (9.3, 4.7–16.1) 42 122 Single (n = 122) 102 (83.6, 75.9–89.8) 5 (4.1, 1.3–9.2) 15 (12.3, 7.1–19.3) 43 125 Single (n = 123) 115 (90.5, 84.0–95.0) 7 (5.5, 2.2–11.0) 1 (0.8, 0.02–4.6) Buccal (n = 2) 2 (100%, 15.8–100) - - Lingual (n = 2) 2 (100%, 15.8–100) - - Total 728 730 632 (86.6, 83.7–89.2) 37 (5, 3.6–7.0) 61 (8.4, 6.4–10.6) CI: Confidence Interval No statistically significant differences were found between males and females in the Vertucci classification of root canals of lower anterior teeth (P = 0.473). Type I (87.5% vs. 85%) and Type II (5.2% vs. 4.8%) configurations were more prevalent in females than in males, whereas Type III configuration was more prevalent in males (10%) compared to females (7.3%) (Fig. 2 ). Discussion Our study found that all mandibular anterior teeth were single-rooted, except for two bi-rooted canines. This finding aligns with the results of Al-Qudah and Awawdeh, who, using the canal staining and tooth-clearing (diaphanization) technique in a Jordanian population, reported that all mandibular anterior teeth, including canines, were single-rooted [ 3 ]. Similar patterns have been reported in other populations. In a Chinese cohort, all mandibular incisors had a single root, while 1.36% of canines exhibited two roots [ 19 ]. In an Iranian population, bi-rooted mandibular anterior teeth were limited to three canines (0.3%) [ 20 ]. Similarly, in a Polish population, 100% of mandibular incisors were single-rooted, with two-rooted cases confined to canines [ 21 ]. Collectively, these findings highlight the importance of thorough diagnostic assessment and pre-treatment imaging to detect additional roots, thereby minimizing the risk of missed anatomy and improving treatment outcomes. In our study, a vast majority of anterior teeth had a single canal (86.3%), whilst 13.7% had two. When canines were excluded, the prevalence of double-canalled incisors (central and lateral) was 16.7%. A previous study on the Jordanian population reported a higher prevalence, with 26.2% of mandibular incisors having two canals [ 3 ]. The discrepancy may be attributed to methodological differences. CBCT provides clinically relevant and meaningful information on root canal morphology. A study done in Iran using CBCT, reported a comparable prevalence of two canals in 16.9% of mandibular incisors [ 20 ], mirroring our findings. Whilst studies employing the use of CBCT on a less closely related ethnic population such as in China reported a substantially higher prevalence of two canals in mandibular incisors (27.5%) [ 19 ]. These differences may reflect true anatomical variation among ethnic groups or could be partially explained by differences in study design and sample size. Nonetheless, the influence of ethnicity on root canal morphology has been supported by investigations in more heterogeneous populations. For example, a Malaysian study found that ethnicity significantly influenced variations in root canal anatomy [ 22 ]. A tooth-specific analysis revealed that the highest prevalence of a second canal occurred in lateral incisors (18.3%), followed by central incisors (15.1%) and canines (8%). This pattern, with lateral incisors being most likely to exhibit two canals, has also been observed in other populations, including Chinese [ 19 ] Iranian[ 20 ], and Spanish cohorts [ 23 ]. Although there is consensus on the relative likelihood of dual canals across these tooth types, absolute prevalence percentages vary widely between studies. For instance, Han et al. reported lateral incisors with two canals at 27.36%, substantially higher than in centrals (15.71%), canines (6.27%), and higher than in our sample [ 19 ]. However, other studies noted a prevalence of laterals with two canals much more similar to the current study, such as Haghanifer at al.’s with 17%. All these results explain the importance of being knowledgeable on the root canal morphology of mandibular anterior teeth [ 20 ]. Clinicians should account for these anatomical variations when managing mandibular anterior teeth, as such considerations are essential to optimizing treatment outcomes. Different classifications have been used to describe root canal anatomy such as those proposed by Vertucci [ 18 ] and, for more complex canal configurations, more recently by Ahmed et al. (2017), whose system is gaining popularity in recent CBCT-based studies for its comprehensiveness and precision[ 24 ]. The classification used in the present study follows that of Vertucci (1984) which is widely recognised as the standard in endodontic literature. In our study, Vertucci type I was the most prevalent configuration found in examined teeth (86.6%) followed by type III (8.4%) and type II (5%). These findings are consistent with other studies investigating root canal anatomy of anterior teeth in different ethnic populations, which also reported type I as the most common configuration [ 19 , 21 , 25 ]. Similar results were observed in studies on the Jordanian population, although type I was detected in a lower percentage of teeth [ 4 ], a variation that may be attributed to the smaller sample size in our study. Another Jordanian study investigating the morphology of mandibular incisors using the clearing and staining technique reported a prevalence of 73.8% for Vertucci type I [ 3 ]. Collectively, these studies, whether based on CBCT, canal staining, or root clearing techniques, highlight that clinicians should expect to encounter Vertucci type I when accessing lower anterior teeth. The present study was unable to identify any Vertucci configurations other than type I, II, III. However, studies carried out on other ethnic populations were able to locate a wider variety of configurations. Han et al. in China located Vertucci type IV, V, VI, VII in 1.16%, 3.18%, 0.05%,0.15% of teeth respectively [ 19 ]. In a Saudi subpopulation, Alshayban et al. found type IV in 0.4% of teeth and type V in 1.2% of teeth [ 26 ]. In a polish population, Sroczyk-Jaszczyńska et al. found types IV, V, VI, VII [ 21 ]. Multiple other studies found morphologies other than type I, II, III [ 25 , 27 , 28 ]. Although these findings are quite rare, it highlights the importance for clinicians to be aware of the possibility of finding more atypical morphologies when treating mandibular anterior teeth. Knowledge of these morphologies can decrease the likelihood of missed canals and allow more accurate canal debridement therefore improving overall success of endodontic treatment. The most common morphology detected in mandibular canines was Vertucci type I with 92.8% of roots conforming to this configuration. Various other studies have also showed similar results such as those done on the Malaysian population (90.7%) [ 22 ], Saudi population (98.4%) [ 26 ], Chinese (93.7%) [ 19 ] and the Portuguese population (90.2%) [ 27 ]. These results were higher than those found in other studies done in Brazil (78%) [ 29 ], and Georgia (66.8%) [ 30 ] which again reinforces the indication that ethnicity influences root morphology. Regarding mandibular incisors, the most common Vertucci configuration was type I (83.3%) which is consistent with most results found by different authors in India [ 31 ], Iran [ 32 ] and China [ 33 ]. They however differ to those by Karobari et al. who aimed to find the morphology of permanent mandibular anterior teeth in a Malaysian population and found Vertucci type III (51%) to be the most common in lateral incisors followed by type I (45%) [ 22 ]. It is important to acknowledge that these differences could be accounted for the differing sample sizes, inclusion/exclusion criteria and methodologies. In terms of mandibular incisors, the lateral incisor showed the most variation form the norm. We detected a fewer percentage of lateral incisors (0.82%) conforming to the type I Vertucci configuration than central incisors (0.85%). In the present study, all observed root canal configurations in mandibular anterior teeth were classifiable using Vertucci’s classification system. Vertucci’s system remains one of the most widely used and simpler systems for describing root canal anatomy, which justifies its use here. According to the recent systematic review and critical analysis by Ahmed et al. (2023), both the Vertucci and Ahmed et al. (2017) systems can accurately classify single-rooted teeth with simple canal configurations. The newer Ahmed system provides greater detail and accuracy for more complex cases, especially in multi-rooted teeth such as maxillary molars, but in the case of mandibular anterior teeth, Vertucci’s classification was sufficient. As in the first part of this study, the retrospective design constitutes a principal limitation, given that the CBCT scans were obtained for a variety of diagnostic purposes rather than exclusively for endodontic evaluation. While this broader clinical context may mitigate the selection bias associated with scans taken solely for endodontic indications, it nonetheless limits the generalisability of the findings [ 7 , 34 ]. Furthermore, variability in imaging parameters (e.g., voxel size, field of view, and scanner type) remains an inherent limitation, as these factors influence image resolution and the detection of fine anatomical details [ 35 ]. The relatively limited sample size and the absence of statistical measures of inter-examiner agreement (such as Cohen’s kappa) also restrict the reproducibility and strength of the conclusions. Prospective studies with larger, standardized datasets and blinded assessments supported by formal reliability testing are warranted to enhance methodological rigor and external validity. Clinical relevance The present study demonstrated possible occurrence of multiple root canals within individual roots of mandibular anterior teeth. Based on these findings, conventional intraoral periapical radiographs should be complemented with angulated projections (10–20° mesial or distal shifts) to enhance the detection of complex canal systems and minimize anatomical superimposition [ 36 ]. In cases where conventional imaging is inconclusive, small field-of-view CBCT is recommended to obtain a detailed three-dimensional evaluation of root canal anatomy [ 7 ]. The occurrence of joining canals (Vertucci Types II and III) was relatively common. This underscores the clinical importance of using electronic apex locators to identify canal convergence prior to mechanical shaping. Early confirmation of confluence enables more conservative canal preparation and reduces the risk of procedural complications, including dentinal wall stripping, apical transportation, and instrument separation [ 37 ]. Furthermore, roots with joining canal configurations frequently contain isthmuses that are challenging to clean adequately using conventional mechanical instrumentation. This emphasizes the need to adopt modern endodontic instruments designed to better adapt to the native canal anatomy while preserving dentin structure. Among these, the XP-endo Shaper (FKG Dentaire, Switzerland) has demonstrated superior efficacy in bacterial reduction compared with traditional systems [ 38 ]. Additionally, ultrasonic activation of sodium hypochlorite is recommended to enhance disinfection within these intricate anatomical spaces [ 39 ]. Given the possible occurrence of multiple canals in mandibular anterior teeth, thorough evaluation of these teeth is essential. Advanced clinical training and the use of magnification can enhance the ability to detect and manage such complexities. When complex morphology is anticipated, referral to an endodontic specialist may be warranted to optimize treatment outcomes and minimize the risk of procedural errors [ 40 ]. Conclusion CBCT offers a reliable clinical method for assessing root canal morphology, yielding results comparable to those obtained with established in vitro techniques. In the 728 mandibular anterior teeth included in this study, 13.7% had two canals, highest in lateral incisors (18.3%) and lowest in canines (8.0%); two canines were two-rooted. Canal number differed by tooth type but not by sex. Vertucci Type I predominated (86.6%). Clinicians should remain alert to the possibility of a second canal in mandibular incisors, as its presence, though less common, has important clinical implications. Abbreviations CBCT = cone-beam computed tomography; STROBE = The Strengthening the Reporting of Observational Studies in Epidemiology Declarations The material contained in the manuscript has not been previously published and is not being concurrently submitted elsewhere. ORCID Rawan Abu Zaghlan https://orcid.org/0000-0001-9542-3126 Faleh Sawair https://orcid.org/0000-0003-1604-5206 Authors' contributions: Rawan Abu Zaghlan: Conceptualization, data curation, original draft preparation Laith Abu Qdais: Data curation Farouq Mansour & Faisal Mansour: original draft preparation Wijdan R El Manaseer: original draft preparation Faleh Sawair: Formal analysis. All the authors read and approved the final manuscript. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Data availability statement: The datasets used and/or analysed during this study are available upon request from the corresponding author. Conflicts of interest: No conflicts of interest have been declared by the authors. Ethics approval and consent to participate: The study was approved by the Institutional Review Board at Jordan University Hospital/University of Jordan (IRB-JUH). This research was conducted in full accordance with the World Medical Association Declaration of Helsinki. The informed consent was waived by the ethics committee as the study is retrospective. Consent for publication: Not applicable Acknowledgement ChatGPT (OpenAI) was used exclusively to check grammar and language clarity while preparing this manuscript. AI-generated output was reviewed and validated by the authors References Costa, F. et al. Association between missed canals and apical periodontitis. Int. Endod J. 52 , 400–406 (2018). mahmood talabani, R. Assessment of root canal morphology of mandibular permanent anterior teeth in an Iraqi subpopulation by cone-beam computed tomography. J. Dent. 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Beshkenadze, E. & Chipashvili, N. Anatomo-morphological feutures of the root canal system in georgian population - cone-beam computed tomography study. Georgian Med. News 2015 :7–14 . Verma, G. R. et al. Cone Beam Computed Tomography Study of Root Canal Morphology of Permanent Mandibular Incisors in Indian Subpopulation. Pol. J. Radiol. 82 , 371–375. https://doi.org/10.12659/PJR.901840 (2017). Aminsobhani, M., Sadegh, M., Meraji, N., Razmi, H. & Kharazifard, M. J. Evaluation of the Root and Canal Morphology of Mandibular Permanent Anterior Teeth in an Iranian Population by Cone-Beam Computed Tomography. J. Dent. (Tehran) . 10 , 358 (2013). Liu, J., Luo, J., Dou, L. & Yang, D. CBCT study of root and canal morphology of permanent mandibular incisors in a Chinese population. Acta Odontol. Scand. 72 , 26–30. https://doi.org/10.3109/00016357.2013.775337 (2014). Fayad, M. I. et al. AAE and AAOMR Joint Position Statement: Use of Cone Beam Computed Tomography in Endodontics 2015 Update. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. 120 , 508–512. https://doi.org/10.1016/J.OOOO.2015.07.033 (2015). Pertek Hatipoğlu, F. et al. Assessment of the Prevalence of Middle Mesial Canal in Mandibular First Molar: A Multinational Cross-sectional Study with Meta-analysis. J. Endod . 49 , 549–558. https://doi.org/10.1016/J.JOEN.2023.02.012 (2023). Sarsam, W., Davies, J. & Al-Salehi, S. K. The role of imaging in endodontics. Br. Dent. J. 2025 . 238 , 7. https://doi.org/10.1038/s41415-025-8511-z (2025). Do, S. & Seo, M-S. The effect of different confluence confirmation strategies on the obturation of Vertucci type II canal: micro-CT analysis. Restor. Dent. Endod . 46 , e12. https://doi.org/10.5395/RDE.2021.46.E12 (2021). Loyola-Fonseca, S. C. et al. Disinfection and Shaping of Vertucci Class II Root Canals after Preparation with Two Instrument Systems and Supplementary Ultrasonic Activation of Sodium Hypochlorite. J. Endod . 49 , 1183–1190. https://doi.org/10.1016/J.JOEN.2023.06.017 (2023). Zou, X. et al. Expert consensus on irrigation and intracanal medication in root canal therapy n.d. https://doi.org/10.1038/s41368-024-00280-5 British Dental Journal. BES publishes A guide to good endodontic practice. Br. Dent. J. 233 , 456 (2022). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7704890","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":520060009,"identity":"f790885a-d8b2-4f25-871b-1c2cf5fedd67","order_by":0,"name":"Rawan Abu 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08:29:31","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":112697,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7704890/v1/403f71101d73f25f274933c9.html"},{"id":92152732,"identity":"981e3133-2013-403e-8489-20a04ed69a7e","added_by":"auto","created_at":"2025-09-25 08:29:31","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":168706,"visible":true,"origin":"","legend":"\u003cp\u003eCBCT images demonstrating root canal morphological variations of mandibular anterior teeth. A: Vertucci type I, B: Vertucci type III, C: two-rooted mandibular canine\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7704890/v1/385e67d3f90618657c014910.png"},{"id":92154102,"identity":"0baf2069-54a1-43d5-9763-afbd6b248ba5","added_by":"auto","created_at":"2025-09-25 08:45:31","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":12275,"visible":true,"origin":"","legend":"\u003cp\u003eFrequency of one- and two-root canal configurations in mandibular anterior teeth among male and female subjects\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7704890/v1/f4caf8eb378a5d5cc08735f4.png"},{"id":92575011,"identity":"1b6293c6-62bf-44b6-92a0-88e1b3bfa655","added_by":"auto","created_at":"2025-10-01 08:17:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1039475,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7704890/v1/b5540f57-f5b3-4edc-9614-080f5164480d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Root and Root Canal Morphology of Mandibular Anterior Teeth in a Jordanian Subpopulation: A Cross-Sectional Cone-Beam Computed Tomography Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSuccessful endodontic therapy depends on treatment of the entire root canal system and missed anatomy is a major cause of treatment failure [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Although mandibular anterior teeth are often assumed to have a single canal [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], clinical and in-vitro studies show frequent additional canals and substantial anatomical variability that can compromise outcomes when untreated [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Therefore, knowledge of possible root canal anatomy variations is essential for achieving success [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Beyond clinical care, root canal anatomy also informs anthropological reconstructions of human population histories [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCone-beam computed tomography (CBCT) enhances anatomic assessment by producing undistorted three-dimensional images of teeth and surrounding tissues [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], and, when justified, has been validated as an accurate method for exploring root canal anatomy clinically [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn Jordan, root canal morphology research relied mainly on canal staining and clearing of extracted teeth [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], and only a small number of CBCT studies have been published [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRoot and root-canal morphology vary across ethnic groups [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], yet Jordanian populations remain underrepresented. The Jordanian subpopulation has distinct genetic and environmental factors that may influence root and canal configuration [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Understanding these population-specific variations is critical for endodontic practitioners, as it allows them to deliver more effective care to patients in Jordan.\u003c/p\u003e\u003cp\u003eTherefore, this study aims to assess the prevalence of root anatomy and root canal morphology in permanent mandibular anterior teeth of a Jordanian subpopulation using CBCT.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eThis study was conducted in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] and utilized the STROBE Checklist for Cross-sectional Studies to guide the study\u0026rsquo;s design and reporting of results.\u003c/p\u003e\u003cp\u003eThis study was approved by the Institutional Review Board at Jordan University Hospital/University of Jordan (IRB-JUH) and was conducted in full accordance with the World Medical Association Declaration of Helsinki. All Jordanian patients who were treated at the University of Jordan Hospital and had undergone CBCT scanning between June 2022 and December 2022 were identified. CBCT scans were consecutively selected from the hospital database to minimize selection bias. Patients were included if they had fully developed permanent mandibular anterior teeth, and if the CBCT scan quality was sufficient to assess the complete root canal morphology. CBCT scans were excluded if they showed:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eRoot canal treatment that altered the native canal anatomy.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePosts, crowns, or restorations causing artefacts.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eInternal or external root resorption.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePoor image quality or limited field of view that impeded clear identification of the root canal anatomy.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eThe scans were performed for various clinical purposes, including implant planning, assessment of maxillofacial pathology, and oral surgical, orthodontic and endodontic evaluations. As such, variations in field of view, voxel size, and diagnostic intent may have influence on the results, these methodological limitations are further elaborated upon in the discussion section. No patient underwent CBCT scanning solely for the purposes of this study.\u003c/p\u003e\u003cp\u003eCBCT scans were acquired using a CS9300 scanner (Carestream health, Rochester, New York). The scanner offers a range of fields of view (5 x 5 cm to 17 x 13.5 cm), isotropic resolutions (90mm to 500 \u0026micro;m), and scan times between 12\u0026ndash;20 seconds. Carestream 3D imaging software was used to view and analyse the images.\u003c/p\u003e\u003cp\u003eTwo examiners collaboratively: LAG, a specialist in dentomaxillofacial radiology, and RAZ, a specialist in endodontics analysed the CBCT images in a darkened room. Brightness, contrast, and sharpness settings were adjusted as necessary to enhance visualisation. The two examiners assessed the scans in the axial, coronal and sagittal planes. In cases of interexaminer disagreement, they reviewed the images together to reach a consensus. The canal configurations were categorised according to Vertucci\u0026rsquo;s classification [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eVertucci\u0026rsquo;s canal configuration classification (1984)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCanal configuration\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDescription\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType I\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA single canal from the pulp chamber to the apex\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType II\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTwo separate canals leaving the pulp chamber but joining short of the apex to form one canal\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType III\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOne canal leaving the pulp chamber, dividing into two within the body of the root and merging again to exit as one canal\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType IV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTwo separate and distinct canals from the pulp chamber to the apex\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType V\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle canal leaving the pulp chamber and dividing short of the apex into two separate and distinct canals with separate apical foramen\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType VI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTwo separate canals leaving the pulp chamber, merging in the body of the root and redividing into two distinct canals short of the apex\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType VII\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOne canal leaving the pulp chamber, dividing then rejoining within the body of the root, and finally redividing into two separate canals short of the apex\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType VIII\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThree separate and distinct canals from pulp chamber to the root apex\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe sample size for this study was determined to assess the anatomical features of mandibular anterior teeth, with a particular focus on the number and configuration of root canals as classified by Vertucci. To calculate the appropriate sample size, we employed a standard formula for estimating proportions with a 95% confidence level and a 5% margin of error. Given the variability in mandibular anterior teeth anatomy, particularly in root canal systems, we used an expected proportion (P) of 0.5, which represents the most conservative estimate when prior data are unavailable. A total of 728 mandibular anterior teeth were included in the study, comprising 120 left central incisors, 119 left lateral incisors, 124 left canines, 118 right central incisors, 122 right lateral incisors and 125 right canines, yielding a total of 730 roots. This sample size provides sufficient statistical power to analyse the anatomical variation of mandibular anterior teeth and to determine the distribution of root canal systems within a Jordanian population. Statistical analysis was performed using SPSS for Windows, version 16.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistics were generated to summarize the data. Group differences were analysed using the chi-square test for categorical variables when the assumptions of the test were met (i.e., all expected cell counts\u0026thinsp;\u0026ge;\u0026thinsp;5). When expected frequencies were small, Fisher\u0026rsquo;s exact test was applied. A significance level was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe sample consisted of 127 patients with 728 teeth, of which 440 teeth (60.4%) were from females and 288 (39.6%) from males. The 728 teeth had 730 roots, with only two cases of lower canines with two roots each: one in a male patient and one in a female patient. The teeth had 828 root canals; 86.3% (628 teeth) had a single root canal and 13.7% (100 teeth) with two root canals in each (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eSignificant differences in the number of root canals between the lower anterior teeth (P\u0026thinsp;=\u0026thinsp;0.032) were found, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The presence of two root canals was most prevalent in the lateral incisors (18.3%). Of the lower anterior teeth, the canines had the lowest prevalence of two root canals (8%).\u003c/p\u003e\u003cp\u003eThe differences in the number of root canals between males and females were not statistically significant.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe number of root canals of lower permanent anterior teeth in a sample of 728 teeth.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTooth\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eNo. of teeth\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eNumber of root canals (%, CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOne\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTwo\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e31\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e101 (84.2, 76.5\u0026ndash;90.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19 (15.8, 9.8\u0026ndash;23.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e32\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e119\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e95 (79.8, 71.4\u0026ndash;86.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e24 (20.2, 13.3\u0026ndash;28.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e33\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e114 (91.9, 85.5\u0026ndash;96.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10 (8.1, 3.8\u0026ndash;14.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e41\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e118\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e101 (85.6, 78.0\u0026ndash;91.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17 (14.4, 8.7\u0026ndash;22.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e42\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e122\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e102 (83.6, 75.9\u0026ndash;89.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20 (16.4, 10.2\u0026ndash;24.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e43\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e115 (92, 85.7\u0026ndash;96.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10 (8, 3.8\u0026ndash;14.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eCI: Confidence Interval\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe Vertucci classification of the root canals of the lower anterior permanent teeth is shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, with statistically significant differences between the different teeth (P\u0026thinsp;=\u0026thinsp;0.0051). Only types I-III were found. Most of the roots have type I (86.6%), followed by type III (8.4%), and type II (5%). The highest prevalence of type I was found in the lower canines (92.8%), while type II was most prevalent in mandibular canines (5.6%) and type III was most prevalent in the lower lateral incisors (13.3%). Type III was least prevalent in the canines, (1.6%).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe Vertucci classification of the root canals of the lower anterior teeth.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTooth\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eNumber of teeth\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eNumber of roots\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u003cp\u003eVertucci classification\u003c/p\u003e\u003cp\u003en (%, CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eII\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eIII\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e31\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSingle (n\u0026thinsp;=\u0026thinsp;120)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e101 (84.2, 76.5\u0026ndash;90.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5 (4.2, 1.4\u0026ndash;9.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14 (11.6, 6.5\u0026ndash;18.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e32\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e119\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSingle (n\u0026thinsp;=\u0026thinsp;119)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e95 (79.8, 71.4\u0026ndash;86.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7 (5.9, 2.4\u0026ndash;11.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17 (14.3, 8.6\u0026ndash;21.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e33\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSingle (n\u0026thinsp;=\u0026thinsp;124)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e114 (91.9, 85.5\u0026ndash;96.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7 (5.7, 2.3\u0026ndash;11.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 (2.4, 0.5\u0026ndash;6.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e41\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e118\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSingle (n\u0026thinsp;=\u0026thinsp;118)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e101 (85.6, 78.0\u0026ndash;91.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6 (5.1, 1.9\u0026ndash;10.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11 (9.3, 4.7\u0026ndash;16.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e42\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e122\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSingle (n\u0026thinsp;=\u0026thinsp;122)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e102 (83.6, 75.9\u0026ndash;89.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5 (4.1, 1.3\u0026ndash;9.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15 (12.3, 7.1\u0026ndash;19.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003e43\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSingle (n\u0026thinsp;=\u0026thinsp;123)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e115 (90.5, 84.0\u0026ndash;95.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7 (5.5, 2.2\u0026ndash;11.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (0.8, 0.02\u0026ndash;4.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBuccal (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2 (100%, 15.8\u0026ndash;100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLingual (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2 (100%, 15.8\u0026ndash;100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e728\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e730\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e632 (86.6, 83.7\u0026ndash;89.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e37 (5, 3.6\u0026ndash;7.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e61 (8.4, 6.4\u0026ndash;10.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eCI: Confidence Interval\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eNo statistically significant differences were found between males and females in the Vertucci classification of root canals of lower anterior teeth (P\u0026thinsp;=\u0026thinsp;0.473). Type I (87.5% vs. 85%) and Type II (5.2% vs. 4.8%) configurations were more prevalent in females than in males, whereas Type III configuration was more prevalent in males (10%) compared to females (7.3%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study found that all mandibular anterior teeth were single-rooted, except for two bi-rooted canines. This finding aligns with the results of Al-Qudah and Awawdeh, who, using the canal staining and tooth-clearing (diaphanization) technique in a Jordanian population, reported that all mandibular anterior teeth, including canines, were single-rooted [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Similar patterns have been reported in other populations. In a Chinese cohort, all mandibular incisors had a single root, while 1.36% of canines exhibited two roots [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In an Iranian population, bi-rooted mandibular anterior teeth were limited to three canines (0.3%) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Similarly, in a Polish population, 100% of mandibular incisors were single-rooted, with two-rooted cases confined to canines [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Collectively, these findings highlight the importance of thorough diagnostic assessment and pre-treatment imaging to detect additional roots, thereby minimizing the risk of missed anatomy and improving treatment outcomes.\u003c/p\u003e\u003cp\u003eIn our study, a vast majority of anterior teeth had a single canal (86.3%), whilst 13.7% had two. When canines were excluded, the prevalence of double-canalled incisors (central and lateral) was 16.7%. A previous study on the Jordanian population reported a higher prevalence, with 26.2% of mandibular incisors having two canals [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The discrepancy may be attributed to methodological differences. CBCT provides clinically relevant and meaningful information on root canal morphology. A study done in Iran using CBCT, reported a comparable prevalence of two canals in 16.9% of mandibular incisors [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], mirroring our findings. Whilst studies employing the use of CBCT on a less closely related ethnic population such as in China reported a substantially higher prevalence of two canals in mandibular incisors (27.5%) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. These differences may reflect true anatomical variation among ethnic groups or could be partially explained by differences in study design and sample size. Nonetheless, the influence of ethnicity on root canal morphology has been supported by investigations in more heterogeneous populations. For example, a Malaysian study found that ethnicity significantly influenced variations in root canal anatomy [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA tooth-specific analysis revealed that the highest prevalence of a second canal occurred in lateral incisors (18.3%), followed by central incisors (15.1%) and canines (8%). This pattern, with lateral incisors being most likely to exhibit two canals, has also been observed in other populations, including Chinese [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] Iranian[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], and Spanish cohorts [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Although there is consensus on the relative likelihood of dual canals across these tooth types, absolute prevalence percentages vary widely between studies. For instance, Han et al. reported lateral incisors with two canals at 27.36%, substantially higher than in centrals (15.71%), canines (6.27%), and higher than in our sample [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHowever, other studies noted a prevalence of laterals with two canals much more similar to the current study, such as Haghanifer at al.\u0026rsquo;s with 17%. All these results explain the importance of being knowledgeable on the root canal morphology of mandibular anterior teeth [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Clinicians should account for these anatomical variations when managing mandibular anterior teeth, as such considerations are essential to optimizing treatment outcomes.\u003c/p\u003e\u003cp\u003eDifferent classifications have been used to describe root canal anatomy such as those proposed by Vertucci [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and, for more complex canal configurations, more recently by Ahmed et al. (2017), whose system is gaining popularity in recent CBCT-based studies for its comprehensiveness and precision[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The classification used in the present study follows that of Vertucci (1984) which is widely recognised as the standard in endodontic literature. In our study, Vertucci type I was the most prevalent configuration found in examined teeth (86.6%) followed by type III (8.4%) and type II (5%). These findings are consistent with other studies investigating root canal anatomy of anterior teeth in different ethnic populations, which also reported type I as the most common configuration [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Similar results were observed in studies on the Jordanian population, although type I was detected in a lower percentage of teeth [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], a variation that may be attributed to the smaller sample size in our study. Another Jordanian study investigating the morphology of mandibular incisors using the clearing and staining technique reported a prevalence of 73.8% for Vertucci type I [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Collectively, these studies, whether based on CBCT, canal staining, or root clearing techniques, highlight that clinicians should expect to encounter Vertucci type I when accessing lower anterior teeth.\u003c/p\u003e\u003cp\u003eThe present study was unable to identify any Vertucci configurations other than type I, II, III. However, studies carried out on other ethnic populations were able to locate a wider variety of configurations. Han et al. in China located Vertucci type IV, V, VI, VII in 1.16%, 3.18%, 0.05%,0.15% of teeth respectively [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In a Saudi subpopulation, Alshayban et al. found type IV in 0.4% of teeth and type V in 1.2% of teeth [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In a polish population, Sroczyk-Jaszczyńska et al. found types IV, V, VI, VII [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Multiple other studies found morphologies other than type I, II, III [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Although these findings are quite rare, it highlights the importance for clinicians to be aware of the possibility of finding more atypical morphologies when treating mandibular anterior teeth. Knowledge of these morphologies can decrease the likelihood of missed canals and allow more accurate canal debridement therefore improving overall success of endodontic treatment.\u003c/p\u003e\u003cp\u003eThe most common morphology detected in mandibular canines was Vertucci type I with 92.8% of roots conforming to this configuration. Various other studies have also showed similar results such as those done on the Malaysian population (90.7%) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], Saudi population (98.4%) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], Chinese (93.7%) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] and the Portuguese population (90.2%) [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. These results were higher than those found in other studies done in Brazil (78%) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], and Georgia (66.8%) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] which again reinforces the indication that ethnicity influences root morphology.\u003c/p\u003e\u003cp\u003eRegarding mandibular incisors, the most common Vertucci configuration was type I (83.3%) which is consistent with most results found by different authors in India [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], Iran [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] and China [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. They however differ to those by Karobari et al. who aimed to find the morphology of permanent mandibular anterior teeth in a Malaysian population and found Vertucci type III (51%) to be the most common in lateral incisors followed by type I (45%) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. It is important to acknowledge that these differences could be accounted for the differing sample sizes, inclusion/exclusion criteria and methodologies. In terms of mandibular incisors, the lateral incisor showed the most variation form the norm. We detected a fewer percentage of lateral incisors (0.82%) conforming to the type I Vertucci configuration than central incisors (0.85%).\u003c/p\u003e\u003cp\u003eIn the present study, all observed root canal configurations in mandibular anterior teeth were classifiable using Vertucci\u0026rsquo;s classification system. Vertucci\u0026rsquo;s system remains one of the most widely used and simpler systems for describing root canal anatomy, which justifies its use here. According to the recent systematic review and critical analysis by Ahmed et al. (2023), both the Vertucci and Ahmed et al. (2017) systems can accurately classify single-rooted teeth with simple canal configurations. The newer Ahmed system provides greater detail and accuracy for more complex cases, especially in multi-rooted teeth such as maxillary molars, but in the case of mandibular anterior teeth, Vertucci\u0026rsquo;s classification was sufficient.\u003c/p\u003e\u003cp\u003eAs in the first part of this study, the retrospective design constitutes a principal limitation, given that the CBCT scans were obtained for a variety of diagnostic purposes rather than exclusively for endodontic evaluation. While this broader clinical context may mitigate the selection bias associated with scans taken solely for endodontic indications, it nonetheless limits the generalisability of the findings [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFurthermore, variability in imaging parameters (e.g., voxel size, field of view, and scanner type) remains an inherent limitation, as these factors influence image resolution and the detection of fine anatomical details [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The relatively limited sample size and the absence of statistical measures of inter-examiner agreement (such as Cohen\u0026rsquo;s kappa) also restrict the reproducibility and strength of the conclusions. Prospective studies with larger, standardized datasets and blinded assessments supported by formal reliability testing are warranted to enhance methodological rigor and external validity.\u003c/p\u003e"},{"header":"Clinical relevance","content":"\u003cp\u003eThe present study demonstrated possible occurrence of multiple root canals within individual roots of mandibular anterior teeth. Based on these findings, conventional intraoral periapical radiographs should be complemented with angulated projections (10\u0026ndash;20\u0026deg; mesial or distal shifts) to enhance the detection of complex canal systems and minimize anatomical superimposition [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. In cases where conventional imaging is inconclusive, small field-of-view CBCT is recommended to obtain a detailed three-dimensional evaluation of root canal anatomy [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe occurrence of joining canals (Vertucci Types II and III) was relatively common. This underscores the clinical importance of using electronic apex locators to identify canal convergence prior to mechanical shaping. Early confirmation of confluence enables more conservative canal preparation and reduces the risk of procedural complications, including dentinal wall stripping, apical transportation, and instrument separation [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFurthermore, roots with joining canal configurations frequently contain isthmuses that are challenging to clean adequately using conventional mechanical instrumentation. This emphasizes the need to adopt modern endodontic instruments designed to better adapt to the native canal anatomy while preserving dentin structure. Among these, the XP-endo Shaper (FKG Dentaire, Switzerland) has demonstrated superior efficacy in bacterial reduction compared with traditional systems [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Additionally, ultrasonic activation of sodium hypochlorite is recommended to enhance disinfection within these intricate anatomical spaces [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGiven the possible occurrence of multiple canals in mandibular anterior teeth, thorough evaluation of these teeth is essential. Advanced clinical training and the use of magnification can enhance the ability to detect and manage such complexities. When complex morphology is anticipated, referral to an endodontic specialist may be warranted to optimize treatment outcomes and minimize the risk of procedural errors [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eCBCT offers a reliable clinical method for assessing root canal morphology, yielding results comparable to those obtained with established in vitro techniques. In the 728 mandibular anterior teeth included in this study, 13.7% had two canals, highest in lateral incisors (18.3%) and lowest in canines (8.0%); two canines were two-rooted. Canal number differed by tooth type but not by sex. Vertucci Type I predominated (86.6%). Clinicians should remain alert to the possibility of a second canal in mandibular incisors, as its presence, though less common, has important clinical implications.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCBCT = cone-beam computed tomography; STROBE = The Strengthening the Reporting of Observational Studies in Epidemiology\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe material contained in the manuscript has not been previously published and is not being concurrently submitted elsewhere.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eORCID\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRawan Abu Zaghlan\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ehttps://orcid.org/0000-0001-9542-3126\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFaleh Sawair\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ehttps://orcid.org/0000-0003-1604-5206\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRawan Abu Zaghlan: Conceptualization, data curation, original draft preparation\u003c/p\u003e\n\u003cp\u003eLaith Abu Qdais: Data curation\u003c/p\u003e\n\u003cp\u003eFarouq Mansour \u0026amp; Faisal Mansour: original draft preparation\u003c/p\u003e\n\u003cp\u003eWijdan R El Manaseer: original draft preparation\u003c/p\u003e\n\u003cp\u003eFaleh Sawair: Formal analysis.\u003c/p\u003e\n\u003cp\u003eAll the authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement:\u003c/strong\u003eThe datasets used and/or analysed during this study are available upon request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest:\u003c/strong\u003eNo conflicts of interest have been declared by the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;approval and consent to participate:\u003c/strong\u003eThe study was approved by the Institutional Review Board at Jordan University Hospital/University of Jordan (IRB-JUH). This research was conducted in full accordance with the World Medical Association Declaration of Helsinki. The informed consent was waived by the ethics committee as the study is retrospective.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eChatGPT (OpenAI) was used exclusively to check grammar and language clarity while preparing this manuscript. AI-generated output was reviewed and validated by the authors\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCosta, F. et al. Association between missed canals and apical periodontitis. \u003cem\u003eInt. Endod J.\u003c/em\u003e \u003cb\u003e52\u003c/b\u003e, 400\u0026ndash;406 (2018).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003emahmood talabani, R. 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J.\u003c/em\u003e \u003cb\u003e233\u003c/b\u003e, 456 (2022).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"cone-beam computed tomography, cross-sectional study, prevalence, root canal morphology, root canal anatomy","lastPublishedDoi":"10.21203/rs.3.rs-7704890/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7704890/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eNumerous studies have explored root anatomy and root canal morphology variations across ethnic groups, but few have focused on the Jordanian population. This study, aimed to assess the prevalence of root anatomy and canal morphology in permanent teeth of a Jordanian subpopulation using cone-beam computed tomography (CBCT). This represents the second part of a four-part series focusing on mandibular anterior teeth. The first part examined mandibular molars, while subsequent parts will investigate the root anatomy and canal morphology of maxillary molars, as well as maxillary and mandibular premolars. CBCT scans of 728 mandibular anterior teeth from patients treated at The University of Jordan Hospital between June and December 2022 were analysed. Canal configurations were categorized according to Vertucci\u0026rsquo;s classification. Overall, 13.7% of teeth had two canals, most often in lateral incisors (18.3%) and least in canines (8%). Two canines were two-rooted with separate buccal and lingual roots. Vertucci Type I predominated (86.6%). No significant gender-related differences were found. A second canal, though uncommon, should be anticipated when treating mandibular anterior teeth in Jordanian patients.\u003c/p\u003e","manuscriptTitle":"Root and Root Canal Morphology of Mandibular Anterior Teeth in a Jordanian Subpopulation: A Cross-Sectional Cone-Beam Computed Tomography Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-25 08:29:26","doi":"10.21203/rs.3.rs-7704890/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c2a8efcb-ec8a-48ce-98b1-b9410f2c4d63","owner":[],"postedDate":"September 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":55278181,"name":"Health sciences/Anatomy"},{"id":55278182,"name":"Health sciences/Diseases"},{"id":55278183,"name":"Health sciences/Health care"},{"id":55278184,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2025-10-27T11:37:18+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-25 08:29:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7704890","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7704890","identity":"rs-7704890","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}