Morphometric analysis of three-rooted mandibular first molars in a Slovene population: a macroscopic and cone-beam computed tomography analysis

Background: This study examined the root morphology of mandibular first molars (MFMs) with radix entomolaris (RE), which presents diagnostic and therapeutic challenges for clinicians. Materials and methods: A total of 17 three-rooted MFMs were taken from a collection of extracted teeth. Root lengths and levels of furcations were measured with a digital calliper. The pulp floor configuration, root canal systems, and RE canal curvatures were evaluated using the cone-beam computed tomography scans. Results: Radix entomolaris was either located disto-lingually, with its coronal portion fixed to the distal root (n = 16) or mid-lingually (n = 1). A literature search identified four additional cases of MFMs with RE located mid-lingually. In the present study, RE was significantly (p <= 0.001) shorter than the distal root (DR) and the mesial root, on average by 2.04 mm and 3.15 mm, respectively. The level of the distal furcation was significantly (p = 0.003) lower than that of the mesiodistal furcation, on average by 1.39 mm. The average divergence angle formed by the cervical portions of the RE and DR canals was 53.14 degrees. All RE canals were severely curved (> 25 degrees) in buccolingual direction. The RE orifice was located slightly disto-lingually to considerably mesio-lingually from the DR orifice. Conclusions: The traditional assumption of a disto-lingually located RE needs to be changed, even though this is the most prevalently found variant of this anatomy. The additional variant includes the presence of a mid-lingually located RE, which has implications for the endodontic access cavity design.