Review began 04/18/2023 Review ended 05/02/2023 Published 05/06/2023 © Copyright 2023 Khanna et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Revisiting Premolars Using Cone-Beam Computed Tomography Analysis and Classifying Their Roots and Root Canal Morphology Using Newer Classification Shreya Khanna , Leena Jobanputra , Jahnvi Mehta , Akshali Parmar , Aarti Panchal , Foram Mehta 1. Conservative Dentistry and Endodontics, Government Dental College and Hospital, Jamnagar, Jamnagar, IND Corresponding author: Shreya Khanna, drshreyakl@gmail.com Abstract Objective: The objective is to compare the internal morphology of premolars while applying the Vertucci and recent classification system for root canal variations in the Gujarat population using CBCT. Materials and methodology: A sample size of 537 CBCT images collected from various diagnostic centers in Gujarat was analyzed. The root canal morphology was then classified by using two methods - Ahmed et al. and Vertucci classification system. Fisher’s exact test and Chi-square test were used for statistical analysis. Results: All the premolars revealed a varied canal configuration. More than half of maxillary first and 42% of maxillary second premolars were double rooted. Vertucci type IV classification was the most common in first maxillary premolars and Type I and type IV were commonly seen in second premolars. According to the new system, the code 2 N B 1 P 1 was commonly seen for first maxillary premolars. The majority of mandibular premolars were single rooted. Classification wise type I Vertucci and 1 N 1 were the most common types observed. Conclusion: Premolars - both maxillary and mandibular - in this subpopulation had a wide range of root canal anatomical variations. Clinicians should be aware of this for a successful treatment outcome. The new system for classifying canal morphology describes the root and canal configurations in a more accurate and practical manner compared to the Vertucci classification and hence can be used routinely. Categories: Dentistry Keywords: cone-beam computed tomography, variations, classification, canal configuration, premolars Introduction A successful root canal treatment necessitates precise knowledge and characterization of both usual and unusual canal anatomy [1]. Continued advancements related to magnification, micro-computed tomography (micro-CT), and cone-beam computed tomography (CBCT) have led to the recognition of the increasingly enormous range of anatomical variations in root canals with an attempt to receive the best possible clinical outcome [2]. The system proposed by Vertucci et al. has been the most frequently used classification and has been of use when categorizing many canal configurations. However, this classification fails to describe the number/configuration of the root(s) in maxillary premolars. In addition, and with an increasing range of imaging methods being used, many previously unreported anatomical complexities are being identified. As an attempt to provide a logical and simple solution, a new system for classifying root and canal morphology was proposed recently, which provides detailed information on tooth notation, number of roots, and root canal configuration. These anatomical variations have been precisely described by a new classification system introduced by Ahmed et al. in an exact, uncomplex, and reliable manner, allowing to classification of such root canals which were termed non-classifiable earlier that can be used clinically [3-5]. This new classification has codes for three separate components: the tooth number, the number of roots, and the root canal configuration [3-5]. The tooth number (N) can be written using any numbering system. The number of roots (R) is added as a superscript before the tooth number (RN). The type of root canal configuration in each root will be written as a superscript number(s) after the tooth number and will define the course of the root canal system beginning from the orifice(s) (O), through the canal (C) to the foramen (foramina) (F) as 1 N 1-2 , 2 N 1 B 1 L 1 , and 2 N 1 M 1 D 1 [3]. Premolars - both maxillary and mandibular - have complexities in their anatomy, often being a cause of endodontic treatment failure [6-18] . CBCT is a non-invasive technology that allows a three-dimensional evaluation of root and canal morphology. To date, there has been no detailed examination of the roots and canal systems of maxillary and mandibular 1 1 1 1 1 1 Open Access Original Article DOI: 10.7759/cureus.38623 How to cite this article Khanna S, Jobanputra L, Mehta J, et al. (May 06, 2023) Revisiting Premolars Using Cone-Beam Computed Tomography Analysis and Classifying Their Roots and Root Canal Morphology Using Newer Classification. Cureus 15(5): e38623. DOI 10.7759/cureus.38623