Root and canal configurations of maxillary first premolars in 22 countries using two classification systems: a multinational cross-sectional study

Pertek Hatipoğlu F. Magat G. Karobari M.I. Madarati A.A. Tulegenova I. Hatipoğlu Ö. Taha N. Makahleh N. Fernández-Grisales R. Bekjanova O. Rahimi M. Donnermeyer D. Madfa A.A. Petridis X. Intriago M.G. Shah T. Allawi S. Ivica A. Lim W.Y. Hamouda A. Jagtap R. Martín-Biedma B. Lehmann A.P. Alfirjani S. Palma P.J. Buchanan G.D.
December 2025 Nature Research

Scientific Reports
2025 #15 Issue 1

This study aimed to evaluate the root and root canal morphology of maxillary first premolars (M1Ps) globally using cone-beam computed tomography (CBCT), comparing results with Vertucci’s and Ahmed et al.‘s classification systems. CBCT images were obtained for various purposes such as orthodontic treatment planning, tooth impaction, implant surgery, and trauma cases. M1Ps were evaluated in three planes to determine root and root canal morphology, and root bifurcation levels were assessed using integrated software. Prevalence variations between countries and overall prevalence were analyzed using meta-analysis software. A total of 6,600 patients (13,200 bilateral M1Ps) were examined. According to Vertucci’s classification, Type IV (59%), Type II (12%), Type I (9%), and Type III (8%) were the most common configurations. Based on Ahmed’s classification,²MP B¹ P¹ was the most prevalent configuration (53%), followed by ¹MP¹ (9%),¹MP^1–2–1 (8%), and ¹MP^2−1-1 (7%). The prevalence of ²MP B¹ P¹ by gender revealed a pooled prevalence of 58% in males and 50% in females. No significant difference was found across age ranges (p > 0.05). Ahmed’s classification system provided a more comprehensive analysis by successfully classifying all cases, whereas Vertucci’s system failed to categorize 1.8–2.7% of the cases. Significant bilateral symmetry in root morphology was noted. There are regional and gender-specific differences in the root canal morphology of M1Ps. Ahmed et al.‘s classification system was more comprehensive, effectively categorizing all observed morphologies compared to Vertucci’s system, which had limitations and left some morphologies unclassified.

Ahmed classification , CBCT , Maxillary premolar teeth , Root Canal morphology , Vertucci classification

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Department of Endodontics, Recep Tayyip Erdogan University, Rize, Turkey
Department of Oral Radiology, Faculty of Dentistry, Necmettin Erbakan University, Konya, Turkey
Department of Conservative Dentistry and Endodontics, Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospital, Saveetha University, Tamil Nadu, Chennai, 600077, India
Restorative Dentistry Department, Faculty of Dentistry, Aleppo University, Aleppo, Syrian Arab Republic
Private Dental Center (Sijam Dental Clinics), Riyadh, Saudi Arabia
School of Dentistry, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
Department of Restorative Dentistry, Recep Tayyip Erdogan University, Rize, Turkey
Department of Conservative Dentistry, Jordan University of Science and Technology, Irbid, Jordan
Jordan University of Science and Technology, Irbid, Jordan
Department of Endodontics, School of Dentistry, CES University, Medellín, Colombia
Department of Faculty Therapeutic Dentistry, Tashkent State Dental Institute, Tashkent, Uzbekistan
Department of Endodontics, The University of Auckland, Auckland, Australia
Department of Periodontology and Operative Dentistry, University of Münster, Münster, Germany
Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
Department of Restorative Dental Science, College of Dentistry, University of Ha’il, Hail, Saudi Arabia
Department of Endodontics, Section of Dental Pathology and Therapeutics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
Endodontic Department of Dentistry, Universidad Central del Ecuador, Quito, Ecuador
Department of Conservative Dentistry and Endodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Chennai, India
Department of Endodontic and Operative Dentistry, Faculty of Dentistry, Damascus University, Damascus, Syrian Arab Republic
University of Zagreb School of Dental Medicine, Zagreb, Croatia
Department of Restorative Dentistry, National Dental Centre, Singapore, Singapore
Department of Endodontic, Faculty of Dentistry, Al-Azhar University, Cairo, Egypt
Director and Assistant Professor, Division of Oral and Maxillofacial Radiology, Department of Care Planning and Restorative Sciences, University of Mississippi Medical Center School of Dentistry, Jackson, Mississippi, 39216, United States
Oral Sciences Research Group, Endodontics and Restorative Dentistry Unit, School of Medicine and Dentistry, Universidade de Santiago de Compostela Health Research Institute of Santiago (IDIS), Santiago, Spain
Department of Conservative Dentisty and Endodontics, Poznan University of Medical Sciences, Poznan, Poland
Department of Conservative Dentistry and Endodontics, University of Benghazi, Benghazi, Libya
Center for Innovation and Research in Oral Sciences (CIROS), Faculty of Medicine, University of Coimbra, Coimbra, 3000-075, Portugal
Institute of Endodontics, Faculty of Medicine, University of Coimbra, Coimbra, 3000-075, Portugal
Department of Odontology, School of Dentistry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
Department of Endodontics, Faculty of Medicine and Health, University of Sydney, Sydney, Australia

Department of Endodontics
Department of Oral Radiology
Department of Conservative Dentistry and Endodontics
Restorative Dentistry Department
Private Dental Center (Sijam Dental Clinics)
School of Dentistry
Department of Restorative Dentistry
Department of Conservative Dentistry
Jordan University of Science and Technology
Department of Endodontics
Department of Faculty Therapeutic Dentistry
Department of Endodontics
Department of Periodontology and Operative Dentistry
Department of Restorative
Department of Restorative Dental Science
Department of Endodontics
Endodontic Department of Dentistry
Department of Conservative Dentistry and Endodontics
Department of Endodontic and Operative Dentistry
University of Zagreb School of Dental Medicine
Department of Restorative Dentistry
Department of Endodontic
Director and Assistant Professor
Oral Sciences Research Group
Department of Conservative Dentisty and Endodontics
Department of Conservative Dentistry and Endodontics
Center for Innovation and Research in Oral Sciences (CIROS)
Institute of Endodontics
Department of Odontology
Department of Endodontics

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