Cone-beam Computed Tomography Evaluation Research Articles

Pre-eruptive intramural resorption in unerupted teeth: a cone-beam computed tomography evaluation of prevalence and related factors

ObjectivePre-eruptive intramural resorption (PEIR) is defined as an abnormal, well-circumscribed radiolucency within the coronal dentin of the tooth, which is often overlooked in plain radiographs. This study aimed to investigate the prevalence of PEIR and its related factors using cone-beam computed tomography (CBCT).MethodsCBCT images of 590 unerupted teeth were evaluated for the presence of PEIR, location of PEIR, number of lesions in the affected tooth, PEIR score, tooth angulation, tooth position, and pericoronal space. Binary logistic tests were used to analyze the association between the characteristics of PEIR and the patient’s demographic data and related factors.ResultsThe tooth prevalence of PEIR was 13.6% among unerupted teeth. However, it was noteworthy that 19.2% of the unerupted teeth with PEIR were planned to be kept. PEIR was significantly associated with transverse (p = 0.020), inverted-angulated (p = 0.035), and centrally-positioned teeth (p = 0.043). The severity of PEIR was more pronounced in teeth with distal (p = 0.019), lingual (p = 0.023), or inverted-angulated (p = 0.040) positions, and in the absence of pericoronal space (p = 0.036).ConclusionPEIR should be suspected in transverse, inverted-angulated, centrally positioned unerupted teeth, particularly in molars, with no pericoronal space. Further monitoring through CBCT is recommended in such cases.Clinical relevanceThe management of unerupted teeth does not always involve surgical removal. Instead, they could be utilized for artificial eruption or tooth transplantation. The present study emphasizes the significance of early detection of PEIR. Clinical recommendations for screening PEIR in unerupted teeth are also proposed, which can be applied to routine plain radiographs.

CBCT Evaluation of Root Canal Morphology of Maxillary First Premolar in Saudi Subpopulation

ABSTRACT Background and Objective: Clinicians must possess a comprehensive understanding of variations in canal morphology and configuration during endodontic procedures to enhance treatment success. This study aims to assess and analyze the canal configurations of maxillary first premolars using Cone-Beam Computed Tomography within the sub-population of Western Saudi Arabia. Materials and Methods: In this cross-sectional study, following the acquisition of ethical clearance from Batterjee Medical College in Jeddah, Saudi Arabia, a retrospective examination of Cone-Beam Computed Tomography (CBCT) scans of maxillary first premolars in adult patients was conducted. The study focused on quantifying the number of canals and characterizing their configurations, with classification based on Vertucci’s categorization. Results: The study examined 399 CBCT images of maxillary first premolars, revealing that type IV canal configurations were the predominant morphology (56.9%), followed by type V (24.6%). Significant gender-related disparities were observed, with females displaying a higher incidence of types I and V canals. At the same time, males exhibited a greater prevalence of types IV and VI canals. Notably, no substantial associations were discerned between canal types and age groups. Conclusion: Within the context of maxillary first premolars, type IV canal configuration emerged as the most prevalent. Gender-based distinctions were evident, with females predominantly presenting types I and V canal configurations, whereas males displayed a higher occurrence of types IV and VI canal configurations.

Research on the model of mandibular alveolar bone defect in rabbits

Objectives: The purpose of this study was to create an animal model of a mandibular alveolar bone defect without compromising the animal’s well-being. Materials and methods: A total of 24 New Zealand white rabbits underwent surgery to create mandibular alveolar bone defects. The animals were sacrificed at 2, 4, 6, 8, 10, and 12 weeks post-surgery. To assess bone regeneration at the surgical site, radiography, dental cone-beam computed tomography (CT), and histological examination using Hematoxylin and Eosin staining were performed on the skull. Results: A straightforward and easily executable method was devised to create the rabbit mandibular alveolar defect model. After 10 weeks, complete soft tissue and bone regeneration were observed. X-ray and cone-beam CT evaluations demonstrated a progressive increase in bone density from weeks 2 to 12. Histological examination revealed that the alveolar bone structure was formed incrementally at the surgical site. The bone and connective tissue had filled the defect after 8 weeks. Conclusion: The creation of a model of mandibular alveolar bone defects in rabbits is a straightforward process that can be used to assess the regeneration of alveolar bone at the defect site. This animal model can serve as the foundation for tests to evaluate the capacity of biomaterials to regenerate the alveolar bone Key words: mandibular alveolar bone, Alveolar bone defects, animal models, bone regenerative medicine, tissue engineering.

The use of guided tissue regeneration in endodontic Microsurgery: Setting a threshold

AimWe aimed to compare the radiographic outcomes of conventional and regenerative approaches in endodontic microsurgery (EMS) and set a critical defect size for healing in conventional and regenerative therapies. MethodologyThe study evaluated 53 root canal-treated teeth (33 patients) with periapical lesions. Among them, 19 teeth (35.8 %) were treated with regenerative treatment, whereas 34 teeth (64.1 %) were managed with the conventional approach. Conventional and regenerative approaches were performed by endodontic and periodontic residents under consultants’ supervision. Healing was evaluated after a minimum period of 6 months by comparing pre- and post-operative cone-beam computed tomography (CBCT) findings. The radiographic interpretation was conducted by a single examiner who was not participating in the surgeries and was blind on the type of treatment prior to CBCT evaluation. New healing criteria were proposed owing to the limitations on the present criteria in evaluating endodontic surgery after regenerative treatment. Critical measurements were calculated for each approach based on periapical lesion dimensions. ResultsThe regenerative approach presented significantly better healing than conventional treatment (mean, 1.21 and 1.59, respectively; p = 0.047). Based on the critical-point calculations, the conventional approach was effective in lesions of up to 3 mm depth and height, whereas the regenerative approach resulted in better healing rates in lesions with 3–9 mm depth and 3–6 mm height. ConclusionsPerforming the regenerative approach in EMS resulted in better healing rates than those of the conventional approach. The conventional approach is recommended for small periapical lesions, whereas the first had better results in larger lesions.

Cone beam computed tomography evaluation of c-shaped canal morphology in mandibular premolar teeth

Cone beam computed tomography evaluation of c-shaped canal morphology in mandibular premolar teeth

A Cone-beam Computed Tomography Evaluation of External Invasive Resorption of Unerupted Teeth. Report of Three Cases

Tooth resorption can occur either physiologically or pathologically and can be classified as internal or external. The term “external invasive resorption” (EIR) has been used to describe lesions originating from any surface defect exposing dentin. The absence of bacterial contamination, an intact pulp space, and a lesion consisting mainly of fibrovascular tissue characterize EIR. This study presents three cases of invasive resorption in unerupted teeth, emphasizing the importance of cone-beam computed tomography (CBCT). In two cases, the primary defect localized on the enamel surface, while in the third case, the focal point of the defect was not clear. CBCT provided detailed visualization of the resorption lesion's size and its relationship with surrounding structures, enhancing the diagnosis of EIR. Histological analysis of the third case confirmed the initial diagnosis. Invasive resorption can occur due to any surface defect in the case of unerupted teeth. Further research and correlation between radiographic and histological analysis are essential for the detection and classification systems in unerupted teeth.

Application of Hyperpure Chlorine Dioxide for Regenerative Endodontic Treatment of a Root-Canal-Treated Immature Tooth with External Cervical Resorption and Periapical Lesion: A Case Report

The consequences of traumatic injuries are pulp necrosis, periapical inflammation, and possible external cervical resorption (ECR). The concomitant cessation of root maturation and dentinogenesis in premature teeth result in a fragile tooth. Revascularization of the pulp might be an alternative treatment option. A 12-year-old patient was referred for retreatment of chronic apical periodontitis with acute exacerbation after root canal treatment of an upper central incisor. During gutta-percha removal, an ECR was detected. First, it was closed internally with Biodentine, followed by an external composite closure after a cone beam computed tomography evaluation. In the first session, chemomechanical cleaning was aided with sodium hypochlorite and hyperpure chlorine dioxide, and the canal was dressed with Ca(OH)2 until the next session. In the next session, only the low-toxicity, but adequate, bactericide hyperpure chlorine dioxide was applied for irrigation, before the provocation of periapical bleeding into the canal. The blood clots were covered with Biodentine, and the tooth was restored with composite filling. During the 24-month follow-up, clinical signs/symptoms had disappeared, and the periapical lesion was resolved. Increased root thickness in the apical third and decreased size of the apical foramen were detected. In conclusion, regenerative endodontic procedures could potentially be used to retreat immature teeth with persistent apical periodontitis and external cervical resorption.

High-resolution CBCT assessing a maxillary central incisor with root bifurcation: A case report

Cone beam computed tomography (CBCT) is an imaging modality widely used in endodontics, since it provides three-dimensional images without superposition of structures. The maxillary central incisor usually presents a single root and one root canal, but anatomical variations can happen. The aim of the present paper is to report a high-resolution CBCT evaluation of an upper central incisor with root bifurcation. This paper shows a descriptive and qualitative assessment of high-resolution CBCT images for endodontic purposes. A 39-year-old male patient was referred to a radiologic clinic to acquire CBCT images of the right upper central incisor, as the referring clinician noticed an anatomical difference between the two upper central incisors on a panoramic radiograph and suspected of dens invaginatus. CBCT images were acquired in high resolution (voxel size of 0.08 mm) and a restricted field-of-view (4x4 cm). CBCT volume displayed an anatomical variation of the central incisor, which presented root bifurcation and two root canals, with a normal clinical crown.  The present case report shows a rare diagnosis of a maxillary central incisor presenting bifurcated root with two root canals, and to the best of the authors’ knowledge, this is the first case report to present high-resolution CBCT images with disclosed acquisition protocols to diagnose a bifurcated central incisor. The documentation of unusual cases has great didact value and contributes to information propagation. In the present case, high-resolution CBCT allowed a detailed evaluation of both roots and root canals, facilitating the clinician’s diagnostic task.

Correlation of Serum Vitamin D with Crestal Bone Level in Dental Implant Patients Using CBCT: A Clinical Retrospective Study.

The purpose of this study is to correlate the role of serum vitamin D levels associated with crestal bone in dental implant patients using cone-beam computed tomography (CBCT). This retrospective study enrolled patients among whom implants were placed after a detailed planning using CBCT and the delayed loading protocol was followed. After 3 months and 6 months of loading, CBCT evaluations were carried out, serum vitamin D levels were also tested at the end of 6 months of loading. A total of 30 patients were recruited with 15 patients in each group based on normal and deficient levels of vitamin D to correlate with crestal bone levels using CBCT. Clinically acceptable crestal bone loss (CBL) was visible with all the implants at different time intervals. Statistical analysis was done for intergroup and intragroup comparisons which showed significant p-value (< 0.05) for CBL at the time of loading, at 3 months, and at 6 months follow-up for both normal and deficient serum values. In the deficient group, the mean value at baseline was 9.69 mm ± 1.10 and the CBL at 6 months follow-up was 8.80 mm ± 1.10 whereas for the normal group at baseline, the mean was 9.08 mm ± 1.21 and at 6 months follow-up was 8.12 mm ± 1.25 which showed meaningful difference. There is a positive correlation seen between CBL on CBCT and vitamin D serum levels. The success of the implant is significantly affected by vitamin D as it regulates the bone physiology and has systemic effects on accelerating bone formation around titanium implants. Vitamin D is essential in maintaining the balance of bone minerals and assists to preserve the crestal bone level making the implant treatment more predictable and successful.

Cone-Beam Computed Tomography Evaluation of Rotary MM Files vs Manual K Files in Primary Molars: An In Vitro Study.

Rotary instrumentation in pediatric dentistry is an emerging concept, thus this study was performed to evaluate the remaining dentine thickness (RDT), canal transportation, centering ability, quality of obturation using cone-beam computed tomography (CBCT), and the time efficiency of rotary versus manual instrumentation in mandibular second primary molars. Forty mandibular primary second molars (160 canals) were randomly and equally allocated to four groups. Instrumentation was done using K files in groups I and II; in each group, the obturation was done by two different obturation techniques; incremental technique and disposable syringe technique, respectively. MM rotary files (Innovative Material and Devices, Inc. [IMD], Shanghai, China) were used in groups III and IV; in each group, the obturation was done by incremental technique and disposable syringe technique. Preoperative and postoperative CBCT scans were performed and evaluated for the RDT, centering ability, canal transportation, and the canal filling quality, which was assessed as (underfill, optimal fill, and overfill). Instrumentation time was recorded for groups I and II collectively (manual instrumentation), and groups II and III collectively (rotary instrumentation). Statistical analysis was done using Chi-square, ANOVA, and post hoc Tukey tests, at p < 0.05). The MM rotary file removed a significantly less amount of dentine at all levels specifically at the middle section (p = 0.003). The canal transportation was significantly higher in the manual group at the cervical level (p = 0.022). In all sections, the rotary group had significantly higher values of centering ratio than the manual group (p < 0.05), which means a lower deviation of rotary instruments. For both types of files, there was no significant difference between different obturation techniques (p > 0.05). Instrumentation time was significantly lower in the rotary group (p < 0.001). Regarding the dentine removal and the shaping ability of MM files acceptable results were obtained; however, no significant difference between the different obturation techniques. Notable time efficiency was reported in the rotary files as well. The use of rotary files resulted in better conservation of tooth structure, better canal centering, and obturation quality as well as less canal transportation and less instrumentation time compared to manual K files.

CBCT Evaluation of Lingual Foramen and its Anatomic Variations in Northeast Indian Population.

The identification of nearby neurovascular structures is a vital part of dental implant treatment planning. Commonly two implants are placed in the mandibular inter foraminal region to support the overdenture. Placing dental implants in this region is considered relatively safe. The purpose of this study was to employ cone beam computed tomography (CBCT) on a representative sample of Northeast Indians to find out the location and distribution of lingual foramen in the anterior mandible. A total of 104 CBCT scans were performed using the Cranex 3D CBCT system. Three Oral and Maxillofacial Radiologists agreed on a visibility grade for assessing the lingual foramen using a 3-point scale. The number and presence of foramina were noted. On cross-sectional pictures, the distance in millimeters between the crest of the alveolar ridge and the superior cortical margin of the foramen was determined. Furthermore, the analysis of the distribution of lingual foramina in terms of frequency and percentages was performed. Scan results showed that the lingual foramen was clearly visible in 65.4% of cases, somewhat visible in 12.5% of scans, and not visible at all in 22.1% of cases. Half of the people in the study had two foramina, whereas 27.9 percent had one and 22.1 percent had none. The mean distance from the crest of the alveolar ridge was 10.84 mm in males whereas 9.91 mm in females. The Northeast Indian population exhibits an unusually high prevalence of lingual foramen in the anterior portion of the mandible. This research will aid in the precise pre-operative identification of the position and number of lingual foramina prior to surgical treatments involving the midline of the mandible.

Cone beam computed tomography evaluation of root canal morphology of maxillary premolars in North-West sub-population of Pakistan

Cone beam computed tomography evaluation of root canal morphology of maxillary premolars in North-West sub-population of Pakistan

Software-supported periodontal diagnostics with three-dimensional cone-beam computed tomography compared to conventional two-dimensional panoramic imaging and clinical diagnostics (a prospective study).

Aim of this study comprised the software-supported evaluation of measurement accuracy between cone-beam computed tomography (CBCT) and panoramic radiographs in the assessment of the periodontal bone level in patients with periodontitis and comparison with clinical periodontal parameters. Twenty patients with severe periodontitis (stage III-IV) were evaluated clinically and radiographically (panoramic and CBCT). Diagnostic interpretation comprised three blinded investigators with different levels of experience. Specific software-basing measurement procedure evaluated radiological distances for the mesial, central, and distal bone levels on the oral and vestibular sides of the teeth investigated and furcation upper and lower boundary. Jaw localization, anatomical region-of-interest, the number of roots and experience of the observers were evaluated. All measurements were carried out twice by the same observers within a 6-week interval. Slightly higher measurement deviations (SD) in the range of 0.47 (0.40) mm were found for CBCT evaluation compared to panoramic imaging. Pearson correlation analysis showed statistically strong positive correlation for the mesial and distal aspects, moderate positive correlation was found for the investigated furcations between both radiographic modalities. Compared to the clinical reference, the mean total error of measurement (SD) was larger for panoramic imaging (0.66 (0.48) mm) than CBCT (0.27 (0.08) mm) for all three observers. Software-supported CBCT analysis delivers better diagnostic information about the bony periodontal conditions of the patient compared to two-dimensional radiographs. However, it remains unclear if these additional information lead to better periodontal outcomes.

Morphological changes in alveolar bone thickness and height after orthodontic proclination or labial movement combined with autogenous soft tissue grafting: a CBCT evaluation

BackgroundAutogenous soft tissue grafting is indicated in thin gingival biotypes before orthodontic proclination or labial movements to increase the keratinized gingiva and prevent gingival recession. However, its effect on local alveolar bone remodeling is unclear. The aim of this study was to investigate the effects of autogenous soft tissue grafting on local alveolar bone after orthodontic proclination or labial movements.MethodsSixteen patients with a thin scalloped gingival biotype, narrow keratinized gingiva, or thin cortical bone requiring orthodontic proclination or labial movement of teeth were included. Cone-beam computed tomography (CBCT) images were obtained before grafting and at least 6 months after surgery. Sixty mandibular teeth were included, and the vertical bone level and horizontal labial bone thickness were measured. The results were compared using paired t-tests or Wilcoxon signed-rank test.ResultsThe horizontal labial bone thickness increased, especially at 6 mm below the cementoenamel junction (CEJ) in the mandibular central and lateral incisors (P < 0.05). The total alveolar bone area of the canines, first premolars, and second premolars increased at 3, 6, and 9 mm below the CEJ, respectively, and the differences were statistically significant (P < 0.05). Additionally, vertical bone height increased minimally on the labial side, but the differences were not statistically significant (P > 0.05).ConclusionsNew bone regeneration was observed on the labial (pressure) side after autogenous soft tissue grafting, which may represent a mechanism to effectively prevent gingival recession and maintain periodontal health.IRB approvalAll the experimental procedures involving humans in this study were approved by the Medical Ethics Committee of Xiangya Stomatological Hospital, Central South University ( No. 20190048).

Three-Dimensional Cone-Beam Computed Tomography Evaluation of Changes in Naso-Maxillary Complex Associated with Rapid Palatal Expansion.

The introduction of Cone-Beam Computed Tomography (CBCT) in orthodontics has added a new tool to diagnosis and treatment planning. The aim of this prospective clinical trial was to investigate the changes in the dimensions of the naso-maxillary complex in growing patients after RPE using CBCT. A total of 16 growing children (8 females, 6 males) with a mean age of 11, 12 ± 1 and 86 years underwent RPE as part of their comprehensive orthodontic treatment. CBCT scans were obtained before RPE (T1), immediately after RPE (T2) and 6 months after RPE (T3). The dimensions of the nasal width, nasal floor and the aperture of the midpalatal suture were calculated in different coronal slices of CBCT. Evaluation of the mean value variance per measurement at the three time intervals were performed using the paired Wilcoxon signed-rank test. Differences between the three time intervals were assessed by performing Multiple Pairwise Comparisons. A statistically significant increase in all measurements was seen immediately after RPE expansion (T2-T1) and six months after expansion (T3-T1). Between the end of expansion and 6 months in retention (T3-T2), a decrease was observed for all measurements. RPE can cause expansion of the nasal cavity in growing patients. The expansion of the midpalatal suture follows a triangular pattern of opening.

Cone Beam Computed Tomography Evaluation of Transportation of Three Endodontic Single File Systems.

Aims: The present study aims to compare and evaluate transportation of three different single endodontic files (EdgeOne Fire, One curve file and Wave One Gold file) by using CBCT. Materials and Methods: Thirty freshly extracted human mandibular first molars with mature apices and intact mesial root randomly distributed into three groups (n=10) only Mesiobuccal canals (MB) with curvatures of 25–35 were prepared by using Edge One Fire (group A), MicroMega One curve file (group B) and Wave One Gold file (group C) and 3-dimensional, high-resolution CBCT images were obtained using CS8100 3D equipment (Carestream Health, Rochester, NY) at three cross-section levels that corresponded to 3-mm, 5-mm, and 7-mm distance from the apical end of the root before and after root canal preparation with 87 KV, 2.00 mA and 150 µm voxel size to determine the degree of canal transportation of the three file systems. Results: the highest degree of root canal transportation appeared with One Curve file while Edge One Fire showed the lowest degree of root canal transportation and there was a statistically significant difference between all three files. Conclusions: Within the limitations in this study, it can be concluded tha all tested Ni-Ti file systems resulted in root canal transportation, and Edge One Fire file is safer during preparation of curved canals than One Curve file.

A CBCT Evaluation of the Proximity of Mandibular Molar Roots and Lingual Cortical Bone in Various Vertical Facial Patterns and Factors Related to Root-Cortical Bone Contact

The objective of this study was to assess the proximity of the mandibular molar roots and the lingual cortical bone in patients with various vertical facial patterns and determine factors related to root-cortical bone contact. A total of 145 patients (84 males, 61 females, mean age: 22.0 ± 1.76 years) were assigned to hypodivergent (36 patients), normovergent (80 patients) and hyperdivergent (29 patients) groups based on their facial height ratio. Cone-beam computed tomography (CBCT) images were used to measure the distance between the mandibular molar roots and the lingual cortical bone, and any instances of root-cortical bone contact were identified. The study investigated the correlation between the contact of the mandibular molar roots with the lingual cortical bone and several variables, including sex and cephalometric measurements. The distance between the mandibular molar roots and the lingual cortical bone was significantly shorter in the hyperdivergent group than in the hypodivergent group (p &lt; 0.05). Of the total root-cortical bone contact, 87.6% was observed in the mandibular second molars, and the distal roots of the mandibular second molars had the highest contact rate at 43.1% in the hyperdivergent group (p &lt; 0.05). Among the evaluated variables, only the distance between the distal root apex of the mandibular second molar and the mandibular plane was found to be associated with contact of the mandibular molar roots with the lingual cortical bone. An increase of 1 mm in this distance was associated with a 22% decrease in the likelihood of contact between the mandibular second molar roots and lingual cortical bone (p &lt; 0.001). Given the proximity and high contact ratio between the mandibular molar roots and lingual cortical bone, it is recommended that these structures be evaluated using CBCT before planning molar distalization or intrusion in hyperdivergent patients.

Alveolar bone defects around mandibular anterior teeth in Class I, II, and III malocclusions: a retrospective CBCT evaluation

Background: The aim of this study was to quantitatively and qualitatively evaluate alveolar defects of mandibular anterior alveolar bone in three different types of malocclusion with cone-beam computed tomography (CBCT) by an observational cross-sectional study.

Reorientation methodology for reproducible head posture in serial cone beam computed tomography images

Low dose and accessibility have increased the application of cone beam computed tomography (CBCT). Often serial images are captured for patients to diagnose and plan treatment in the craniofacial region. However, CBCT images are highly variable and lack harmonious reproduction, especially in the head’s orientation. Though user-defined orientation methods have been suggested, the reproducibility remains controversial. Here, we propose a landmark-free reorientation methodology based on principal component analysis (PCA) for harmonious orientation of serially captured CBCTs. We analyzed three serial CBCT scans collected for 29 individuals who underwent orthognathic surgery. We first defined a region of interest with the proposed protocol by combining 2D rendering and 3D convex hull method, and identified an intermediary arrangement point. PCA identified the y-axis (anterioposterior) followed by the secondary x-axis (transverse). Finally, by defining the perpendicular z-axis, a new global orientation was assigned. The goodness of alignment (Hausdorff distance) showed a marked improvement (> 50%). Furthermore, we clustered cases based on clinical asymmetry and validated that the protocol was unaffected by the severity of the skeletal deformity. Therefore, it could be suggested that integrating the proposed algorithm as the preliminary step in CBCT evaluation will address a fundamental step towards harmonizing the craniofacial imaging records.

Bilateral symmetry and anatomical root variations of mandibular second molars in North Indian populations using cone beam computed tomography.

To evaluate bilateral symmetry and anatomical variations of root morphology of permanent mandibular second molar using systematic evaluation of CBCT scans. This cross-sectional study involved the mandible which were imaged using serial axial cone-beam computed tomography (CBCT) from 680 North Indian patients who visited dental hospital for various reasons unrelated to the study. CBCT Records with presence of bilateral fully erupted permanent mandibular second molars with fully formed apexes were selected. Bilaterally present two root and three canal configurations were most consistently seen (75.88 % and 59.11 %, respectively). The occurrence of two roots with two canals and four canals was 15.14% and 1.61% respectively. Mandibular second molar present with one extra root, radix entomolaris with three canals and four canals was 0.44% and 3.53% while radix paramolaris present with three canals and four canals 1.32% and 1.03% respectively. The occurrence of C-shaped root bilaterally with C shaped canal was 15.88% whereas the presence of one fused root bilaterally was 0.44%. The presence of four roots bilaterally with four canals was identified in only one CBCT scanned image (0.14%). The frequency distribution of root morphology on bilateral symmetrical analysis revealed 98.58 % bilateral symmetry. In 402 CBCT scans, bilateral presence of two roots with three canals was the most typical root structure seen in mandibular second molars (59.11%). A rare variation found was the presence of four roots occurring bilaterally, seen in only 1 CBCT scan. Bilateral symmetrical analysis of root morphology revealed 98.58 % bilateral symmetry. Key words:Anatomic root variations, mandibular second molar, Cone Beam Computed Tomography scans, bilateral symmetry.