Mandibular incisors are traditionally described as having a single root and a single canal. Traditionally, it is considered the simplest tooth to treat endodontically. However, numerous studies have reported anatomical variations in the anterior teeth of the mandible. Mandibular incisors frequently exhibit anatomical variations, including the presence of a second root canal, which is often located lingually. This lingually placed canal is often overlooked by clinicians due to the narrow mesiodistal dimension of the tooth, superimposition on conventional radiographs, and limited understanding of the complex internal anatomy. The clinicians often fail to locate the lingual canal due to a lack of experience and understanding of root canal morphology, leading to continuing periapical pathology and eventual endodontic failure. Consequently, a thorough diagnostic approach is essential. The use of multiple angulated periapical radiographs, and where indicated, advanced imaging techniques, can greatly enhance the detection of canal bifurcations. In addition, carefully modified access cavity designs that extend slightly towards the cingulum improve the likelihood of locating the lingual canal orifice. The report emphasizes careful radiographic evaluation, modified access cavity design, and the use of magnification for identification and management of the lingual canal. This case series aims to describe the diagnosis and location of nonsurgical endodontic management of mandibular incisors with two canals, emphasizing the clinical and radiographic identification for successful treatment. Keywords: Endodontic treatment, Two canals, Bifurcation

Temporary restorative materials are important for maintaining coronal seal during multi-visit endodontic procedures. Coltosol F, a moisture-activated, self-setting material, is valued for its simplicity and sealing ability, though concerns exist regarding its potential to induce tooth fractures. To evaluate the clinical performance of Coltosol F as temporary restoration material, focusing on tooth fracture incidence, spontaneous dislodgement and the role of a cotton pellet as a spacer material. DuoTemp placed with a cotton pellet and Coltosol F placed without a cotton pellet were used as control groups. A retrospective analysis of 153 consecutive patients requiring primary endodontic treatments (n = 185) performed in an endodontic clinical section from 2019 to 2024 was conducted. All treatments were performed by postgraduate master operators through a predefined rehabilitation protocol. A total of 111 patients, corresponding to 138 Coltosol F treated teeth, were analyzed: 107 teeth with a cotton pellet used as a spacer material (Group A) and 31 without (Group B). Additional groups included 15 patients with 18 teeth provisionally restored with Coltosol F and a cotton pellet under a provisional crown (Group C), and 27 patients with 29 teeth provisionally restored with DuoTEMP (Group D). Outcomes evaluated after 7-14 days included coronal fractures, root fractures and material dislodgment. At 7-14 days, adverse events were rare. In the Group A with cotton pellet group, we observed 3 coronal fractures (2.8%), 1 root fracture (0.9%), and 5 spontaneous dislodgements (4.6%). In the Group B, there were 1 coronal fracture (3.2%), 1 root fracture (3.2%), and 1 dislodgement (3.2%). Group C had no adverse events. Group D showed 1 coronal fracture (3.4%) and no dislodgement. Between-group differences were not statistically significant. Coltosol F showed a low short-term incidence of fracture and dislodgement during 7-14-day inter-appointment temporization. No statistically significant differences were detected between groups. No adverse events were observed when the temporary restoration was shielded by a provisional crown.

Protoporphyrin IX fluorescence for real-time visualization of bacterial persistence during root canal treatment.

Dental pulp inflammation and impaired tissue repair remain critical challenges in endodontic therapy, often exacerbated by hypoxia and dysregulated immune responses. We developed a procyanidin-copper-loaded oxygen-generating microneedle hydrogel (CA-PCC-CAT) releasing active components into deeply infected pulp tissue in a pH-responsive manner to exert potent antioxidative and anti-inflammatory effects. In vitro experiments demonstrated that the hydrogel effectively protected hDPSCs through its multifunctions, including antibacterial activity, antioxidative stress modulation, anti-inflammatory action, and hypoxia alleviation. Simultaneously, it augmented macrophage efferocytosis by scavenging reactive oxygen species (ROS), thereby facilitating the clearance of apoptotic cells and enhancing tissue repair. This study represents a promising strategy for developing multifunctional biomaterials to amplify the anti-inflammatory capacity of hDPSCs and advance the field of pulp preservation and regenerative therapy.

Background and objectives: Head and neck cancer patients frequently undergo radiotherapy, which can affect the properties of dental hard tissues. This study aimed to evaluate the effects of root canal treatment, radiotherapy, and sonic activation during irrigation on the fracture resistance of mandibular anterior teeth. Methods: 80 extracted mandibular anterior teeth were randomly divided into five groups: untreated control (Group I); root canal treatment without radiotherapy or sonic activation (Group II); root canal treatment without radiotherapy but with sonic activation (Group III); root canal treatment with 70 Gray (Gy) radiotherapy and sonic activation (Group IV); and root canal treatment with radiotherapy but without sonic activation (Group V). Radiotherapy was administered in fractionated doses (2 Gy/day, 5 days/week) over 7 weeks. Following instrumentation, root canal obturation was performed accordingly. Fracture resistance was measured using a universal testing apparatus with vertical loading until fracture. Statistical analyses included Shapiro-Wilk normality testing followed by appropriate non-parametric Kruskal-Wallis test followed by Dunn's post hoc test with Bonferroni correction for multiple comparisons. Results: All root canal-treated groups exhibited significantly lower fracture resistance compared to the untreated control group [1572.3 (1217.0-1841.2) N, p < 0.05]. No statistically significant differences were observed between irradiated and non-irradiated groups (p > 0.05). Similarly, sonic activation during irrigation did not significantly affect the fracture resistance values (p > 0.05). Conclusions: Under the specific conditions of this in vitro protocol, fractionated radiotherapy and sonic activation did not demonstrate statistically significant effects on fracture resistance in mandibular anterior teeth, while endodontic procedures reduced fracture resistance.

Background/Objectives: The presence of untreated second mesio-buccal canals (MB2) in maxillary first molars is usually associated with endodontic treatment failure. Previous CBCT-based investigations have evaluated the quality of root canal fillings and the prevalence of apical lesions in endodontically treated teeth. However, evidence specifically addressing untreated MB2 canals and their association with apical periodontitis remains limited. Therefore, the aim of this cross-sectional study was to evaluate the prevalence of unfilled MB2 canals in endodontically treated maxillary first molars and their association with apical periodontitis. Methods: CBCT scans of 75 patients from an endodontic practice were retrospectively analyzed. Maxillary first molars (teeth 16 and 26) were evaluated for the presence and filling status of root canals (MB1, MB2, palatal, distal) and the presence of periapical radiolucency using the CBCT periapical index. Two calibrated examiners independently assessed all images. The association between unfilled MB2 canals and apical periodontitis was analyzed using chi-square tests, and odds ratios with 95% confidence intervals were calculated. Results: The mean patient age was 53.4 ± 15.5 years (range: 14-80). An MB2 canal was present in 84% (63/75) of eligible teeth. Among teeth with an MB2 canal, only 20.6% (13/63) were endodontically filled, while 79.4% remained untreated. Apical periodontitis was observed in 65.3% (49/75) of all teeth. A significant association was found between unfilled MB2 canals and apical periodontitis (p < 0.001), with an odds ratio of 0.095 (95% CI: 0.022-0.402), indicating that filled MB2 canals significantly reduced the possible risk of periapical pathology. Conclusions: A high prevalence of unfilled MB2 canals was observed in this German population (79.4%). Furthermore, unfilled MB2 canals were strongly associated with apical periodontitis. Therefore, clinicians should utilize all available diagnostic tools, including CBCT and dental microscopes, to maximize MB2 canal identification and improve endodontic treatment outcomes.

This study aimed to evaluate the antimicrobial and antibiofilm properties of a novel endodontic sealer against Enterococcus faecalis (E. faecalis). Long-lasting antimicrobial sealers can inhibit bacterial growth and reduce persistent infections following root canal treatment. The primary objective was to compare the new sealer with the AH Plus sealer in terms of antimicrobial and antibiofilm efficacy. Five experimental sealer formulations (Groups A-E) were prepared using the spatula mixing method. Disks (6 mm diameter) were fabricated and evaluated using colony-forming unit (CFU) counts and disk diffusion assays. Biofilm formation by E. faecalis was assessed prior to testing the antibiofilm activity, which was quantified using the minimum biofilm inhibitory concentration (MBIC). Group D and AH Plus sealer demonstrated the lowest CFU counts among the new sealer formulations (P>0.05). Group D exhibited the largest inhibition zone compared to the other experimental groups (P>0.05). The mean MBIC against E. faecalis was 256 μg/mL for both Group D and AH Plus sealer. The newly developed sealer (Group D) displayed antimicrobial and antibiofilm effects comparable to AH Plus sealer against E. faecalis. Group D shows promise as a candidate for further evaluation in clinical studies, demonstrating efficacy similar to the commercially available AH Plus sealer.

The aim of this study was to evaluate the effect of different irrigation solutions used during root canal irrigation in root canal treatment on the microhardness of nickel-titanium (NiTi) files subjected to different heat treated. The pre-preparation microhardness levels of EndoArt Smart Blue and EndoArt Smart Gold (İnci Dental Productions Co, Istanbul, Turkey) file systems were measured at five different points using a microhardness testing device (HMV-2000; Shimadzu, Tokyo, Japan). Microhardness evaluation was performed on thirty-two 30.04 files from each file system. A total of 64 single-rooted and single-canaled mandibular incisor teeth were prepared up to size 30.04 using file systems. The preparation was completed with the irrigation solutions (5.25% NaOCl, 17% EDTA, ozonated water, and distilled water) for an average of 3 min with a 30.04 file. After preparation, the microhardness levels of the 30.04 files were again measured. The differences between the microhardness values were statistically compared. According to the obtained data, the pre-preparation measurement values were higher than the post-preparation values (p < 0.05). No statistically significant differences were found between the microhardness measurement values (p > 0.05). The highest and lowest microhardness changes were observed in the EndoArt Smart Blue file system, in the ozonated water (195.63 ± 71.04 VHN (Vickers Hardness Number)) and distilled water (152.88 ± 51.10 VHN) groups, respectively. In this study, different irrigation solutions did not have a statistically significant effect on the microhardness of heat-treated NiTi files.

Objective: To determine the anesthetic effectiveness of inferior alveolar nerve block with 2% lidocaine and inferior alveolar nerve block with 2% lidocaine supplemented with 4% articaine buccal infiltration for the mandibular molars in non-surgical root canal treatment with symptomatic irreversible pulpitis.Methods: This prospective interventional comparative single-blind study was conducted at PNS Shifa Hospital, Karachi. Based on the non-probability convenience sampling, 88 adults aged 18-52 years old, with irreversible pulpitis of vital mandibular molars diagnosed as spontaneous lingering pain with positive cold pulp test, were randomly allocated to either Group A, who received IANB with 2% lidocaine alone or Group B received IANB with 2% lidocaine supplemented with 4% articaine buccalinfiltration. Heft Parker VAS Scale was used to report pain levels during the endodontic treatment. SPSS 27.00 software version was used to analyze the data.Results: Mean age in Group A was 35.6 ± 9.16 years, while in Group B it was 32.9 ± 10.54 years. Mean VAS pain score in Group A was 3.3 ± 2.68 compared to 3.0 ± 2.39 in Group B. There were 20 (45.5%) males and 24 (54.5%) females in Group A, and 30 (68.2%) males and 14 (31.8%) females in Group B. Pain severity in Group-A was no Pain 6 (13.6%), Mild Pain 21 (47.7%), Moderate Pain 11 (25.0%), and Severe Pain 6 (13.6%); in Group-B, No Pain 5 (11.4%), Mild Pain 28 (63.6%), ModeratePain 6 (13.6%), and Severe Pain 5 (11.4%). Treatment effectiveness was achieved in 28 (63.6%) patients in Group A and 33 (75.0%) in Group B.Conclusion: The combined approach of IANB with 2% lidocaine supplemented with 4% articaine buccal infiltration had significantly improved the anesthetic success outcome as compared to the 2% lidocaine alone for IANB.

INTRODUCTION. Evaluation of endodontic treatment outcomes through radiographic assessment is subject to interobserver variability and depends heavily on clinician experience. Artificial intelligence (AI) platforms offer potential for standardized, objective assessment of periapical healing. MATERIALS AND METHODS. This retrospective study analyzed 400 panoramic radiographs from patients who underwent root canal treatment between January 2023 and December 2024. An AI platform developed using TensorFlow and Keras, with model training in PyTorch and validation in MATLAB Deep Learning Toolbox, was employed. Three blinded expert endodontists independently assessed all radiographs, with consensus serving as the gold standard. Outcomes were classified as healed, healing, or diseased based on periapical index criteria. Diagnostic performance metrics including sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated. RESULTS. The AI platform demonstrated overall accuracy of 89.8% in classifying treatment outcomes. For detecting healed cases, sensitivity was 92.3%, specificity 87.6%, PPV 88.9%, and NPV 91.5%. For diseased / persistent pathology detection, sensitivity was 88.7%, specificity 93.2%, PPV 84.3%, and NPV 95.1%. Agreement between AI and expert consensus was substantial (Cohen’s κ = 0.834, p &lt; 0.001). AI performance was superior in anterior teeth (93.2% accuracy) compared to molars (86.4% accuracy, p = 0.008). Processing time per radiograph averaged 2.3 ± 0.4 seconds. CONCLUSIONS. The AI-driven platform demonstrated high diagnostic accuracy comparable to expert assessment, with potential for standardized, rapid evaluation of endodontic treatment outcomes. Further prospective validation and clinical integration studies are warranted.

Root canal treatment is crucial for preventing oral diseases, and its success hinges on the effective removal of biofilm and debris from the canal wall by the irrigant. However, the intricate and narrow anatomy of root canals limits the efficacy of irrigant jet in the critical apical region, hindering fluid mixing and the removal of wall-adherent material. To address this, a passive self-exciting jet technique using a novel slot jet needle is proposed. This design aims to reorganize the flow and induce secondary jet self-excitation within the narrow cavity, thereby enhancing root canal irrigation effect. The influence of the slot angle and aperture diameter is first investigated, and the results show that the efficacy of jet coupling depends not only on the slot jet direction but also on the relative strength of the jets. The irrigation performance is optimal when the slot angle is 90 deg and the aperture diameter is 0.1 mm. Furthermore, the influence of the tapering angle is investigated using the principle of a tapering nozzle. Compared to the clinically common prototype 30 G needle, the optimized design increases the effective cleaning area by up to 20.82% and the extending depth by up to 50.79%, while reducing the mean apical pressure by up to 23.39%. These improvements demonstrate that the cleaning performance, mass exchange capability, and safety are improved simultaneously.

Abstract Aim: The aim of this study was to perform a two-dimensional (2D) and three-dimensional (3D) comparative evaluation of bone regeneration using autologous platelet-rich fibrin (PRF) versus calcium phosphosilicate-based bone putty in large periapical lesions before and after endodontic surgery. Materials and Methods: Fifty patients with a history of dental trauma and periapical pathology involving the maxillary and mandibular anterior and premolar tooth regions were randomly allocated into two groups, with 25 patients in each group. All patients underwent endodontic surgery following root canal treatment. Bony defects were managed with autologous PRF in Group I and bone putty in Group II. After a 1-year follow-up period, 2D healing was assessed using intraoral periapical radiographs (IOPARs), and area calculation was performed using ImageJ software. 3D healing was evaluated using cone-beam computed tomography (CBCT), and volumetric analysis was conducted using ITK-SNAP software. Results: Patients in Group II exhibited a significantly greater reduction in lesion volume (95.017% ±5.809%) and area (98.376% ± 2.916%) compared to those in Group I (volume reduction: 72.449% ± 14.264% and area reduction: 87.868% ± 11.048%). Bone healing assessed through CBCT and volumetric analysis using ITK-SNAP (83.733 ± 15.668%) was found to be more accurate than 2D area evaluation (93.122 ± 9.598) using IOPAR. Conclusion: Calcium phosphosilicate-based bone putty demonstrated significantly faster bone regeneration than PRF. CBCT-based volumetric assessment (3D) provides a more objective and accurate evaluation of bone healing than conventional IOPAR-based area assessment (2D) and may serve as a valuable tool for assessing treatment outcomes in complex endodontic surgeries.

Accuracy and efficiency of four guided techniques for calcified canal access: an in vitro study with a novel 3D-printed model.

Long-term clinical outcomes for single dental crowns versus extensive direct restorations: A register-based cohort study with up to 10 years of follow-up in a Swedish population.

Introduction: Digital impressions are dental scans captured using Three-dimensional (3-D) scanning technology. Scanning deeper areas can affect the accuracy and completeness of the digital impression, potentially leading to inaccuracies in the final restoration. Scanning post spaces at greater depths and narrower diameters can pose significant challenges for digital scanning. Aim: To compare the volume of post space impressions made using the digital impression technique (Primescan/Dentsply Sirona) with the volume obtained from Cone Beam Computed Tomography (CBCT) imaging. Materials and Methods: The present in-vitro study was conducted between January and April 2025 in the Department of Conservative Dentistry and Endodontics at DAPM RV Dental College, Bengaluru, Karnataka, India. A total of 15 extracted single-canal, single-rooted permanent teeth were collected for this in-vitro study. All the teeth were cut coronally to maintain an equal length of 22 mm. Endodontic treatment was performed on all the teeth, followed by post space preparation, leaving behind 5 mm of gutta-percha. Group A: A CBCT reference scan was performed for all the samples; the volume of the post space was measured using on-demand software for each tooth, which served as a control. Group B: The same samples were subjected to a digital impression (Primescan/Dentsply Sirona), and the volume of the post space was recorded using Exocad software. Group B values were compared with the corresponding group A reference values. Results: The intraoral scanned images (group B) recorded a slightly smaller volume than that obtained from CBCT. Although the mean difference between the two methods was 0.7384 mm3 , it was shown to be statistically significant (p&lt;0.001). Conclusion: Based on the analysis of the study results, it can be concluded that the mean difference in volume between CBCT and Primescan was 0.738 mm3 , with the Primescan recording 97.82% of the volume. The Primescan demonstrates clinically acceptable accuracy in scanning the post space.

Abstract Background: Complete disinfection of the root canal while preserving dentinal integrity remains a major challenge. Diode laser activation improves irrigant penetration yet its combined effect with novel irrigants Triton and Twin Kleen on dentin composition remains unclear. Aims: To compare the effect of Triton, Twin Kleen, and sodium hypochlorite (5.25% NaOCl) +ethylenediaminetetraacetic acid (17% EDTA) with and without diode laser activation on the radicular dentin composition. Materials and Methods: Eighty extracted human mandibular premolars were prepared and divided into four groups ( n = 20): Normal saline, Triton, Twin Kleen, and NaOCl + EDTA. Each group was further subdivided into diode laser-activated and nonactivated subgroups. Longitudinal dentin sections were analyzed using attenuated total reflectance Fourier-transform infrared spectroscopy to assess the root dentin inorganic and organic alterations. Statistical Analysis: Kruskal–Wallis and Mann–Whitney U tests ( P &lt; 0.05). Results: Among both laser and nonlaser activated groups, normal saline preserved the highest carbonate and amide peaks, followed by Triton and Twin Kleen and least in NaOCl + EDTA. Diode laser activation slightly decreased all FTIR ratios. Conclusion: Triton activated with and without diode laser, maintained dentin composition effectively, supporting its use as a single step irrigant in endodontic therapy.

Abstract Context: The role of Root canal sealers is a very crucial role in endodontic therapy by forming a hermetic seal within the canal, filling minor voids between the dentinal wall and gutta-percha to prevent microleakage from bacterial infiltration from the oral cavity and tissues of periapical areas. Aim: This study aims to compare and evaluate the depth of penetration and microleakage of AH Plus, Bio-C, Sealapex, and MTA Fillapex using a confocal laser scanning microscope (CLSM). Subjects and Methods: This study evaluated sealer penetration and microleakage in 170 single-rooted teeth divided into two groups ( n = 85 each). Group A assessed sealer penetration of Group I: MTA Fillapex, Group II: Selapex, Group III: Bio-C, Group IV: AH Plus, and Group V: Control group (obturated without sealer) using 0.1% Rhodamine B-labeled sealers, and CLSM was done at 3 mm and 5 mm from the apex. Group B measured microleakage in the above-mentioned 5 groups, after 7-day immersion of samples in 0.1% Rhodamine B and evaluating dye penetration longitudinally from the cemento-dentinal junction. Statistical Analysis: Data were analyzed using paired t-tests, Tukey Honestly Significant Difference, ANOVA, and Pearson’s correlation as statistical tools. Results: Group III has demonstrated the highest sealer penetration at both 3 mm and 5 mm levels, and exhibits the best microleakage resistance. However, minimum penetration has been shown by Group I and Group II at 3 mm and 5 mm, respectively. Group II has shown the highest microleakage among the sealers. Conclusion: Bio-C sealer performed best, whereas Sealapex has shown the worst both in sealer penetration and microleakage.

Abstract Aim: To evaluate periapical healing following nonsurgical root canal treatment of large periapical lesions using three bioactive materials, assessed using cone-beam computed tomography (CBCT) at 6 months and 1 year. Materials and Methods: A total of 40 teeth were taken for this retrospective study with single or multirooted teeth and periapical pathology of 4–8 mm in diameter, present with preoperative and follow-up CBCT scans available. All the cases considered underwent endodontic treatment using one of three bioactive materials (mineral trioxide aggregate, Biodentine, and bioceramics). Assessment of healing was done based on radiographic CBCT scans and CBCT–periapical index (PAI) criteria. The teeth were divided into healing, healed, or diseased based on the changes in the CBCT-PAI score after 6 months and 1 year. All the data were recorded in a tabular form and sent for statistical analysis using Chi-square test, t-test, and Friedman’s test. Results: While there was a statistically significant difference in individual teeth after 6 months ( P = 0.01) and 1 year ( P = 0.004), with maxillary incisors showing the highest percentage of healing after 1 year (29.6%), no significant difference was seen between the use of the three bioactive materials after 6 months ( P = 0.97) or 1 year ( P = 0.78), respectively. There was no statistically significant difference in age-wise ( P = 0.27; 0.82) or gender-wise ( P = 0.82; 0.39) distribution. Conclusion: Among all the teeth assessed, single-rooted maxillary teeth showed the highest amount of healing. All three bioactive materials showed a favorable outcome for the treatment regardless of the material used. In addition, healing outcomes were not significantly influenced by patient age or gender.

Abstract Aim: The study aimed to evaluate and compare the apical sealing ability of three different sealers, i.e., NT Biocera Flo, AH Plus, and Calapex modified with chitosan nanoparticles using spectrophotometric evaluation. Methodology: Thirty-six extracted single-rooted mandibular premolars were selected. Access opening and biomechanical preparation were done using the step-back technique, and samples were randomly divided into three groups with three different sealers ( n = 12): Group 1 – NT Biocera Flo with chitosan nanoparticles, Group 2 – AH Plus with chitosan nanoparticles, and Group 3 – Calapex with chitosan nanoparticles. Following obturation, samples were immersed in 2% methylene blue for 72 h. Teeth were then dissolved in 35% nitric acid, and dye penetration was quantified using a spectrophotometer at 670 nm. Data were statistically analyzed using Kruskal–Wallis and Mann–Whitney U tests. Results: Group 1 (NT Biocera Flo + chitosan nanoparticles) demonstrated the lowest mean dye penetration (1.56 ± 0.48), followed by Group 2 (AH Plus + chitosan nanoparticles) (2.02 ± 0.57), whereas Group 3 (Calapex + chitosan nanoparticles) showed the highest leakage (2.53 ± 0.34). Conclusions: NT Biocera Flo with chitosan nanoparticles demonstrated superior apical sealing ability, followed by AH Plus and Calapex. Context: Achieving an effective apical seal is critical to prevent microleakage and ensure the long-term success of root canal therapy. This study assesses the effect of chitosan nanoparticle incorporation on the apical sealing ability of commonly used endodontic sealers. Settings and Design: This in vitro experimental study was conducted in the Department of Conservative Dentistry and Endodontics, using extracted human mandibular premolar teeth to evaluate the apical sealing ability of different chitosan-modified endodontic sealers. A randomized laboratory design was employed, with samples allocated into three groups based on the sealer used, followed by standardized preparation, obturation, dye penetration, and spectrophotometric analysis.

Abstract Background: Missed root canals are a common cause of endodontic failure and are often related to complex root canal anatomy that cannot be adequately visualized using conventional radiography. Cone-beam computed tomography (CBCT) allows three-dimensional assessment and improves the detection of untreated canals. Aim: The aim of this study was to determine the prevalence of missed canals in endodontically treated mandibular first molars in a Central Indian population and to evaluate their association with extra roots. Materials and Methods: This retrospective cross-sectional study evaluated 400 CBCT scans of endodontically treated mandibular first molars obtained from government and private imaging centers in Central India. Canals appearing unfilled from the cementoenamel junction to the apex were recorded as missed canals. The presence of extra roots was also assessed. Data were analyzed using the Chi-square and Fisher’s exact tests, with statistical significance set at P &lt; 0.05. Results: Missed canals were detected in 88 teeth, representing a prevalence of 22.0%. Extra roots were identified in 15 (3.75%) teeth, of which 11 (73.3%) exhibited missed canals. Teeth with extra roots showed a significantly higher prevalence of missed canals compared to those without extra roots (73.3% vs. 20.0%; χ 2 = 20.92, P &lt; 0.001), with an 11-fold increased odds (odds ratio = 11.0). No significant association was observed between gender and missed canals ( P = 1.00). Conclusion: CBCT revealed a high prevalence of missed canals in mandibular first molars, with extra roots significantly increasing the risk. These findings emphasize the clinical value of CBCT in detecting anatomical complexities and preventing endodontic treatment failure.