Apical Foramen Positional Variability and Its Minimal Distance from the Anatomical Apex in Premolars

Objectives: This study aimed to determine the position of the AF in relation to the root surfaces of human permanent premolar teeth in the region using cone-beam computed tomography (CBCT) imaging. Materials and Methods: A descriptive cross-sectional study was conducted using CBCT images of 206 patients from the Iraqi Kurdistan region. Multiplanar CBCT scans were analyzed to determine the AF position relative to the root canal surface of the premolars. The mean distance between the AF and anatomical apex was measured and compared between quadrants and sexes. Statistical analysis was performed using Fisher’s chi-square and t-tests, with a significance threshold set at p = 0.05. Results: The central AF location was the most prevalent in premolars, followed by distal and mesial locations. However, the central and mesial positions were the most prevalent in the mandibular right second premolar. The mean AF-anatomic apex distance for the first premolars on the right side was 0.6205 mm. For the second premolars, the distances were 0.6205 mm in males and 0.5854 mm in females. No significant variations were observed based on the parameters outlined in the methodology. Conclusion: The apical foramen was predominantly located centrally in the premolars, followed by the distal position. To enhance the success rate of root canal therapy, a minimum of 1 mm safety margin from the anatomic apex in premolars is recommended to improve treatment outcomes.