Mapping Root and Canal Anatomy in Saudi Populations Using Cone-Beam Computed Tomography: Prevalence, Classification, and Clinical Implications for Endodontic Practice

Accurate understanding of root and canal anatomy is essential for endodontic success. Cone beam computed tomography (CBCT) improves visualization over 2 D imaging and supports systematic, reproducible interpretation in clinical practice. Objective: To synthesize CBCT based evidence on root and canal morphology in Saudi subpopulations and outline the clinical implications for access, scouting, and preparation. Methods: We followed PRISMA aligned methods to identify English original studies from Saudi centers reporting CBCT findings on permanent teeth. Eligibility included observational designs describing root number, Vertucci configuration, second mesiobuccal canal (MB2), C shaped canals, and relevant inter orifice measurements. Due to heterogeneity in tooth types, reporting schemes, and CBCT parameters, we conducted a structured narrative synthesis. Results: in included studies, mandibular molars most commonly exhibited two roots with three canals, with Vertucci type IV frequent in mesial roots and type I in distal roots. C shaped morphology was reported in mandibular molars, with notable regional and sex related variation. In maxillary molars, MB2 was detected in first molars and less often in second molars; inter-orifice spatial relationships were mapped at the pulp floor level, reinforcing the need for methodical troughing and magnification. Premolars were predominantly single-rooted/single-canal in mandibular arches, whereas maxillary first premolars commonly showed two roots; taxonomy influenced reporting. Conclusions: CBCT guided, tooth specific strategies integrating demographic risk cues, standardized interpretation, and meticulous clinical exploration, can reduce missed anatomy and optimize endodontic outcomes. Future multicenter studies using harmonized CBCT acquisition and classification frameworks are warranted to refine prevalence estimates and clinical pathways.