Investigation of root canal morphology of mandibular anterior permanent teeth with two different classifications in the population of Turkey: A cone-beam computed tomography study

ABSTRACT Aim: Understanding root canal morphology is essential for successful endodontic treatment, as untreated canals are a major cause of failure. Traditional systems, such as Vertucci’s, are limited in describing complex configurations. The recently proposed Ahmed classification offers a more comprehensive approach. This study aimed to evaluate the root canal morphology of mandibular anterior teeth in a Turkish population using both systems. Methods: A retrospective analysis of 5394 mandibular anterior teeth from 899 cone-beam computed tomography scans (patients aged 14–70 years) was performed. Root canal morphology was classified according to Vertucci (1984) and Ahmed et al. (2017). Coronal, sagittal, and axial images were assessed in 1-mm slices by an experienced endodontist and a calibrated observer. Inter-examiner agreement was calculated using Cohen’s kappa. Data were analyzed with Pearson’s Chi-square and Bonferroni-corrected Z tests (P < 0.05). Results: All mandibular central and lateral incisors were single-rooted, whereas 12 canines had two roots. Vertucci Type I was most prevalent, followed by Type III. According to Ahmed’s system, two variations unclassifiable by Vertucci ( 1 TN 1-2-3-2 and 1 TN 1-2-1-2-1 ) were identified. Root canal variations were significantly more frequent in females for central incisors and canines and in males for lateral incisors (P < 0.05). Variations peaked in the 21–30-year age group. Conclusion: Mandibular anterior teeth in the Turkish population predominantly exhibit Vertucci Type I and III configurations. Gender and age significantly influenced canal complexity. Ahmed’s classification provided a more accurate description of complex and multirooted morphologies, demonstrating clinical superiority over the traditional Vertucci system.