Geographical diversity in root canal anatomy of primary molars and its clinical implications: A systematic review and meta-analysis

Abstract

Background: Anatomical variability in primary molars across geographic regions presents significant challenges in pediatric endodontics. Regional differences in root canal morphology complicate diagnosis and treatment planning, emphasizing the need for population-specific insights. Objective: This review synthesizes evidence on geographical variations in root canal anatomy, focusing on population-specific characteristics and their clinical relevance. Materials and Methods: Following PRISMA guidelines, databases including PubMed, Scopus, Web of Science, EBSCOhost, Embase, and the Cochrane Register were comprehensively searched. Studies employing advanced imaging modalities such as cone-beam computed tomography, micro-computed tomography, multidetector computed tomography, and nano-computed tomography to analyze root canal morphology were included. Observational studies describing root canal configurations and prevalence in primary molars were reviewed. A meta-analysis was performed to determine pooled prevalence rates and geographical trends for Vertucci canal configurations in maxillary and mandibular molars. Results: The analysis of 36 studies encompassing 4863 primary molars revealed significant regional variations. Australian maxillary molars exhibited a higher prevalence of fused roots, while Indian and Turkish mandibular molars displayed more accessory canals. Japanese molars were characterized by thinner dentin walls, reflecting population-specific trends in root canal anatomy. Conclusion: Geographical variations in root canal morphology underscore the need for region-specific research and tailored treatment strategies in pediatric endodontics. Advanced imaging modalities play a pivotal role in improving diagnostic accuracy and optimizing clinical outcomes.