The importance of Cone-Beam computed tomography in clinical research: gender differences and bilateral symmetry of permanent teeth anatomy in a saudi arabian population

Aims and Objectives: To retrospectively explore the relationship of maxillary and mandibular permanent dentition taking into consideration the number of roots, their respective quantity of root canals, the bilateral symmetry of root canal morphology and root canal configurations between both genders, in a Saudi Arabian population. Materials and Methods: This study comprised of 208 subjects (48% males and 52% females) with a mean age of 28.74±9.56 years. The CBCT images of the recruited subjects were evaluated for all permanent teeth except third molars. A careful examination was obtained by optimal visualization using all software features to investigate the differences between both genders and to evaluate the bilateral symmetry of number of roots, number of canals and root canal system configurations. The data was analyzed using SPSS 25. Cohen’s Kappa test was used for reliability and bilateral symmetry, while, Chi-squared test was used for the differences ii between both genders in relation to the study variables. A P-value < 0.05 was considered significant. Results: Gender differences: A total of 5254 maxillary and mandibular permanent teeth were evaluated. In relation to the number of roots, there were no significant differences between the genders for maxillary and mandibular teeth (P= 0.064) as well as for maxillary and mandibular teeth separately (P= 0.315 and P= 0.100, respectively). Significant difference was found between males and females in relation to number of canals of maxillary teeth (P= 0.014). For mandibular teeth, the significant level of difference was at the cut-off point (P= 0.050). For both arches the distribution among both genders was not significant (P= 0.082). Conversely, the difference between both genders with regard to canal configuration of maxillary roots was highly statistically significant (P< 0.001). For mandibular teeth, difference between males and females in relation to canal configuration of anterior and premolar teeth was significant (P= 0.016) while, the same was not significant when related mesial roots of 1st and 2nd molars (P= 0.205). However, a greater significance was found when distal roots of 1st and 2nd molars were compared (P< 0.001). Bilateral symmetry: The Bilateral symmetry of number of roots was 100% in maxillary centrals, laterals, canines, 1st molars, and 2nd molars. In the mandibular arch however, it was 100% in mandibular centrals, and 2nd premolars only. The most frequent asymmetry was exhibited by the maxillary 1st premolars (14.9%). In relation to number of canals, the bilateral symmetry was 100% in maxillary centrals and laterals only. The commonest asymmetry was found in maxillary 2nd molars (18.9%). When canal configuration was assessed, the bilateral symmetry was found to be 100% in maxillary centrals and laterals. However, the most frequent asymmetry was found in maxillary 2nd premolars (32.2%). iii Conclusion: No significant differences were found between both genders in relation to the number of roots. Regarding number of canals, significant differences were detected only in 3 out of 14 groups of teeth. Overall, females had lower number of canals than males. Canal configuration was also governed by gender in this study. Bilateral symmetry was more evident when number of roots were assessed than the canal configurations Clinical relevance: The influence of gender should be considered when root canal morphology is assessed and henceforth root canal treatment is to be performed. Clinicians should be aware of these variations particularly when treating contralateral teeth in the same individual as well. Also, the utilization of CBCT could aid in proper dental therapy for teeth when conventional 2-D radiographs are inconclusive.