Therefore, the aim of this study was to evaluate the influence of bifid and non-bifid apical configurations of the mesial root of mandibular first molars in the canal anatomy, using micro-CT imaging system. Despite the anatomy of the mesial root of mandibular first molars had been deeply investigated in the literature (Keleş & Keskin, 2017a, 2018, Villas-Bôas et al., 2011), to date no study had correlated different morphological aspects of this root with its internal anatomy. More recently, a micro-computed tomographic (micro-CT) study demonstrated that the apical shape of the mesiobuccal root of maxillary first molars had a significant influence in the complexity of the root canal system (Ordinola-Zapata, Martins, Niemczyk, & Bramante, 2019). Authors explained that differences in the external root morphology of this group of teeth have been linked to distinct occlusal loading regimes and that variations in their internal root structure has not yet been precisely quantified (Kupczik & Hublin, 2010). Later, in an anthropological study of Homo sapiens from Northwest Africa, Kupczik and Hublin (2010) described the presence of bifid-tipped mesial roots in mandibular molars.
According to him, this new nomenclature had a considerable biological significance considering that more anatomical variations could be observed in the area between the tip and the next third of the tooth than beyond the first third of the tooth from the tip. In 1981, Turner suggested that multiple root number of the maxillary first premolars could be defined on the basis of root bifurcation and used the term ‘bifid-tipped’ to describe an incipient two-rooted appearance observed in this group of teeth (Turner, 1981).
Consequently, in infected canals, the microbial load in additional anatomies must be properly reduced during preparation procedures once harbour persistent bacteria may jeopardize the treatment outcome (Costa et al., 2019). This complexity has been found to compromise the chemomechanical protocols for root canal disinfection by the inability of instruments and antibacterial solutions to reach inaccessible areas of the root canal system (Alves et al., 2016). The mesial root frequently presents a complex canal configuration, with isthmus communications, ramifications, recesses, and accessory canals (Villas-Bôas et al., 2011). This tooth usually has two roots, one mesial and one distal, widely separated at the apex. Mandibular first molars are the most frequent endodontically treated teeth (Wayman, Patten, & Dazey, 1994).
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