Aim: The rising average age increases edentulous cases, demanding more implant–prosthetic rehabilitation, with cardiovascular diseases being significant factors. This study compared healthy patients (CG = Control Group) and those with cardiovascular disease (TG = Test Group) for implant survival, Marginal Bone Loss (MBL), peri-implant tissue level parameters as Periodontal Screening and Recording (PSR), Plaque Index (PI), Bleeding on Probing (BoP) Peri-implant Probing Depth (PPD), and surgical complications. Smoking impact on both groups and medication influence in the TG were secondary outcomes. Patients underwent full-arch implant prosthetic rehabilitation. Methods: Implant survival rate, MBL, and surgical complications were recorded during the monitoring period (7 years), while peri-implant parameters were assessed at the end of the observational time. A total of 26 and 28 CG and TG patients were recruited, respectively. Results: A total of 128 implants were placed in CG, while 142 in the TG. Implant survival and MBL showed no significant differences (p > 0.05). Nevertheless, peri-implant parameters were more unfavorable in TG. The only significant surgical complication was higher bleeding rates in the TG (p < 0.05). Conclusions: Cardiovascular patients showed similar implant survival and MBL but had adverse peri-implant parameters and increased bleeding rates. Higher smoking levels may relate to unfavorable implant outcomes. Further investigation is needed on drug impact with larger samples.

Background: Mandibular second molars show notable variability in root canal structures and C-shaped morphology, with possible differences among populations. Methods: This retrospective cross-sectional CBCT study included 500 patients attending the Department of Dentistry at IRCCS Ospedale San Raffaele (Milan, Italy) with bilateral mandibular second molars and was reported according to STROBE guidelines. CBCT scans (Hyperion X5; voxel size 0.125 mm) were assessed by two endodontists using standardized criteria. Root-based canal configurations were classified according to Vertucci in cases with complete bilateral coding of homologous mesial and distal roots; C-shaped morphology was classified using Fan’s system and analyzed separately because Vertucci coding is not applicable to C-shaped systems. Categorical variables were analyzed using χ² or Fisher’s exact test, continuous variables with parametric or non-parametric tests, and right–left comparisons with paired-sample tests (p < 0.05). Results: Complete bilateral Vertucci coding was feasible in 494/500 patients (98.8%), yielding 988 mesial and 988 distal roots for analysis. C-shaped canal configuration was detected in 1.2% of patients (6/500; 95% CI 0.44–2.59%); females showed a higher proportion than males (2.0% vs. 0.4%), with no evidence of a sex association (Fisher’s exact test, p = 0.216). Fan subtype annotation was available for 5/6 patients and 7 teeth; C1, C3, and C4 patterns were observed. In the Vertucci dataset, mesial roots most frequently exhibited Types II (52.0%) and IV (26.5%), whereas distal roots were predominantly Type I (62.4%), followed by Type III (29.8%). Contralateral symmetry was observed in 27.3% of mesial roots (135/494; 95% CI 23.4–31.5%) and 59.1% of distal roots (292/494; 95% CI 54.6–63.5%). Mean pulp chamber roof-to-floor distance was 2.623 ± 0.263 mm on the right and 2.567 ± 0.343 mm on the left (paired p < 0.001; mean difference 0.056 mm; 95% CI 0.023–0.089 mm). Conclusions: In this cohort, C-shaped morphology was rare, and no evidence of a sex association was found, although the small number of cases limits statistical power. Mesial roots showed more variability than distal roots, and contralateral symmetry was moderate and greater for distal roots than for mesial roots, supporting contralateral anatomy as a helpful—rather than predictive—clinical reference.

Background: The apical anatomy of mandibular second molars may include accessory foramina not adequately represented by classifications of the main root canal configuration. This ex vivo micro-computed tomographic study evaluated the frequency, number, and two-dimensional perimeter of accessory apical foramina associated with independent mesial and distal canal systems. Methods: Sixty-four extracted mandibular second molars were selected, including teeth with completely separate roots and teeth with partial external root fusion, provided that the mesial and distal canal systems remained independent and terminated in distinct main foramina. Mesial systems were stratified by Vertucci configuration as Type I (n = 21), Type II (n = 21), and Type IV (n = 22), whereas all distal systems were Type I. Specimens were scanned at an isotropic voxel size of 10.98 μm. Accessory apical foramina were defined as openings distinct from the main apical foramen or foramina that were continuous with the canal system and communicated with the external root surface. Mesial and distal systems were compared using paired analyses. Results: Accessory apical foramina were detected in 42/64 mesial systems (65.6%) and 21/64 distal systems (32.8%). Their frequency was significantly higher in mesial systems. Overall, 152 accessory foramina were identified in mesial systems and 66 in distal systems, with significantly higher paired counts mesially (p = 0.0002). Among the 15 teeth presenting accessory apical foramina in both the mesial and distal canal systems, the mean number of accessory foramina was similar between the two systems, whereas distal accessory foramina had a larger mean two-dimensional perimeter. Mesial Vertucci configuration was not significantly associated with their presence or number. Conclusions: Accessory apical foramina occurred frequently, particularly in mesial canal systems. Main canal configuration did not fully represent apical foraminal complexity, emphasizing the importance of cleaning, disinfection, and obturation of the entire apical canal system. Because the sample was deliberately stratified by mesial canal configuration, the reported frequencies characterize the selected sample and should not be interpreted as population prevalence estimates.