Morphological traits and caries susceptibility of the cusp of carabelli in permanent maxillary molars: A study in Lahore, Pakistan

Objective

To evaluate the prevalence, morphological traits, and caries susceptibility of the Cusp of Carabelli (CoC) in permanent maxillary molars among patients in Lahore, Pakistan.

Design

A descriptive cross-sectional study was conducted among 432 participants aged 12 years or older at Lahore Medical and Dental College. Clinical examination of maxillary first and second molars was performed using the Arizona State University Dental Anthropology System (ASUDAS) for CoC traits and the International Caries Detection and Assessment System (ICDAS) for caries assessment. Inter- and intra-examiner calibration ensured diagnostic reliability (Cohen's Kappa >0.90).

Results

CoC (ASUDAS grades 1–7) was observed in 201 individuals (46.5 %) on maxillary first molars and in 7 individuals (1.6 %) on second molars, with bilateral expression more common than unilateral. The right first molar showed a higher prevalence of CoC and caries incidence. Morphological traits ranged from subtle grooves to pronounced cusps, with small vertical grooves (ASUDAS 1) being the most frequent. Caries susceptibility correlated positively with CoC prominence (p < 0.001). Multivariate logistic regression identified CoC grade as the strongest predictor of caries, overshadowing age, side, and molar position, and substantially improving model sensitivity (0 % to 97.2 %).

Conclusion

CoC is a prevalent trait and is significantly associated with early-stage dental caries in maxillary first molars. Its presence, particularly in prominent forms, may pose an increased risk of caries. These findings underscore the need for enhanced preventive strategies and clinical attention in individuals with CoC.