Clinicians should be well-versed in the anatomy, variations, and teeth anomalies. Developmental disturbances of the teeth can lead to alterations in size, shape, number, structure, and eruption of the teeth. Developmental disturbances can lead to germination, fusion, concrescence, dilaceration, talons, cusps, dens in dente, etc. Protostylid, an additional cusp on the buccal aspect of the maxillary molar, which is a rare clinical finding, can lead to plaque accumulation, making oral hygiene maintenance difficult. This leads to clinical attachment loss and bone loss. This condition may often go undiagnosed. It should be diagnosed to prevent further complications. This case has been reported to make clinicians aware of the importance of diagnosing the case at the earliest possible time so that complications can be prevented and management is easier. From the perspective of forensic dentistry, this morphological feature, though uncommon, may be useful for the classification and identification of victims in mass causalities and bite marks on bodies or inanimate objects. This is one of the rarest cases of protostylids reported to date. This may not only pose a significant problem in endodontic therapy due to morphological alterations in root canals and periodontal therapy due to grove formation leading to an inability to maintain a plaque-free area (bone loss) but also be of very significant interest from the perspective of forensic dentistry.

A protostylid is a relatively rare dental developmental aberration characterized as an extra cusp located on the mesial half of the buccal surface of the molars. A protostylid is rarely to be reported due to its low rate of occurrence. This case report describes a patient referred for endodontic treatment due to the presence of a protostylid on the buccal surface of the maxillary first molar that induced apical periodontitis.
A 53-year-old female reported a 3-month history of pain of chewing with her upper left posterior teeth over 3 months. In the clinical examination, an abraded anomalous cusp-like structure was found on the buccal surface of tooth 26, Cone beam computed tomography (CBCT) revealed a supernumerary cusp with an intact root canal inside, which was fused with the mesiobuccal (MB) root canal in the middle of the root. In addition, extensive periapical radiolucency was observed around tooth 26. The tooth was diagnosed as apical periodontitis, and endodontic treatment was performed. The initial lesion in tooth 26 gradually healed over 1 year of observation.
To our knowledge, this case is the first to describe the endodontic management of a maxillary first molar with a protostylid and advances our understanding of supernumerary cusps. This case provides a reference for the treatment of protostylid.

Developmental malformations of the teeth might result in alterations of their size, shape, and structure. An accessory cusp is a developmental alteration to the shape of the teeth and is more commonly found in anterior teeth, and its occurrence in permanent molars is quite rare. Accessory cusps occurring in permanent mandibular molars are termed as protostylids. Although they do not pose any significant problem with respect to the function and occlusion, it is of tremendous importance in forensic odontology. This case report presents a rare finding of protostylid on the permanent mandibular molar, and its clinical implications are illustrated.

BACKGROUND: Dental morphology is a highly heritable characteristic which is stable with time and has a fairly high state of preservation. Nonmetric dental traits have crucial role in ethnic classifications of a population that helps in forensic racial identification purposes.
OBJECTIVE: To determine the frequency and variability of possible nonmetric tooth traits using extracted permanent posterior teeth from Kerala population for discerning racial ethnicity.
METHODS: This qualitative, cross-sectional study was carried out using 1743 extracted intact permanent posterior teeth collected from different dental clinics situated all over Kerala.
RESULTS: The more common features on premolars were multiple lingual cusps (31.21%), distal accessary ridges (16.28%) and Tom\'s root (17.9%). In upper first molars, Carabelli trait expression was 17.78% and other common features included metaconulo, cusp 5 and enamel extensions.
CONCLUSIONS: Posterior tooth traits had variable expression in the study population. Low prevalence rate of Carabelli trait in this study is characteristic of Asian population. This research explored new elements of invaluable tooth traits values to understand racial ethnicity of Kerala population.

The present article is a case report on the cusp expression of protostylid in the deciduous inferior molars and in the first permanent inferior molar, in which the correspondence and bilateral symmetry of the mentioned expression can be evidenced, as well as the their relation with the foramen cecum of the mesiobuccal furrows of the deciduous and of the permanent inferior molars.

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Human jaws and teeth display a high degree of morphological individuality as they represent personal, family and population characteristics. A protostylid is a supernumerary or accessory cusp located on the mesial half of the buccal surface on the molars that may seldom pose problems while its presence may not be a cause for alarm in most instances. This case report presents a rare finding of protostylid on the buccal surface of the primary molars in 4 children. From the perspective of forensic dentistry, this morphological feature, though uncommon, may be useful for classification and identification of victims in mass causalities and bite marks on bodies or inanimate objects.

The objective of this article is to increase our understanding of the root canal system of the anomalous structures like paramolar tubercles. The knowledge of the internal anatomy of the paramolar tubercles is very important as they influence the treatment modalities and associated problems in many dental disciplines. This case report investigates the anatomical and morphological characteristics of a rare case of two well-developed lobulated cusps occurring on the buccal surface of maxillary right second molar with the aid of spiral computed tomography. Unlike to previous reports, in our case the tubercles had their own pulp chamber with its root fused to the mesiobuccal and distobuccal roots of maxillary right second molar, while its canal remained independent from the main root canals.