The maxillary second premolar, while frequently single rooted, exhibits a high degree of morphological diversity in its internal canal system. This unpredictability can lead to clinical oversights if a simple anatomy is assumed. The aim of this study was to review current knowledge regarding the number of roots and root canal configurations in permanent maxillary second premolars across different populations. A comprehensive literature search was conducted using the PubMed database for studies published between 2015 and December 2025, with the keyword “maxillary second premolar anatomy.” Out of 358 identified articles, 27 studies met the inclusion criteria and were analyzed. Only human-based studies on maxillary second premolars that used CBCT imaging and were written in English were included. The reviewed studies revealed that single-rooted maxillary second premolars are the most prevalent morphology, occurring in over 70% of cases, although significant variations exist among different ethnic groups. The presence of two roots was the second most common configuration, while three-rooted teeth were rare (<2%). Gender-related differences were also observed, with a higher prevalenc
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