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Van Valen (1962) grouped deviations from perfect symmetry in an organism into three categories: (1) directional asymmetry; (2) antisymmetry; and (3) fluctuating asymmetry (an asymmetry involving a paired structure that is usually symmetrical). Fluctuating asymmetry may be either quantitative or qualitative (Lundström 1961). Bilateral asymmetry in root number is quantitative variation and root morphology asymmetry is qualitative variation. Fluctuating asymmetry has been associated with congenital abnormalities, genetic syndromes, and elevated levels of inbreeding, and it is also thought to be a general indicator of stress caused by nutritional and/ or disease during development (Scott and Turner 2000). Teeth in corresponding quadrants of the upper and lower jaws are normally symmetrical structures that exhibit mirror imagery. Asymmetry does occur, at varying levels, for all crown and root traits, including overall tooth size, cuspal dimensions, hypodontia and hyperdontia. Numerous studies have explored both the quantitative and qualitative nature of fluctuating asymmetry in crowns of the teeth (both size and morphological variation) among various populations (Lundström 1963; Garn et al. 1966; Dibennardo and Bailit 1978; Baume 1979; Townsend 1981; Noss et al. 1983; Kieser et al. 1986; Kieser and Groeneveld 1988; Scott and Turner 2000; Wetherell et al. 2004). But, with regard to fluctuating asymmetry for root number and morphology, studies are very limited (Sabala et al. 1994). The present cases highlight the importance of the clinician and researcher to understand this phenotypic variation. A total of 21 cases are described exhibiting macroscopic fluctuating asymmetry in root number and morphology of permanent premolars and molars. This report describes four mandibular second premolars with extra roots, seven mandibular first molars with extra roots, four mandibular second molars with C-shaped roots, two mandibular second molars with extra roots, three mandibular third molars with extra roots, and one maxillary second molar with extra root configurations. The subjects reported here were treated in the Department of Conservative Dentistry and Endodontics in the CSI College of Dental Sciences, Madurai, India, or a private referral clinic in Madurai, India, during the period between year June 2007 and December 2010 and were from the local indigenous Tamil speaking population. The bilateral eccentric periapical radiographs of patients who visited for treatment of either pain or caries were obtained (30-degree mesial angulation using a protractor). All the periapical radiographs were taken using an X-Mind® AC X-ray generator (Satelec Acteon Group, Gustave Eiffel, France) operated at 70 kVp and 8 Fluctuating Asymmetry in Root Number and Morphology of Permanent Premolars and Molars—Case Reports