A pyramidal molar is which has completely fused roots with a solitary enlarged canal. The purpose of this retrospective study was to assess the prevalence and characteristics of pyramidal molars among adolescent.<br/>A total of 1,612 patients’ panoramic radiographs were screened. A total of 12,896 first and second molars were evaluated. The relative incidence and the correlations regarding the location of pyramidal molar (maxillary versus mandibular) and gender were analyzed using the chi-square test.<br/>The overall incidence of patients with pyramidal molars was 1.49%. 24 patients were found to have a pyramidal molar and it was more prevalent in women (18 women and 6 men). The prevalence of pyramidal molars from all first and second molars examined was 0.31%. 88 percent of pyramidal molars occurred in maxilla. All pyramidal molars were second molar.<br/>Pyramidal molar has a relatively poor periodontal prognosis compared with common multi-rooted teeth and it is important to understand the structural characteristics of root canal during pulp treatment. Clinicians should be able to understand the anatomical properties of pyramidal molar and apply it to treatment and prognostic evaluation.