Introduction: Scientifically and practically, morphological variances in tooth structure have always attracted the dentist's attention. The expression of varying cuspal traits that elicit distinct characteristics has beneficial tool for categorizing the population. The Cusp of Carabelli(COC) changed the tooth dimension, making forceps adaptation more difficult.

Objective: The purpose of this study is to see if there's a link between the COC trait and upper 1st molar teeth extraction in the Pakistani urban population of Karachi. This could be a useful criterion for forensic odontology and person identification.

Methodology: A cross-sectional study was carried out on total of 650 dental casts models of individuals seeking orthodontic treatment. Our parameter was to examine the presence of COC of maxillary first permanent molar and its forensic odontology. Among them, 75 patients came for tooth extraction of 1st carious maxillary molar. 

Results: This study exhibited that COC changes the tooth dimension, making tooth extraction more difficult. The COC were 44% moderate tubercle, 27.1% smooth, 27.2% small tubercle, and 1.7% greater tubercle.

Conclusion: There is a link between COC and tooth extraction difficulty due to forceps adaption difficulties. Apart from that, it might be useful in determining an individual's ethnic origin.

Keywords; Cusp of Carabelli; Cuspal variations; Forensic odontology; Mesiopalatal