A micro-computed tomographic evaluation of root canal isthmuses in maxillary and mandibular first molars of a Black South African population

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Objective: To evaluate root canal isthmuses in maxillary and mandibular first molars of Black South Africans using micro-computed tomography. Methods: The prevalence, location (root third) and type of isthmuses were recorded on 93 maxillary and 84 mandibular first molars from 116 skeletonized individuals. Associations with arch side, sex and age were examined by chi-squared test, with strength of association given as the bias-adjusted Cramér’s V and 95% confidence interval (CI). Reliability used percentage agreement and Cohen’s kappa (κ) coefficient. Results: Intra- and inter-observer agreement were excellent: 96.73% (κ = 0.90) and 97.78% (κ = 0.95) for the maxillary teeth and 94.12% (κ = 0.75) and 96.08% (κ = 0.94) for the mandibular teeth. Apical isthmuses in the mandibular mesial root were more common in males (95.35%) compared to females (78.05%) (p = 0.003; adjusted Cramér’s V = 0.351, 95% CI 0.151–1.000) Overall (p = 0.004) and apically (p = 0.027) distal root isthmuses appeared to increase with age. In the maxilla, isthmuses were more prevalent in the mesio-buccal root of combined sexes. A higher prevalence was noted in the disto-buccal root of males (p = 0.047). Generally, Fan Type III isthmuses and the apical third region were more common. Conclusion: These findings could strengthen endodontic treatment planning and diagnosis. Significant differences should be interpreted cautiously given the exploratory, ex vivo design.

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