Morphological assessment of the isthmus in mesial root canals of first mandibular molars.

Root canal morphology and its anatomical variations pose a great challenge to endodontists.

Aim: The aim of this in silico study was to perform a qualitative and quantitative analysis of the threedimensional morphological characteristics of the isthmus in the mesial root canals of mandibular molars using microcomputed tomography (micro-CT).

Material and method: Six hundred first mandibular molars were selected, including 317 with two mesial canals with isthmuses between the canals, and fully formed root. Isthmus morphology was determined in 3D longitudinal sections using Fan et al. (2010) classification. Root length, and the volume and area of apical and coronal level were measured. Additionally, the structural model index (SMI) of the canals were also assessed.

Results: The prevalence of isthmuses in the mesial root canals was 32% type II, 29% type III, 22% type IV, and 17% type I. The root length was found to be 9.1±0.5 mm, the volume and area, of all root canal system, were 41.8±40.1 mm3 and 63.6±24.2 mm2 respectively. The isthmi volume and area alone were 11.06±9.03 mm3 and 30.02±11.02 mm2. The study confirmed that isthmuses are present in mesial canals of mandibular first molars, being more frequent in the apical third.

Conclusion: The high prevalence of isthmuses with complex morphological features underscores the importance of using intracanal medications to disinfect areas unprepared by instruments.