article · Journal of Endodontics and Restorative Dentistry
Micro-computed tomography was used to examine the prevalence, location, and type of root canal isthmuses in 93 maxillary and 84 mandibular first molars from 116 skeletonised Black South African individuals. Isthmuses were evaluated across root thirds and analysed for associations with arch side, sex, and age. The analysis revealed that apical isthmuses in the mandibular mesial root were significantly more frequent in males than in females, at 95.35 percent compared to 78.05 percent. Distal root isthmuses also increased with age, both overall and specifically in the apical region. For maxillary molars, isthmuses were most prevalent in the mesio-buccal root, with males showing a higher prevalence in the disto-buccal root. Across all samples, Fan Type III configurations and positions in the apical third were most common, providing detailed anatomical reference data to inform endodontic procedures.
Successful root canal treatments depend on an accurate understanding of internal tooth anatomy to ensure thorough cleaning and sealing. Because complex canal connections can harbour bacteria and cause treatment failure, detailing how root canal isthmuses vary by age, sex, and root position helps dental clinicians anticipate hidden structures and improve clinical diagnosis and procedural planning.
This research represents early-stage, ex vivo anatomical investigation without a direct product pipeline. The data could be used by dental practitioners to refine endodontic clinical protocols or integrated by developers into dental training simulators and radiographic reference databases. Given the exploratory nature of the study, real-world application is limited to clinical guidance and educational modeling rather than immediate near-market technology.
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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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DOI: 10.71350/endores.2026.009
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