Three-dimensional morphologic classifications and analysis of canal isthmuses in permanent molars

Purpose To investigate the three-dimensional morphology of isthmuses in molars according to their boundary characteristics using micro-computed tomography (micro-CT). Methods Micro-CT reconstructed images of 248 molars were evaluated. Isthmuses were classified into four types based on the boundary characteristics: isthmus with roof, isthmus with floor, band-shaped isthmus, and isthmus without boundary. The tooth and root with isthmuses, the number and location of the isthmuses in the root, and the canal configurations were recorded. The maximum of the major diameter of all canal cross-sections in one isthmus ( d max ), the minor diameter of the canal in same cross-section ( d min ), the distance between the d max cross-section and apex ( D m − a ), isthmus length ( L i ), and distance from the isthmus ending cross-section to apex ( D e − a ) were measured and analysed with a significance threshold set to 5%. Results Isthmuses were present in 75.4% specimens. The four types of isthmuses were found in various molars and roots. Their distribution in different root locations and canal configurations was significantly different. The d max , d min , L i , and D e − a were analysed according to different molars and different isthmus types; their respective median values were 2.508 mm, 0.07 mm, 3.09 mm, and 3.96 mm. Conclusion The three-dimensional classification of isthmuses according to the boundary characteristics provides a comprehensive picture of the isthmus in molars. Their corresponding distributions in different molars, location in roots, and canal configurations will be helpful in predicting the type of isthmus based on the tooth position and canal configurations.