Comparison of isthmus detection methods in the apical third of mesial roots of maxillary and mandibular first molars: macroscopic observation versus operating microscope.

The aims of this study were to assess the presence and the frequency of isthmuses in the mesial roots of the maxillary and mandibular first molars (at two resection levels from the apex), and to compare the findings obtained by macroscopic observation (MO) and operating microscope (OM). Forty maxillary and 40 mandibular mesial roots were observed at 3 and 5 mm from the apex initially macroscopically and then with the use of an OM. The presence of an isthmus and the number of root canals detected were recorded. Data were analyzed statistically by Fisher's exact test for isthmus evaluation and Wilcoxon signed rank-test for number of root canals at a confidence interval of 95%. Comparison between MO and OM regarding the number of roots with isthmuses provided the following results: Mandibular group: At 3 mm level: MO 19 ?s. OM 27; at 5 mm level: MO 31 ?s. OM 32. Maxillary group: At 3 mm level: MO 9 ?s. OM 14; at 5 mm level: MO 19 ?s. OM 21. Significant differences (p<0.05) were found concerning the accuracy of the isthmus detection methods at both resection levels (3 and 5 mm) and both types of roots, as well as for the number of the canals inspected under the OM between the two resection levels of the mesial roots of the maxillary first molars. Under the tested conditions, OM increased the diagnostic accuracy of isthmus detection at both resection levels and root types.