Skip to main content
Top
Published in: BMC Oral Health 1/2023

Open Access 01-12-2023 | Research

Effect of access cavities on the biomechanics of mandibular molars: a finite element analysis

Authors: Xiao Wang, Dan Wang, Yi-rong Wang, Xiao-gang Cheng, Long-xing Ni, Wei Wang, Yu Tian

Published in: BMC Oral Health | Issue 1/2023

Login to get access

Abstract

Introduction

This study aimed to predict the fracture resistance of a mandibular first molar (MFM) with diverse endodontic cavities using finite element analysis (FEA).

Methods

Five experimental finite element models representing a natural tooth (NT) and 4 endodontically treated MFMs were generated. Treated MFM models were with a traditional endodontic cavity (TEC) and minimally invasive endodontic (MIE) cavities, including guided endodontic cavity (GEC), contracted endodontic cavity (CEC) and truss endodontic cavity (TREC). Three loads were applied, simulating a maximum bite force of 600 N (N) vertically and a normal masticatory force of 225 N vertically and laterally. The distributions of von Mises (VM) stress and maximum VM stress were calculated.

Results

The maximum VM stresses of the NT model were the lowest under normal masticatory forces. In endodontically treated models, the distribution of VM stress in GEC model was the most similar to NT model. The maximum VM stresses of the GEC and CEC models under different forces were lower than those of TREC and TEC models. Under vertical loads, the maximum VM stresses of the TREC model were the highest, while under the lateral load, the maximum VM stress of the TEC model was the highest.

Conclusion

The stress distribution of tooth with GEC was most like NT. Compared with TECs, GECs and CECs may better maintain fracture resistance, TRECs, however, may have a limited effect on maintenance of the tooth resistance.
Literature
1.
go back to reference Toure B, Faye B, Kane AW, Lo CM, Niang B, Boucher Y. Analysis of reasons for extraction of endodontically treated teeth: a prospective study. J Endod. 2011;37(11):1512–5.PubMedCrossRef Toure B, Faye B, Kane AW, Lo CM, Niang B, Boucher Y. Analysis of reasons for extraction of endodontically treated teeth: a prospective study. J Endod. 2011;37(11):1512–5.PubMedCrossRef
2.
go back to reference Clark D, Khademi JA. Case studies in modern molar endodontic access and directed dentin conservation. Dent Clin North Am. 2010;54(2):275–89.PubMedCrossRef Clark D, Khademi JA. Case studies in modern molar endodontic access and directed dentin conservation. Dent Clin North Am. 2010;54(2):275–89.PubMedCrossRef
3.
go back to reference Silva E, Pinto KP, Ferreira CM, Belladonna FG, De-Deus G, Dummer PMH, Versiani MA. Current status on minimal access cavity preparations: a critical analysis and a proposal for a universal nomenclature. Int Endod J. 2020;53(12):1618–35.PubMedCrossRef Silva E, Pinto KP, Ferreira CM, Belladonna FG, De-Deus G, Dummer PMH, Versiani MA. Current status on minimal access cavity preparations: a critical analysis and a proposal for a universal nomenclature. Int Endod J. 2020;53(12):1618–35.PubMedCrossRef
4.
go back to reference Barbosa AFA, Silva E, Coelho BP, Ferreira CMA, Lima CO, Sassone LM. The influence of endodontic access cavity design on the efficacy of canal instrumentation, microbial reduction, root canal filling and fracture resistance in mandibular molars. Int Endod J. 2020;53(12):1666–79.PubMedCrossRef Barbosa AFA, Silva E, Coelho BP, Ferreira CMA, Lima CO, Sassone LM. The influence of endodontic access cavity design on the efficacy of canal instrumentation, microbial reduction, root canal filling and fracture resistance in mandibular molars. Int Endod J. 2020;53(12):1666–79.PubMedCrossRef
5.
go back to reference Silva E, Pinto KP, Ajuz NC, Sassone LM. Ten years of minimally invasive access cavities in endodontics: a bibliometric analysis of the 25 most-cited studies. Restor Dent Endod. 2021;46(3):e42.PubMedPubMedCentralCrossRef Silva E, Pinto KP, Ajuz NC, Sassone LM. Ten years of minimally invasive access cavities in endodontics: a bibliometric analysis of the 25 most-cited studies. Restor Dent Endod. 2021;46(3):e42.PubMedPubMedCentralCrossRef
6.
go back to reference Reeh ES, Messer HH, Douglas WH. Reduction in tooth stiffness as a result of endodontic and restorative procedures. J Endod. 1989;15(11):512–6.PubMedCrossRef Reeh ES, Messer HH, Douglas WH. Reduction in tooth stiffness as a result of endodontic and restorative procedures. J Endod. 1989;15(11):512–6.PubMedCrossRef
7.
go back to reference Pilo R, Metzger Z, Brosh T. Effect of root morphology on the susceptibility of endodontically treated teeth to vertical root fracture: an ex-vivo model. J Mech Behav Biomed Mater. 2017;69:267–74.PubMedCrossRef Pilo R, Metzger Z, Brosh T. Effect of root morphology on the susceptibility of endodontically treated teeth to vertical root fracture: an ex-vivo model. J Mech Behav Biomed Mater. 2017;69:267–74.PubMedCrossRef
8.
go back to reference Munari LS, Bowles WR, Fok ASL. Relationship between Canal Enlargement and Fracture load of Root dentin sections. Dent Mater. 2019;35(5):818–24.PubMedCrossRef Munari LS, Bowles WR, Fok ASL. Relationship between Canal Enlargement and Fracture load of Root dentin sections. Dent Mater. 2019;35(5):818–24.PubMedCrossRef
9.
go back to reference Aslan TSB, Er Ö, Ustun Y, Cinar F. Evaluation of fracture resistance in root canal-treated teeth restored using different techniques. Niger J Clin Pract. 2018;21(6):795–800.PubMedCrossRef Aslan TSB, Er Ö, Ustun Y, Cinar F. Evaluation of fracture resistance in root canal-treated teeth restored using different techniques. Niger J Clin Pract. 2018;21(6):795–800.PubMedCrossRef
10.
go back to reference Clark D, Khademi J. Modern molar endodontic access and directed dentin conservation. Dent Clin North Am. 2010;54(2):249–73.PubMedCrossRef Clark D, Khademi J. Modern molar endodontic access and directed dentin conservation. Dent Clin North Am. 2010;54(2):249–73.PubMedCrossRef
11.
go back to reference Silva E, Versiani MA, Souza EM, De-Deus G. Minimally invasive access cavities: does size really matter? Int Endod J. 2021;54(2):153–5.PubMedCrossRef Silva E, Versiani MA, Souza EM, De-Deus G. Minimally invasive access cavities: does size really matter? Int Endod J. 2021;54(2):153–5.PubMedCrossRef
12.
go back to reference Abou-Elnaga MY, Alkhawas MAM, Kim HC, Refai AS. Effect of Truss Access and Artificial Truss Restoration on the fracture resistance of endodontically treated Mandibular First Molars. J Endod. 2019;45(6):813–7.PubMedCrossRef Abou-Elnaga MY, Alkhawas MAM, Kim HC, Refai AS. Effect of Truss Access and Artificial Truss Restoration on the fracture resistance of endodontically treated Mandibular First Molars. J Endod. 2019;45(6):813–7.PubMedCrossRef
13.
go back to reference Connert T, Krug R, Eggmann F, Emsermann I, ElAyouti A, Weiger R, Kuhl S, Krastl G. Guided Endodontics versus Conventional Access Cavity Preparation: a comparative study on substance loss using 3-dimensional-printed Teeth. J Endod. 2019;45(3):327–31.PubMedCrossRef Connert T, Krug R, Eggmann F, Emsermann I, ElAyouti A, Weiger R, Kuhl S, Krastl G. Guided Endodontics versus Conventional Access Cavity Preparation: a comparative study on substance loss using 3-dimensional-printed Teeth. J Endod. 2019;45(3):327–31.PubMedCrossRef
14.
go back to reference Jiang Q, Huang Y, Tu X, Li Z, He Y, Yang X. Biomechanical Properties of First Maxillary Molars with different endodontic cavities: a finite element analysis. J Endod. 2018;44(8):1283–8.PubMedCrossRef Jiang Q, Huang Y, Tu X, Li Z, He Y, Yang X. Biomechanical Properties of First Maxillary Molars with different endodontic cavities: a finite element analysis. J Endod. 2018;44(8):1283–8.PubMedCrossRef
15.
go back to reference Saber SM, Hayaty DM, Nawar NN, Kim HC. The Effect of Access cavity designs and sizes of Root Canal Preparations on the Biomechanical Behavior of an endodontically treated Mandibular First Molar: a finite element analysis. J Endod. 2020;46(11):1675–81.PubMedCrossRef Saber SM, Hayaty DM, Nawar NN, Kim HC. The Effect of Access cavity designs and sizes of Root Canal Preparations on the Biomechanical Behavior of an endodontically treated Mandibular First Molar: a finite element analysis. J Endod. 2020;46(11):1675–81.PubMedCrossRef
16.
go back to reference Luo B, Sun X, He L, Zhao L, Liu X, Jiang Q. Impact of different axial wall designs on the fracture strength and stress distribution of ceramic restorations in mandibular first molar. BMC Oral Health. 2022;22(1):549.PubMedPubMedCentralCrossRef Luo B, Sun X, He L, Zhao L, Liu X, Jiang Q. Impact of different axial wall designs on the fracture strength and stress distribution of ceramic restorations in mandibular first molar. BMC Oral Health. 2022;22(1):549.PubMedPubMedCentralCrossRef
17.
go back to reference Wu J, Liu Y, Li B, Wang D, Dong X, Sun Q, Chen G. Numerical simulation of optimal range of rotational moment for the mandibular lateral incisor, canine and first premolar based on biomechanical responses of periodontal ligaments: a case study. Clin Oral Investig. 2021;25(3):1569–77.PubMedCrossRef Wu J, Liu Y, Li B, Wang D, Dong X, Sun Q, Chen G. Numerical simulation of optimal range of rotational moment for the mandibular lateral incisor, canine and first premolar based on biomechanical responses of periodontal ligaments: a case study. Clin Oral Investig. 2021;25(3):1569–77.PubMedCrossRef
18.
go back to reference D’Souza KM, Aras MA. Three-dimensional finite element analysis of the stress distribution pattern in a mandibular first molar tooth restored with five different restorative materials. J Indian Prosthodont Soc. 2017;17(1):53–60.PubMedPubMedCentralCrossRef D’Souza KM, Aras MA. Three-dimensional finite element analysis of the stress distribution pattern in a mandibular first molar tooth restored with five different restorative materials. J Indian Prosthodont Soc. 2017;17(1):53–60.PubMedPubMedCentralCrossRef
19.
go back to reference Lara-Mendes STO, Barbosa CFM, Santa-Rosa CC, Machado VC. Guided Endodontic Access in Maxillary Molars using cone-beam computed tomography and computer-aided Design/Computer-aided Manufacturing System: a Case Report. J Endod. 2018;44(5):875–9.PubMedCrossRef Lara-Mendes STO, Barbosa CFM, Santa-Rosa CC, Machado VC. Guided Endodontic Access in Maxillary Molars using cone-beam computed tomography and computer-aided Design/Computer-aided Manufacturing System: a Case Report. J Endod. 2018;44(5):875–9.PubMedCrossRef
20.
go back to reference Tsotsis P, Dunlap C, Scott R, Arias A, Peters OA. A survey of current trends in root canal treatment: access cavity design and cleaning and shaping practices. Aust Endod J. 2021;47(1):27–33.PubMedCrossRef Tsotsis P, Dunlap C, Scott R, Arias A, Peters OA. A survey of current trends in root canal treatment: access cavity design and cleaning and shaping practices. Aust Endod J. 2021;47(1):27–33.PubMedCrossRef
21.
go back to reference Moore B, Verdelis K, Kishen A, Dao T, Friedman S. Impacts of contracted endodontic cavities on instrumentation efficacy and biomechanical responses in Maxillary Molars. J Endod. 2016;42(12):1779–83.PubMedCrossRef Moore B, Verdelis K, Kishen A, Dao T, Friedman S. Impacts of contracted endodontic cavities on instrumentation efficacy and biomechanical responses in Maxillary Molars. J Endod. 2016;42(12):1779–83.PubMedCrossRef
22.
go back to reference Marchesan MA, James CM, Lloyd A, Morrow BR, Garcia-Godoy F. Effect of access design on intracoronal bleaching of endodontically treated teeth: an ex vivo study. J Esthet Restor Dent. 2018;30(2):E61–7.PubMedCrossRef Marchesan MA, James CM, Lloyd A, Morrow BR, Garcia-Godoy F. Effect of access design on intracoronal bleaching of endodontically treated teeth: an ex vivo study. J Esthet Restor Dent. 2018;30(2):E61–7.PubMedCrossRef
23.
go back to reference Neelakantan P, Khan K, Hei Ng GP, Yip CY, Zhang C, Pan Cheung GS. Does the orifice-directed dentin conservation Access Design Debride Pulp Chamber and Mesial Root Canal Systems of Mandibular Molars similar to a traditional Access. Design? J Endod. 2018;44(2):274–9.PubMedCrossRef Neelakantan P, Khan K, Hei Ng GP, Yip CY, Zhang C, Pan Cheung GS. Does the orifice-directed dentin conservation Access Design Debride Pulp Chamber and Mesial Root Canal Systems of Mandibular Molars similar to a traditional Access. Design? J Endod. 2018;44(2):274–9.PubMedCrossRef
24.
go back to reference Plotino G, Grande NM, Isufi A, Ioppolo P, Pedulla E, Bedini R, Gambarini G, Testarelli L. Fracture strength of endodontically treated teeth with different Access cavity designs. J Endod. 2017;43(6):995–1000.PubMedCrossRef Plotino G, Grande NM, Isufi A, Ioppolo P, Pedulla E, Bedini R, Gambarini G, Testarelli L. Fracture strength of endodontically treated teeth with different Access cavity designs. J Endod. 2017;43(6):995–1000.PubMedCrossRef
25.
go back to reference Santosh SS, Ballal S, Natanasabapathy V. Influence of minimally invasive Access cavity designs on the fracture resistance of endodontically treated mandibular Molars subjected to Thermocycling and dynamic loading. J Endod. 2021;47(9):1496–500.PubMedCrossRef Santosh SS, Ballal S, Natanasabapathy V. Influence of minimally invasive Access cavity designs on the fracture resistance of endodontically treated mandibular Molars subjected to Thermocycling and dynamic loading. J Endod. 2021;47(9):1496–500.PubMedCrossRef
26.
go back to reference Madani ZS, Mehraban N, Moudi E, Bijani A. Root and Canal morphology of Mandibular Molars in a selected iranian Population using Cone-Beam Computed Tomography. Iran Endod J. 2017;12(2):143–8.PubMedPubMedCentral Madani ZS, Mehraban N, Moudi E, Bijani A. Root and Canal morphology of Mandibular Molars in a selected iranian Population using Cone-Beam Computed Tomography. Iran Endod J. 2017;12(2):143–8.PubMedPubMedCentral
27.
go back to reference Zadik Y, Sandler V, Bechor R, Salehrabi R. Analysis of factors related to extraction of endodontically treated teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106(5):e31–35.PubMedCrossRef Zadik Y, Sandler V, Bechor R, Salehrabi R. Analysis of factors related to extraction of endodontically treated teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106(5):e31–35.PubMedCrossRef
28.
go back to reference Berman LHHK. Cohen’s pathways of the pulp. 12th ed. edn. St Louis: Elsevier Health Sciences; 2020. Berman LHHK. Cohen’s pathways of the pulp. 12th ed. edn. St Louis: Elsevier Health Sciences; 2020.
29.
go back to reference Fu Y, Zhang L, Gao Y, Huang D. A comparison of volume of tissue removed and biomechanical analysis of different Access cavity designs in 2-rooted Mandibular First Molars: a multisample 3-dimensional finite element analysis. J Endod. 2022;48(3):362–9.PubMedCrossRef Fu Y, Zhang L, Gao Y, Huang D. A comparison of volume of tissue removed and biomechanical analysis of different Access cavity designs in 2-rooted Mandibular First Molars: a multisample 3-dimensional finite element analysis. J Endod. 2022;48(3):362–9.PubMedCrossRef
30.
go back to reference Silva E, Rover G, Belladonna FG, De-Deus G, da Silveira Teixeira C, da Silva Fidalgo TK. Impact of contracted endodontic cavities on fracture resistance of endodontically treated teeth: a systematic review of in vitro studies. Clin Oral Investig. 2018;22(1):109–18.PubMedCrossRef Silva E, Rover G, Belladonna FG, De-Deus G, da Silveira Teixeira C, da Silva Fidalgo TK. Impact of contracted endodontic cavities on fracture resistance of endodontically treated teeth: a systematic review of in vitro studies. Clin Oral Investig. 2018;22(1):109–18.PubMedCrossRef
31.
go back to reference Nayak A, Jain PK, Kankar PK, Jain N. Computer-aided design-based guided endodontic: a novel approach for root canal access cavity preparation. Proc Inst Mech Eng H. 2018;232(8):787–95.PubMedCrossRef Nayak A, Jain PK, Kankar PK, Jain N. Computer-aided design-based guided endodontic: a novel approach for root canal access cavity preparation. Proc Inst Mech Eng H. 2018;232(8):787–95.PubMedCrossRef
32.
go back to reference Ozyurek T, Ulker O, Demiryurek EO, Yilmaz F. The Effects of Endodontic Access Cavity Preparation Design on the fracture strength of endodontically treated Teeth: traditional Versus Conservative Preparation. J Endod. 2018;44(5):800–5.PubMedCrossRef Ozyurek T, Ulker O, Demiryurek EO, Yilmaz F. The Effects of Endodontic Access Cavity Preparation Design on the fracture strength of endodontically treated Teeth: traditional Versus Conservative Preparation. J Endod. 2018;44(5):800–5.PubMedCrossRef
33.
go back to reference Chlup ZŽR, Kania J, Přibyl M. Fracture behaviour of teeth with conventional and mini-invasive access cavity designs. J Eur Ceram Soc. 2017;37(14):4423–9.CrossRef Chlup ZŽR, Kania J, Přibyl M. Fracture behaviour of teeth with conventional and mini-invasive access cavity designs. J Eur Ceram Soc. 2017;37(14):4423–9.CrossRef
34.
go back to reference Sabeti M, Kazem M, Dianat O, Bahrololumi N, Beglou A, Rahimipour K, Dehnavi F. Impact of Access Cavity Design and Root Canal Taper on Fracture Resistance of Endodontically treated Teeth: an Ex vivo investigation. J Endod. 2018;44(9):1402–6.PubMedCrossRef Sabeti M, Kazem M, Dianat O, Bahrololumi N, Beglou A, Rahimipour K, Dehnavi F. Impact of Access Cavity Design and Root Canal Taper on Fracture Resistance of Endodontically treated Teeth: an Ex vivo investigation. J Endod. 2018;44(9):1402–6.PubMedCrossRef
35.
go back to reference Zehnder MS, Connert T, Weiger R, Krastl G, Kuhl S. Guided endodontics: accuracy of a novel method for guided access cavity preparation and root canal location. Int Endod J. 2016;49(10):966–72.PubMedCrossRef Zehnder MS, Connert T, Weiger R, Krastl G, Kuhl S. Guided endodontics: accuracy of a novel method for guided access cavity preparation and root canal location. Int Endod J. 2016;49(10):966–72.PubMedCrossRef
36.
go back to reference Silva E, Lima CO, Barbosa AFA, Augusto CM, Souza EM, Lopes RT, De-Deus G, Versiani MA. Preserving dentine in minimally invasive access cavities does not strength fracture resistance of restored mandibular molars. Int Endod J. 2021;54(6):966–74.PubMedCrossRef Silva E, Lima CO, Barbosa AFA, Augusto CM, Souza EM, Lopes RT, De-Deus G, Versiani MA. Preserving dentine in minimally invasive access cavities does not strength fracture resistance of restored mandibular molars. Int Endod J. 2021;54(6):966–74.PubMedCrossRef
37.
go back to reference Chan MYC, Cheung V, Lee AHC, Zhang C. A literature review of minimally invasive Endodontic Access Cavities - Past, Present and Future. Eur Endod J. 2022;7(1):1–10.PubMed Chan MYC, Cheung V, Lee AHC, Zhang C. A literature review of minimally invasive Endodontic Access Cavities - Past, Present and Future. Eur Endod J. 2022;7(1):1–10.PubMed
38.
go back to reference Katona TR, Eckert GJ. The mechanics of dental occlusion and disclusion. Clin Biomech (Bristol Avon). 2017;50:84–91.PubMedCrossRef Katona TR, Eckert GJ. The mechanics of dental occlusion and disclusion. Clin Biomech (Bristol Avon). 2017;50:84–91.PubMedCrossRef
39.
go back to reference Ausiello P, Ciaramella S, Fabianelli A, Gloria A, Martorelli M, Lanzotti A, Watts DC. Mechanical behavior of bulk direct composite versus block composite and lithium disilicate indirect class II restorations by CAD-FEM modeling. Dent Mater. 2017;33(6):690–701.PubMedCrossRef Ausiello P, Ciaramella S, Fabianelli A, Gloria A, Martorelli M, Lanzotti A, Watts DC. Mechanical behavior of bulk direct composite versus block composite and lithium disilicate indirect class II restorations by CAD-FEM modeling. Dent Mater. 2017;33(6):690–701.PubMedCrossRef
40.
go back to reference Correia AMO, Tribst JPM, Matos FS, Platt JA, Caneppele TMF, Borges ALS. Polymerization shrinkage stresses in different restorative techniques for non-carious cervical lesions. J Dent. 2018;76:68–74.PubMedCrossRef Correia AMO, Tribst JPM, Matos FS, Platt JA, Caneppele TMF, Borges ALS. Polymerization shrinkage stresses in different restorative techniques for non-carious cervical lesions. J Dent. 2018;76:68–74.PubMedCrossRef
41.
go back to reference Eskitascioglu G, Belli S, Kalkan M. Evaluation of two post core systems using two different methods (fracture strength test and a finite elemental stress analysis). J Endod. 2002;28(9):629–33.PubMedCrossRef Eskitascioglu G, Belli S, Kalkan M. Evaluation of two post core systems using two different methods (fracture strength test and a finite elemental stress analysis). J Endod. 2002;28(9):629–33.PubMedCrossRef
Metadata
Title
Effect of access cavities on the biomechanics of mandibular molars: a finite element analysis
Authors
Xiao Wang
Dan Wang
Yi-rong Wang
Xiao-gang Cheng
Long-xing Ni
Wei Wang
Yu Tian
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2023
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-023-02878-3

Other articles of this Issue 1/2023

BMC Oral Health 1/2023 Go to the issue