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COMPARISON OF FRACTURE RESISTANCE BETWEEN TRADITIONAL ENDODONTIC ACCESS AND MINIMAL ENDODONTIC ACCESS IN 3D-PRINTED MANDIBULAR FIRST MOLARS

Kwon, Pil
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Thesis/Dissertation
Date
2024-08
Advisor
Nissan, Roni
Committee member
Orrego, Santiago
Yang, Maobin
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Department
Oral Biology
Subject
Dentistry
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http://hdl.handle.net/20.500.12613/10654
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Kwon_temple_0225M_15850.pdf
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DOI
http://dx.doi.org/10.34944/dspace/10616
Abstract
Introduction: Many clinicians have employed the traditional endodontic access (TEA), which involves a straight-line access to root canals and a complete removal of the roof of the pulp chamber, whereas others advocate the minimal endodontic access (MEA) to minimize the removal of tooth structure. Several studies have compared the fracture resistance of TEA to that of MEA using human extracted teeth, but variability in size, morphology, and strength resistance has remained as uncontrolled variables.Purpose: This study aims to compare the fracture resistance of teeth accessed using TEA to those accessed with MEA, using identical 3D-printed mandibular first molars to eliminate variables present in natural human molars. Materials and Methods: 45 identical 3D-printed mandibular first molars were randomly assigned to three groups (n=15): TEA, MEA, and control. For the TEA group, the roof of the pulp chamber was completely removed, and a straight-line access was made to all three canals. For the MEA group, access was made at the central fossa without complete removal of the roof, just enough to access all three canals. For the control group, no access was made, and the crown was left intact. Each tooth in the TEA and MEA groups were instrumented, obturated, and restored with composite resin. The teeth were embedded in a self-curing epoxy resin to the cementoenamel junction (CEJ). All samples were mounted on the Instron Universal Testing Machine (Instron, Norwood, MA), and a continuous compressive force was loaded with a round end at the central fossa, 30˚ from the long axis at the speed of 0.5mm/min until fracture. The load at fracture (N) was recorded for each sample. One-way ANOVA and Tukey’s honestly significant difference test were used for statistical analysis. Results: The mean maximum load at fracture for the control, TEA, and MEA was 1171.37 ± 160.35, 697.95 ± 121.14, and 1047.08 ± 167.79, respectively. The control group and MEA showed significantly greater resistance to fracture than TEA group, and no significant difference was noted between the control group and MEA. The mean instrumentation time for TEA was 1 minute and 40 seconds (SD: 7 seconds). The mean instrumentation time for MEA was 2 minutes and 7 seconds (SD: 9 seconds). The mean instrumentation time of TEA was significantly lower than that of MEA, conveying better access to the canals. Conclusion: Under the limitations of this study, it can be concluded that MEA showed significantly greater resistance to fracture compared to TEA yet with longer instrumentation time.
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