Impact of Conservative Endodontic Cavities on Root Canal Preparation and Biomechanical Behavior of Upper Premolars Restored with Different Materials

The purpose of this study was to evaluate the impact of conservative endodontic cavities (CECs) on root canal preparation, restoration, and biomechanical behavior of teeth prepared using different shaping systems and restorative materials. Ninety upper premolars with a bifurcated root were matched based on morphology and randomly assigned to a control group (n = 10) or 1 of the following experimental groups (n = 40): traditional endodontic cavity and CEC. Teeth were subdivided according to instrumentation (n = 10) as follows: ProTaper Universal (Dentsply Maillefer, Ballaigues, Switzerland), Reciproc (VDW GmbH, Munich, Germany), Reciproc Blue (VDW GmbH), and Hyflex EDM (Coltene/Whaledent, Altstätten, Switzerland). After canal obturation, teeth were restored using temporary material, conventional composite, regular bulk fill composite, or bulk fill flow combined with conventional composite. Before and after preparation and after obturation, the teeth were scanned using micro–computed tomographic imaging. Canal transportation (CT), the percentage of untouched canal surfaces (UCSs), voids in restoration (VRs), and residual filling material in the pulp chamber were evaluated. Finite element analysis, fracture resistance, and the failure pattern were recorded. The data were analyzed using analysis of variance and the Tukey and chi-square tests. CECs had greater CT, percentage of filling material, and VRs compared with traditional endodontic cavities (P < .0001). The highest CT and UCSs were observed in CEC with ProTaper Universal. Bulk fill flow combined with conventional composite showed a lower percentage of VRs compared with other restorative materials (P < .05). Finite element analysis, fracture resistance, and failure pattern revealed similar behaviors in all groups (P > .05) . CECs had a negative impact on root canal centralization, UCSs, cleaning of the pulp chamber, and percentage of VRs. Controlled memory instruments were the most adequate for the root canal preparation of CECs. The endodontic cavity did not influence the biomechanical behavior of restored teeth.