Effect of restorative procedures on the strength of endodontically treated molars

Endodontically treated molar teeth are considered susceptible to fracture because of loss of tooth bulk. This study evaluated the significance of retaining intact marginal ridges and selective cusp coverage in preserving tooth stiffness during restoration. Strain gauges were bonded to four cusps of 36 intact extracted human lower molars. Teeth were loaded mesially and distally in a closed-loop servohydraulic system to measure stiffness. Endodontic access was followed by mesio-occlusal or mesio-occlusodistal preparation. Teeth were restored with either amalgam (no overlay), amalgam overlay, or gold overlay with partial or complete cusp coverage. Relative stiffness was calculated for all test conditions. Preserving a marginal ridge in molars did not fully conserve the strength of adjacent cusps; selective cusp coverage reinforced only the capped cusps; full occlusal coverage with gold or amalgam strengthened all cusps, but gold did so more consistently. It is more important to cover cusps than to preserve tooth structure (including a marginal ridge) in endodontically treated molar teeth.