Could different direct restoration techniques affect interfacial gap and fracture resistance of endodontically treated anterior teeth?

Objectives To evaluate different direct restoration techniques on various cavity designs in anterior endodontically treated teeth (ETT). Materials and methods Ninety upper central incisors ( n = 90) were selected, endodontically treated, and divided into three groups ( n = 30) accordingly to the cavity design: minimal endodontic cavity access (group A), endodontic access + mesial class III cavity (group B), and endodontic access + two class III cavities (group C). Three subgroups ( n = 10) were then created accordingly to the restoration technique: nano hybrid composite restoration (subgroup a), glass fiber post + dual-cure luting cement (subgroup b), and bundled glass fiber + dual-cure luting cement (subgroup c). Samples underwent micro-CT scan, chewing simulation, and a second micro-CT scan. 3D quantification (mm 3 ) of interfacial gap progression was performed; then, samples underwent fracture resistance test. Data were statistically analyzed setting significance at p < 0.05. Results Groups A and B showed significantly lower interfacial gap progression compared with group C. Subgroup b performed significantly better compared with subgroups a and c. Improved fracture strength was reported for group C compared with group A, while both subgroups b and c performed better than subgroup a. Conclusions Cavity design significantly influenced interfacial gap progression and fracture resistance. Fiber posts significantly lowered gap progression and improved fracture resistance while bundled fibers only increased fracture resistance. A significant reduction of non-repairable fractures was recorded when fibers were applied. Clinical relevance A minimally invasive approach, conserving marginal crests, should be applied whenever possible. Inserting a fiber post is indicated when restoring anterior ETT, in order to reduce gap progression, improve fracture resistance, and avoid catastrophic failures.