A comparative evaluation of the effect of different access cavity designs on root canal instrumentation efficacy and resistance to fracture assessed on maxillary central incisors: An in vitro study

AIM: The purpose of this study is to evaluate and compare the effect of different access cavity designs on root canal instrumentation efficacy using micro-computed tomography (CT) scan and resistance to fracture evaluated using the universal testing machine on maxillary central incisor. MATERIALS AND METHODOLOGY: Forty extracted human permanent maxillary central incisors were divided into four groups for each access cavity. The access cavities were prepared according to predefined criteria and were further assessed under Micro-CT to evaluate pre and postoperative instrumentation efficacy. After biomechanical preparation and obturation, the teeth were wrapped with tin foil to maintain a thickness of 0.2–0.3 mm as periodontal ligament. Then, the silicon impression material was applied in the acrylic alveolus, to maintain and simulate the thickness of periodontal ligament and fracture resistance was checked using the universal testing machine. STATISTICAL ANALYSIS: Data were analyzed using one-way analysis of variance test. Pair-wise comparison was made using post hoc multiple comparison (Tukey) test. RESULTS: Fracture resistance was highest (1272 N) for the control group followed by the Lingual Conventional Access Group (1153.90 N). Fracture resistance for Lingual Cingulum Access Group was 1130.70 N and least for the Lingual Incisal Straight-Line Access Group (1022.80 N). This difference in fracture resistance among all the groups was significant (P = 0.001). Overall comparison showed that dentin volume reduction (DVR) for Group II was 22.45 mm3, for Group III was 17.37 mm(3) and for Group IV was 28. 41 mm(3). This difference in DVR among the three groups was significant (P = 0.001). CONCLUSION: The most effective instrumentation efficacy was obtained in lingual incisal straight-line access group, followed by lingual cingulum access group, followed by lingual conventional access group. The most effective fracture resistance was obtained in the lingual conventional access group, followed by the lingual cingulum access group, followed by the lingual incisal straight-line access group.