Minimally invasive access cavities in endodontics
Main Article Content
Abstract
Background: The access cavity is a critical stage in root canal therapy and it may influence the subsequent steps of the treatment. The new minimally invasive endodontic access cavity preparation concept aims to preserve sound tooth structure by conserving as much intact dentine as possible including the pulp chamber's roof, to keep the teeth from fracturing during and after endodontic treatment. While there is great interest in such access opening designs in numerous publications, still there is a lack of scientific evidence to support the application of such modern access cavity designs in clinical practice. This review aims to critically examine the literature on minimal access cavity preparations, explain the effect of minimally invasive access cavity designs on various aspects of root canal treatment, and identify areas where additional research is required. Data: An electronic search for English-language articles was performed using the following databases: Google Scholar, PubMed, and Research Gate. The following keywords were used: "minimally invasive access cavity", "conservative endodontic cavity ", and "classification of access cavity". Study selection: 64 papers that were the most relevant to the topics in this review were selected between 1969 to 26 February 2022. Conclusions: Minimally invasive access cavities can be classified into conservative, ultraconservative, truss access, caries and restorative-driven cavities. There is a deficiency of proof that a minimally invasive access cavity maintains the resistance to fracture of endodontically treated teeth greater than traditional access cavities. There was no difference in the percentage of untouched walls and debris removal in teeth with conservative vs traditional access cavities, however, truss and ultraconservative access cavities resulted in poor irrigation efficacy compared to traditional ones. Also, the lower cyclic fatigue resistance of rotary instruments and root canal obturation with voids were associated with minimally invasive access cavities. The studies about minimally invasive access cavities still have a wide range of methodological disadvantages or register unsatisfactory or inconclusive results. Therefore, further research on this topic is needed especially with the everyday advancement of techniques and armamentarium used in endodontics.
Received date: 06-03-2023
Accepted date: 06-04-2923
Published date: 15-06-2023
Downloads
Article Details
Issue
Section
This work is licensed under a Creative Commons Attribution 4.0 International License.
Licenses and Copyright
The following policy applies in The Journal of Baghdad College of Dentistry (JBCD):
# JBCD applies the Creative Commons Attribution (CC BY) license to articles and other works we publish. If you submit your paper for publication by JBCD, you agree to have the CC BY license applied to your work. Under this Open Access license, you as the author agree that anyone can reuse your article in whole or part for any purpose, for free, even for commercial purposes. Anyone may copy, distribute, or reuse the content as long as the author and original source are properly cited. This facilitates freedom in re-use and also ensures that JBCD content can be mined without barriers for the needs of research.
# If your manuscript contains content such as photos, images, figures, tables, audio files, videos, etc., that you or your co-authors do not own, we will require you to provide us with proof that the owner of that content (a) has given you written permission to use it, and (b) has approved of the CC BY license being applied to their content. We provide a form you can use to ask for and obtain permission from the owner. If you do not have owner permission, we will ask you to remove that content and/or replace it with other content that you own or have such permission to use.Don't assume that you can use any content you find on the Internet, or that the content is fair game just because it isn't clear who the owner is or what license applies.
# Many authors assume that if they previously published a paper through another publisher, they own the rights to that content and they can freely use that content in their paper, but that’s not necessarily the case, it depends on the license that covers the other paper. Some publishers allow free and unrestricted re-use of article content they own, such as under the CC BY license. Other publishers use licenses that allow re-use only if the same license is applied by the person or publisher re-using the content. If the paper was published under a CC BY license or another license that allows free and unrestricted use, you may use the content in your JBCD paper provided that you give proper attribution, as explained above.If the content was published under a more restrictive license, you must ascertain what rights you have under that license. At a minimum, review the license to make sure you can use the content. Contact that JBCD if you have any questions about the license. If the license does not permit you to use the content in a paper that will be covered by an unrestricted license, you must obtain written permission from the publisher to use the content in your JBCD paper. Please do not include any content in your JBCD paper which you do not have rights to use, and always give proper attribution.
# If any relevant accompanying data is submitted to repositories with stated licensing policies, the policies should not be more restrictive than CC BY.
# JBCD reserves the right to remove any photos, captures, images, figures, tables, illustrations, audio and video files, and the like, from any paper, whether before or after publication, if we have reason to believe that the content was included in your paper without permission from the owner of the content.
How to Cite
References
Yahata Y, Masuda Y, Komabayashi T. Comparison of apical centring ability between incisal‐shifted access and traditional lingual access for maxillary anterior teeth. Aust Endod J. 2017;43(3):123-128.
Siqueira Jr JF, Rôças IN. Clinical implications and microbiology of bacterial persistence after treatment procedures. J Endod. 2008;34(11):1291-1301. e1293.
Saygili G, Uysal B, Omar B, Ertas ET, Ertas H. Evaluation of relationship between endodontic access cavity types and secondary mesiobuccal canal detection. BMC Oral Health. 2018;18(1):1-6.
Alovisi M, Pasqualini D, Musso E, Bobbio E, Giuliano C, Mancino D, et al. Influence of contracted endodontic access on root canal geometry: an in vitro study. J Endod. 2018;44(4):614-620.
Clark D, Khademi J. Modern molar endodontic access and directed dentin conservation. Dent Clinics. 2010;54(2):249-273.
Gambarini G, Krastl G, Chaniotis A, ElAyouti A, Franco V. Clinical challenges and current trends in access cavity design and working length determination: First European Society of Endodontology (ESE) clinical meeting: ACTA, Amsterdam, The Netherlands, 27th October 2018. p. 397-399.
Plotino G, Grande NM, Isufi A, Ioppolo P, Pedullà E, Bedini R, et al. Fracture strength of endodontically treated teeth with different access cavity designs. J Endod. 2017;43(6):995-1000.
Augusto C, Barbosa A, Guimarães C, Lima C, Ferreira C, Sassone L, et al. A laboratory study of the impact of ultraconservative access cavities and minimal root canal tapers on the ability to shape canals in extracted mandibular molars and their fracture resistance. Int Endod J. 2020;53(11):1516-1529.
Silva A, Belladonna F, Rover G, Lopes R, Moreira E, De‐Deus G, et al. Does ultraconservative access affect the efficacy of root canal treatment and the fracture resistance of two‐rooted maxillary premolars? Int Endod J. 2020;53(2):265-275.
Shihab D, Mahdee A. Root and Root Canal Morphology : Study Methods and Classification. J Baghdad Coll Dent. 2021.;33 (4 ):11-19.
Silva E, Pinto K, Ferreira C, Belladonna F, De‐Deus G, Dummer P, et al. Current status on minimal access cavity preparations: a critical analysis and a proposal for a universal nomenclature. Int Endod J. 2020;53(12):1618-1635.
Tsotsis P, Dunlap C, Scott R, Arias A, Peters OA. A survey of current trends in root canal treatment: Access cavity design and cleaning and shaping practices. Aust Endod J. 2021;47(1):27-33.
Chan MYC, Cheung V, Lee AHC, Zhang C. A Literature Review of Minimally Invasive Endodontic Access Cavities-Past, Present and Future. Eur Endod J. 2022 Mar 1;7:1-0.
Patel S, Rhodes J. A practical guide to endodontic access cavity preparation in molar teeth. Br Dent J. 2007;203(3):133-140.
Corsentino G, Pedullà E, Castelli L, Liguori M, Spicciarelli V, Martignoni M, et al. Influence of access cavity preparation and remaining tooth substance on fracture strength of endodontically treated teeth. J Endod. 2018;44(9):1416-1421.
Levin H. Access cavities. Dent Clin N Am. 1967:701-710.
Roperto R, Sousa YT, Dias T, Machado R, Perreira RD, Leoni GB, et al. Biomechanical behavior of maxillary premolars with conservative and traditional endodontic cavities. Quintessence Int. 2019;50(5):350-356.
Vieira GC, Pérez AR, Alves FR, Provenzano JC, Mdala I, Siqueira Jr JF, et al. Impact of contracted endodontic cavities on root canal disinfection and shaping. J Endod. 2020;46(5):655-661.
Neelakantan P, Khan K, Ng GPH, Yip CY, Zhang C, Cheung GSP. Does the orifice-directed dentin conservation access design debride pulp chamber and mesial root canal systems of mandibular molars similar to a traditional access design? J Endod. 2018;44(2):274-279.
Clark D, Khademi J, Herbranson E. The new science of strong endo teeth. Dent today. 2013;32(4):112-117.
Eaton JA, Clement DJ, Lloyd A, Marchesan MA. Micro–computed tomographic evaluation of the influence of root canal system landmarks on access outline forms and canal curvatures in mandibular molars. J Endod. 2015;41(11):1888-1891.
Gambarini G, Galli M, Morese A, Stefanelli LV, Abduljabbar F, Giovarruscio M, et al. Precision of dynamic navigation to perform endodontic ultraconservative access cavities: a preliminary in vitro analysis. J Endod. 2020;46(9):1286-1290.
Kishen A. Mechanisms and risk factors for fracture predilection in endodontically treated teeth. Endod topics. 2006;13(1):57-83.
Dastjerdi MR, Chaijan KA, Tavanafar S. Fracture resistance of upper central incisors restored with different posts and cores. Restor Dent Endod. 2015;40(3):229-235.
Ikram O, Patel S, Sauro S, Mannocci F. Micro‐computed tomography of tooth tissue volume changes following endodontic procedures and post space preparation. Int Endod J. 2009;42(12):1071-1076.
Lin F, Ordinola-Zapata R, Fok AS, Lee R. Influence of minimally invasive endodontic access cavities and bonding status of resin composites on the mechanical property of endodontically-treated teeth: A finite element study. Dent Mater. 2022;38(2):242-250.
Krishan R, Paqué F, Ossareh A, Kishen A, Dao T, Friedman S. Impacts of conservative endodontic cavity on root canal instrumentation efficacy and resistance to fracture assessed in incisors, premolars, and molars. J Endod. 2014;40(8):1160-1166.
Moore B, Verdelis K, Kishen A, Dao T, Friedman S. Impacts of contracted endodontic cavities on instrumentation efficacy and biomechanical responses in maxillary molars. J Endod. 2016;42(12):1779-1783.
Chlup Z, Žižka R, Kania J, Přibyl M. Fracture behaviour of teeth with conventional and mini-invasive access cavity designs. J Eur Ceram Soc. 2017;37(14):4423-4429.
De-Deus G, Silva EJNL, Vieira VTL, Belladonna FG, Elias CN, Plotino G, et al. Blue thermomechanical treatment optimizes fatigue resistance and flexibility of the Reciproc files. J Endod. 2017;43(3):462-466.
Arola D, Reprogel R. Effects of aging on the mechanical behavior of human dentin. Biomaterials. 2005;26(18):4051-4061.
A. Versiani M, Souza E, De‐Deus G. Critical appraisal of studies on dentinal radicular microcracks in endodontics: methodological issues, contemporary concepts, and future perspectives. Endod Topics. 2015;33(1):87-156.
Maske A, Weschenfelder VM, Soares Grecca Vilella F, Burnett Junior LH, de Melo TAF. Influence of access cavity design on fracture strength of endodontically treated lower molars. Aust Endod J. 2021;47(1):5-10.
Saberi EA, Pirhaji A, Zabetiyan F. Effects of endodontic access cavity design and thermocycling on fracture strength of endodontically treated teeth. Clin Cosmet Investig Dent. 2020;12:149.
Saeed M, Al-Obadi M, Salim A, Alsawaf AY, Hadi K. Impact of Access Cavity Design on Fracture Resistance of Endodontically Treated Molars: A Systematic Review. Clin Cosmet Investig Dent. 2021;13:1.
Bóveda C, Kishen A. Contracted endodontic cavities: the foundation for less invasive alternatives in the management of apical periodontitis. Endod Topics. 2015;33(1):169-186.
Rover G, Belladonna FG, Bortoluzzi EA, De-Deus G, Silva EJNL, Teixeira CS. Influence of access cavity design on root canal detection, instrumentation efficacy, and fracture resistance assessed in maxillary molars. J Endod . 2017;43(10):1657-1662.
Barbosa A, Silva E, Coelho B, Ferreira C, Lima C, Sassone L. The influence of endodontic access cavity design on the efficacy of canal instrumentation, microbial reduction, root canal filling and fracture resistance in mandibular molars. Int Endod J. 2020;53(12):1666-1679.
Xia J, Wang W, Li Z, Lin B, Zhang Q, Jiang Q, et al. Impacts of contracted endodontic cavities compared to traditional endodontic cavities in premolars. BMC oral health. 2020;20(1):1-8.
Peng W, Zhou X, Gao Y, Xu X. Effect of access cavity preparation on dentin preservation, biomechanical property and instrumentation efficacy: a Micro-CT study. . J Endod . 2022.
Gluskin AH, Peters CI, Peters OA. Minimally invasive endodontics: challenging prevailing paradigms. Br Dent J. 2014;216(6):347-353.
Niemi TK, Marchesan MA, Lloyd A, Seltzer RJ. Effect of instrument design and access outlines on the removal of root canal obturation materials in oval-shaped canals. . J Endod . 2016;42(10):1550-1554.
Rover G, de Lima C, Belladonna F, Garcia L, Bortoluzzi E, Silva E, et al. Influence of minimally invasive endodontic access cavities on root canal shaping and filling ability, pulp chamber cleaning and fracture resistance of extracted human mandibular incisors. Int Endod J. 2020;53(11):1530-1539.
Dammaschke T, Nykiel K, Sagheri D, Schäfer E. Influence of coronal restorations on the fracture resistance of root canal‐treated premolar and molar teeth: A retrospective study. Aust Endod J. 2013;39(2):48-56.
van Dijken JW, Pallesen U. A randomized controlled three year evaluation of “bulk-filled” posterior resin restorations based on stress decreasing resin technology. Dent Mater. 2014;30(9):e245-e251.
Silva E, Oliveira V, Silva A, Belladonna F, Prado M, Antunes H, et al. Effect of access cavity design on gaps and void formation in resin composite restorations following root canal treatment on extracted teeth. Int Endod J. 2020;53(11):1540-1548.
Boscatto RH, Prado M, Silva EJNL, de Lima CO, de-Jesus-Soares A, Frozoni M. Influence of the endodontic access cavity design and restorative technique on hard tissue removal and fracture resistance of mandibular premolars. Res Soc Dev. 2022;11(1).
Bosenbecker J, Barbon FJ, de Souza Ferreira N, Morgental RD, Boscato N. Tooth discoloration caused by endodontic treatment: A cross‐sectional study. J Esthet Restor Dent. 2020;32(6):569-574.
Lenherr P, Allgayer N, Weiger R, Filippi A, Attin T, Krastl G. Tooth discoloration induced by endodontic materials: a laboratory study. Int Endod J. 2012;45(10):942-949.
Marchesan MA, James CM, Lloyd A, Morrow BR, García‐Godoy F. Effect of access design on intracoronal bleaching of endodontically treated teeth: an ex vivo study. J Esthet Restor Dent . 2018;30(2):E61-E67.
Peters OA, Barbakow F. Dynamic torque and apical forces of ProFile. 04 rotary instruments during preparation of curved canals. Int Endod J. 2002;35(4):379-389.
Walia H, Brantley WA, Gerstein H. An initial investigation of the bending and torsional properties of Nitinol root canal files. J Endod. 1988;14(7):346-351.
Parashos P, Messer HH. Rotary NiTi instrument fracture and its consequences. J Endod. 2006;32(11):1031-1043.
Bahcall JK, Carp S, Miner M, Skidmore L. The causes, prevention, and clinical management of broken endodontic rotary files. Dent Today. 2005;24(11):74, 76, 78-80; quiz 80.
Pedullà E, La Rosa GRM, Boninelli S, Rinaldi OG, Rapisarda E, Kim H-C. Influence of different angles of file access on cyclic fatigue resistance of Reciproc and Reciproc Blue instruments. . J Endod. 2018;44(12):1849-1855.
Pedullà E, La Rosa GRM, Virgillito C, Rapisarda E, Kim H-C, Generali L. Cyclic fatigue resistance of nickel-titanium rotary instruments according to the angle of file access and radius of root canal. . J Endod. 2020;46(3):431-436.
Silva EJNL, Attademo RS, da Silva MCD, Pinto KP, Antunes HdS, Vieira VTL. Does the type of endodontic access influence in the cyclic fatigue resistance of reciprocating instruments? Clin Oral Investig. 2021;25(6):3691-3698.
Spicciarelli V, Marruganti C, Marzocco D, Martignoni M, Ounsi H, Grandini S. Influence of Endodontic Access Cavity Design on Fracture Strength of Maxillary Incisors and Premolars and on Fatigue Resistance of Reciprocating Instruments. Front Dent Med. 2020:11.
Corsentino G. Influence of Access Cavity Design on Fatigue Resistance of Reciproc Blue: Conservative vs. Truss Access. Int J Oral Dent Health. 2021;7:125.
Reeh ES, Messer HH, Douglas WH. Reduction in tooth stiffness as a result of endodontic and restorative procedures. . J Endod. 1989;15(11):512-516.
Tantbirojn D, Versluis A, Pintado MR, DeLong R, Douglas WH. Tooth deformation patterns in molars after composite restoration. Dent Mater. 2004;20(6):535-542.
Palin WM, Fleming GJ, Nathwani H, Burke FT, Randall RC. In vitro cuspal deflection and microleakage of maxillary premolars restored with novel low-shrink dental composites. Dent Mater. 2005;21(4):324-335.
Taha NA, Palamara JE, Messer HH. Cuspal deflection, strain and microleakage of endodontically treated premolar teeth restored with direct resin composites. J Dent. 2009;37(9):724-730.
González-López S, De Haro-Gasquet F, Vílchez-Díaz M, Ceballos L, Bravo M. Effect of restorative procedures and occlusal loading on cuspal deflection. Oper Dent. 2006;31(1):33-38. (