Effect of Access Design and Location on Stress Distribution Within Endodontically Treated Maxillary Incisors: A Three-Dimensional Finite Element Analysis

Abstract

The optimal approach to access cavity preparation in anterior teeth requiring root canal treatment, especially those affected by traumatic injuries, remains contentious among endodontists. Minimally invasive techniques aim to preserve tooth structure while maintaining strength. The effect of different access cavity designs on stress concentration and distribution in necrotized anterior teeth needing root canal treatment is not well documented. This study aims to evaluate and compare the effect of various access cavity designs on stress distribution in anterior teeth using three-dimensional finite element analysis. Three-dimensional finite element models of maxillary central incisors were created. Three groups with different access cavity designs were analyzed: Group A (Cervical access), Group B (Middle access), and Group C (Incisal access). A load of 100 N was applied at a 45-degree angle to the tooth axis in each model, and stress distribution was analyzed. Maximum stress values (in MPa) were recorded for each design. Group A: Enamel (587.52), Dentin (163.97), Composite (65.11); Group B: Enamel (880.93), Dentin (132.32), Composite (81.27); Group C: Enamel (493.92), Dentin (126.99), Composite (42.39). The study found significant differences in stress distribution among different access cavity designs, with traditional middle access showing the highest stress concentration. These findings could inform clinical decisions to optimize outcomes in root canal treatments.