Stiffness of endodontically-treated teeth related to restoration technique

Endodontically-treated posterior teeth are susceptible to fracture; consequently, full-occlusal-coverage restorations are recommended. We designed this study to examine the potential for alternative restorative techniques for pulpless teeth, using strain gauges mounted on extracted maxillary second premolars to measure strains generated by nondestructive occlusal loading. Cuspal stiffness was evaluated on the following sequentially performed procedures: unaltered tooth, completion of all endodontic procedures, appropriate restorative preparation, and restoration. The restorative procedures evaluated were: (1) amalgam, (2) cast gold onlay, (3) composite restoration with enamel etch, and (4) composite restoration with enamel and dentin etch. Finally, all teeth were loaded to fracture. Cast gold was the strongest restorative material tested (2.11 relative stiffness, compared with that of the unaltered tooth at 1.00), and amalgam was the weakest (0.35 relative stiffness). Composite restoration and enamel plus dentin etch were almost as strong as the unaltered tooth (0.87 relative stiffness), while enamel-etch-only yielded lower stiffness (0.51).