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Fracture Resistance of Endodontically Treated Teeth with Different Perforation Diameters: An In Vitro Analysis
Flora Kakoura1, Kleoniki Lyroudia1, Nikolaos Economides1
1Department of Endodontology, School of Dentistry, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece.
Dentistry Journal
|January 27, 2026
Summary
Iatrogenic root perforations significantly reduce the fracture resistance (FR) of endodontically treated teeth. Larger perforation diameters (2.1 mm and 1 mm) were associated with a notable decrease in FR compared to intact teeth.
Area of Science:
- Endodontics
- Dental Materials Science
- Biomechanical Engineering
Background:
- Iatrogenic root perforations are procedural complications during endodontic treatment.
- The structural integrity and fracture resistance (FR) of endodontically treated teeth can be compromised by perforations.
Purpose of the Study:
- To evaluate the correlation between the diameter of iatrogenic root perforations and the fracture resistance (FR) of endodontically treated teeth.
- To quantify the impact of different perforation sizes on root strength.
Main Methods:
- Sixty-five single-rooted teeth were prepared and divided into five groups: intact, instrumented only, and instrumented with perforations of 2.1 mm, 1 mm, or 0.5 mm.
- Perforations were standardized in location and angle (105° to root surface).
- Fracture testing was performed using a universal testing machine applying vertical compressive load until fracture; data analyzed with ANOVA and Tukey test.
Main Results:
- Mean fracture loads were: Group 1 (intact) 342.68 N, Group 2 (instrumented) 322.96 N, Group 3 (2.1 mm perforation) 214.65 N, Group 4 (1 mm perforation) 212.66 N, and Group 5 (0.5 mm perforation) 307.14 N.
- Statistically significant reductions in FR were observed for teeth with 2.1 mm and 1 mm perforations compared to intact teeth (p < 0.05).
- The 0.5 mm perforation group did not show a statistically significant decrease in FR.
Conclusions:
- Iatrogenic root perforations, particularly those measuring 2.1 mm and 1 mm in diameter, significantly compromise the fracture resistance of endodontically treated teeth.
- The size of the perforation is a critical factor influencing the mechanical stability of the root.
- Minimizing perforation size during endodontic procedures is crucial for maintaining root strength.
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