Cuspal deflection in molars in relation to endodontic and restorative procedures

The extent of cuspal flexure following endodontic and restorative procedures has important consequences for potential fracture. This study was undertaken to determine the extent to which cusps of molars are weakened by progressively larger restorative preparations and endodontic access. Cuspal flexure of 13 extracted, intact human mandibular molars was measured under controlled occlusal loading. A ramped load of 100 N was applied to the mesial cusps via a steel sphere, using a closed-loop servohydraulic testing machine. Lateral cuspal displacement was recorded by linear measuring devices (direct current differential transformers) accurate to 1 micron. Increasingly extensive MO or MOD cavity preparations followed by endodontic access were cut in each tooth. Cuspal deflection increased with increasing cavity size and was greatest following endodontic access. Cuspal deflections of more than 10 microns were observed. These findings reinforce the importance of cuspal coverage to minimize the danger of marginal leakage and cuspal fracture in endodontically treated teeth.