Impacts of Tooth Structure Preservation Directed Access and Canal Instrumentation – Is Less More?

The occurrence of tooth/root fracture is a well-recognized cause of tooth loss after endodontic treatment. It has been attributed to tooth structure removal associated with traditional endodontic cavity and canal instrumentation concepts. This understanding has given rise to novel Contracted Endodontic Cavity (CEC) designs that highlight directed dentin conservation while discarding traditional principles of outline and convenience form, and to minimal canal instrumentation/shaping, both in line with the contemporary concept of minimally invasive dentistry. It has been argued that tooth structure preservation directed access and instrumentation may increase fracture resistance of teeth potentially resulting in extended long-term survival; however, it has also been argued that it may compromise canal disinfection potentially resulting in impaired periapical healing.
This lecture will describe the clinical applications of CEC and minimal canal instrumentation/shaping and review contemporary research into their possible impacts in specific tooth types. The potential benefits and risks associated with tooth structure preservation directed access and instrumentation will be debated in the context of minimally invasive endodontics, and options for clinicians to consider.