This systematic review aimed to investigate whether minimally invasive root canal preparation ensures higher fracture resistance compared to conventional root canal preparation in endodontically treated teeth (ETT). A comprehensive search strategy was conducted on the “PubMed, Web of Science, and Scopus” databases, alongside reference and hand searches, with language restrictions applied. Two independent reviews selected pertinent laboratory studies that explored the effect of minimally invasive root canal preparation on fracture resistance, in comparison to larger preparation counterparts. The quality of the studies was assessed, and the risk of bias was categorized as low, moderate, or high. The electronic search yielded a total of 1,767 articles. After applying eligibility criteria, 8 studies were included. Given the low methodological quality of these studies and the large variability of fracture resistance values, the impact of reduced apical size and/or taper on the fracture resistance of the ETT can be considered uncertain. This systematic review could not reveal sufficient evidence regarding the effect of minimally invasive preparation on increasing fracture resistance of ETT, primarily due to the inherent limitations of the studies and the moderate risk of bias.

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• Impact of conservative versus conventional instrumentation on the release of inflammatory mediators and post‐operative pain in mandibular molars with asymptomatic irreversible pulpitis: A randomized clinical trial
  Sıla Nur Usta, Ana Arias, Emre Avcı, Emmanuel João Nogueira Leal Silva
  International Endodontic Journal.2025;[Epub]     CrossRef
• Micro‐computed tomography evaluation of minimally invasive root canal preparation in 3D‐printed C‐shaped canal
  Nutcha Supavititpattana, Siriwan Suebnukarn, Panupat Phumpatrakom, Kamon Budsaba
  Australian Endodontic Journal.2024; 50(3): 621.     CrossRef
• Ex vivo investigation on the effect of minimally invasive endodontic treatment on vertical root fracture resistance and crack formation
  Andreas Rathke, Henry Frehse, Maria Bechtold
  Scientific Reports.2024;[Epub]     CrossRef

The aim of this review was to evaluate the effects of different access cavity designs on endodontic treatment and tooth prognosis. Two independent reviewers conducted an unrestricted search of the relevant literature contained in the following electronic databases: PubMed, Science Direct, Scopus, Web of Science, and OpenGrey. The electronic search was supplemented by a manual search during the same time period. The reference lists of the articles that advanced to second-round screening were hand-searched to identify additional potential articles. Experts were also contacted in an effort to learn about possible unpublished or ongoing studies. The benefits of minimally invasive access (MIA) cavities are not yet fully supported by research data. There is no evidence that this approach can replace the traditional approach of straight-line access cavities. Guided endodontics is a new method for teeth with pulp canal calcification and apical infection, but there have been no cost-benefit investigations or time studies to verify these personal opinions. Although the purpose of MIA cavities is to reflect clinicians' interest in retaining a greater amount of the dental substance, traditional cavities are the safer method for effective instrument operation and the prevention of iatrogenic complications.

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  Bioengineering.2024; 11(9): 878.     CrossRef
• Impact of Access Cavity Design on Fracture Resistance of Endodontically Treated Maxillary First Premolar: In Vitro
  Anju Daniel, Abdul Rahman Saleh, Anas Al-Jadaa, Waad Kheder
  Brazilian Dental Journal.2024;[Epub]     CrossRef
• Management of Traumatized Teeth With Severely Calcified Canals and Minimally Invasive Access Cavity Using the AReneto® System: A Case Report
  Pucha Sai Manaswini, Varun Prabhuji, Champa C, Srirekha A, Veena S Pai
  Cureus.2024;[Epub]     CrossRef
• Exploring the Impact of Access Cavity Designs on Canal Orifice Localization and Debris Presence: A Scoping Review
  Mario Dioguardi, Davide La Notte, Diego Sovereto, Cristian Quarta, Andrea Ballini, Vito Crincoli, Riccardo Aiuto, Mario Alovisi, Angelo Martella, Lorenzo Lo Muzio
  Clinical and Experimental Dental Research.2024;[Epub]     CrossRef
• The effect of computer aided navigation techniques on the precision of endodontic access cavities: A systematic review and meta-analysis
  P. R. Kesharani, S. D. Aggarwal, N. K. Patel, J. A. Patel, D. A. Patil, S. H. Modi
  Endodontics Today.2024; 22(3): 244.     CrossRef
• Minimally Invasive Access Cavity Designs: A Review
  Sushmita Rane, Varsha Pandit, Ashwini Gaikwad, Shivani Chavan, Rajlaxmi Patil, Mrunal Shinde
  Journal of Pharmacy and Bioallied Sciences.2024; 16(Suppl 3): S1971.     CrossRef
• Influence of Cavity Designs on Fracture Resistance: Analysis of the Role of Different Access Techniques to the Endodontic Cavity in the Onset of Fractures: Narrative Review
  Mario Dioguardi, Davide La Notte, Diego Sovereto, Cristian Quarta, Angelo Martella, Andrea Ballini, Cornelis H. Pameijer
  The Scientific World Journal.2024;[Epub]     CrossRef
• Digital precision meets dentin preservation: PriciGuide™ system for guided access opening
  Varun Prabhuji, A. Srirekha, Veena Pai, Archana Srinivasan, S. M. Laxmikanth, Shwetha Shanbhag
  Journal of Conservative Dentistry and Endodontics.2024; 27(8): 884.     CrossRef
• Minimal Invasive Endodontics: A Comprehensive Narrative Review
  Jaydip Marvaniya, Kishan Agarwal, Dhaval N Mehta, Nirav Parmar, Ritwik Shyamal , Jenee Patel
  Cureus.2022;[Epub]     CrossRef

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  Pablo Machado Soares, Lucas Saldanha da Rosa, Rafaela Oliveira Pilecco, Gabriel Kalil Rocha Pereira, Amanda Maria de Oliveira Dal Piva, João Paulo Mendes Tribst, Luiz Felipe Valandro, Cornelis Johannes Kleverlaan, Marilia Pivetta Rippe
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• Effect of powder air polishing and ultrasonic scaling on the marginal and internal interface (tooth-veneer) of ceramic veneers: an in vitro study
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  Clinical Oral Investigations.2024;[Epub]     CrossRef
• Clinical performance of two onlay designs for molars after root canal treatment
  Shujiang Chen, Meng Lu, Zhimin Zhu, Wenchuan Chen
  Journal of Oral Science.2023; 65(3): 171.     CrossRef
• Tooth‐cusp preservation with lithium disilicate onlay restorations: A fatigue resistance study
  Elizabeth Griffis, Islam Abd Alraheam, Lee Boushell, Terrence Donovan, Dennis Fasbinder, Taiseer A. Sulaiman
  Journal of Esthetic and Restorative Dentistry.2022; 34(3): 512.     CrossRef
• Cyclic fatigue vs static loading for shear bond strength test of lithium disilicate and dentin substrates: A comparison of resin cement viscosities
  Kiara Serafini Dapieve, Renan Vaz Machry, Ana Carolina Cadore-Rodrigues, Jessica Klöckner Knorst, Gabriel Kalil Rocha Pereira, Niek De Jager, Luiz Felipe Valandro, Cornelis Johannes Kleverlaan
  Dental Materials.2022; 38(12): 1910.     CrossRef
• Fracture resistance and 3D finite element analysis of machined ceramic crowns bonded to endodontically treated molars with two planes versus flat occlusal preparation designs: an in vitro study
  Omnia Nabil, Carl Hany Halim, Ashraf Hassan Mokhtar
  F1000Research.2021; 8: 1020.     CrossRef
• Establishment of optimal variable elastic modulus distribution in the design of full-crown restorations by finite element analysis
  Jianghai CHEN, Yutao JIAN, Shumin CHEN, Xiaodong WANG, Li DAO, Ke ZHAO
  Dental Materials Journal.2021; 40(6): 1403.     CrossRef
• Load-bearing capacity of CAD/CAM 3D-printed zirconia, CAD/CAM milled zirconia, and heat-pressed lithium disilicate ultra-thin occlusal veneers on molars
  A. Ioannidis, D. Bomze, C.H.F. Hämmerle, J. Hüsler, O. Birrer, S. Mühlemann
  Dental Materials.2020; 36(4): e109.     CrossRef
• Fracture resistance and 3D finite element analysis of machined ceramic crowns bonded to endodontically treated molars with two planes versus flat occlusal preparation designs: an in vitro study
  Omnia Nabil, Carl Hany Halim, Ashraf Hassan Mokhtar
  F1000Research.2019; 8: 1020.     CrossRef
• The effect of adhesive failure and defects on the stress distribution in all-ceramic crowns
  Yonggang Liu, Yuanzhi Xu, Bo Su, Dwayne Arola, Dongsheng Zhang
  Journal of Dentistry.2018; 75: 74.     CrossRef

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  Sneha Rathaur, Pankaj K Gupta, Sonal Dhote, Kumari S Pravin, Komal Kishlay, Seema Gupta
  Cureus.2025;[Epub]     CrossRef
• Influence of Contracted Endodontic Cavity Design on the Debridement Efficacy of Three Different Irrigant Activation Systems in Human Permanent Mandibular Molars: A Scanning Electron Microscopy Analysis
  Srilekha Jayakumar, Vignesh Srinivasan, Janani Karunakaran, Jwaalaa Rajkumar, Vashni Solomon, Aarthi Thiagarajan
  World Journal of Dentistry.2025; 16(1): 62.     CrossRef
• The Effect of Additional Silane Pre-Treatment on the Microtensile Bond Strength of Resin-Based Composite Post-and-Core Build-Up Material
  Chia-Ying Wu, Keigo Nakamura, Aya Miyashita-Kobayashi, Akiko Haruyama, Yukiko Yokoi, Akihiro Kuroiwa, Nobuo Yoshinari, Atsushi Kameyama
  Applied Sciences.2024; 14(15): 6637.     CrossRef
• The Influence on Fracture Resistance of Different Composite Resins and Prefabricated Posts to Restore Endodontically Treated Teeth
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  Polymers.2023; 15(1): 236.     CrossRef
• Comparison of the pull-out bond strength of endodontically treated anterior teeth with monolithic zirconia endocrown and post-and-core crown restorations
  Durmus A. Bozkurt, Emine B. Buyukerkmen, Arslan Terlemez
  Journal of Oral Science.2023; 65(1): 1.     CrossRef
• Minimally invasive access cavities in endodontics
  Lubna A Abdulrazaq, Ahmed H Ali, Federico Foschi
  Journal of Baghdad College of Dentistry.2023; 35(2): 65.     CrossRef
• Comparison of Fracture Resistance of Endodontically Treated Teeth With Traditional Endodontic Access Cavity, Conservative Endodontic Access Cavity, Truss Endodontic Access Cavity, and Ninja Endodontic Access Cavity Designs: An In Vitro Study
  Prasad Patil , Pooja Newase, Swapnil Pawar, Hasmukh Gosai , Dharmendra Shah, Sameer M Parhad
  Cureus.2022;[Epub]     CrossRef
• Effect of different access cavity designs on fracture toughness of endodontically treated teeth: a systematic review and network meta-analysis
  Momina A. Motiwala, Meisha Gul, Robia Ghafoor
  Evidence-Based Dentistry.2022;[Epub]     CrossRef
• Fracture resistance of polyetheretherketone, Ni-Cr, and fiberglass postcore systems: An in vitro study
  Hossein Pourkhalili, Donya Maleki
  Dental Research Journal.2022; 19(1): 20.     CrossRef
• The effect of bulk-fill composites: Activa and Smart Dentin Replacement on cuspal deflection in endodontically treated teeth with different access cavity designs
  Rupali Karale, BJ Prathima, BR Prashanth, NS Shivaranjan, Neha Jain
  Journal of Conservative Dentistry.2022; 25(4): 375.     CrossRef
• Efficacy of Root Canal Instrumentation and Fracture Strength Assessment in Primary Molars after Preparing Two Different Shapes of Access Cavity: An Ex Vivo Histological Study
  Yashika Singhal, Vandana Reddy
  International Journal of Clinical Pediatric Dentistry.2021; 14(4): 518.     CrossRef
• MANAGEMENT OF ELISS CLASS IV FRACTURE USING FIBER POST : A CASE REPORT
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  Flavia Florentino Teixeira da Silva, André Hayato Saguchi, Sidnea Aparecida Freitas Paiva, Guilherme Espósito Pires, Mariana Isidoro, Aldo Brugnera Junior, Paulo Francisco Cesar, Ângela Toshie Araki
  Brazilian Journal of Oral Sciences.2021;[Epub]     CrossRef
• Does ultraconservative access affect the efficacy of root canal treatment and the fracture resistance of two‐rooted maxillary premolars?
  A. A. Silva, F. G. Belladonna, G. Rover, R. T. Lopes, E. J. L. Moreira, G. De‐Deus, E. J. N. L. Silva
  International Endodontic Journal.2020; 53(2): 265.     CrossRef
• Effect of Glass Fiber Post Diameter on Fracture Resistance of Endodontically Treated Teeth
  Saied Nokar, Mahsa Sadat Mortazavi, Somayeh Niakan
  Pesquisa Brasileira em Odontopediatria e Clínica Integrada.2020;[Epub]     CrossRef
• One‐step fiber post cementation and core build‐up in endodontically treated tooth: A clinical case report
  José Mauricio dos Santos Nunes Reis, Carlos R. de Moura Oliveira, Erica G. J. Reis, Bruno A. Mascaro, Filipe de Oliveira Abi‐Rached
  Journal of Esthetic and Restorative Dentistry.2020; 32(1): 5.     CrossRef
• Impact of contracted endodontic cavities on fracture resistance of endodontically treated teeth: a systematic review of in vitro studies
  Emmanuel João Nogueira Leal Silva, Gabriela Rover, Felipe Gonçalves Belladonna, Gustavo De-Deus, Cleonice da Silveira Teixeira, Tatiana Kelly da Silva Fidalgo
  Clinical Oral Investigations.2018; 22(1): 109.     CrossRef
• Fracture Strength of Endodontically Treated Teeth with Different Access Cavity Designs
  Gianluca Plotino, Nicola Maria Grande, Almira Isufi, Pietro Ioppolo, Eugenio Pedullà, Rossella Bedini, Gianluca Gambarini, Luca Testarelli
  Journal of Endodontics.2017; 43(6): 995.     CrossRef
• Comparison of push-out bond strength of fiber-reinforced composite resin posts according to cement thickness
  Jun-Seong Park, Jeong-Sub Lee, Jeong-Won Park, Won-Gyun Chung, Eun-Hee Choi, Yoon Lee
  The Journal of Prosthetic Dentistry.2017; 118(3): 372.     CrossRef
• Tratamiento restaurador de lesiones dentales traumáticas. Reporte de tres casos clínicos
  Johann Vladimir Uzcátegui Quintero, Alinne Hernández Ayala, Ricardo González Plata, Enrique Ríos Szalay
  Revista Odontológica Mexicana.2017; 21(3): 185.     CrossRef
• The effects of post and core material combination on the surface strain of the 4-unit zirconia fixed partial denture margins
  Yoko ISHIKAWA, Wataru KOMADA, Tasuku INAGAKI, Reina NEMOTO, Satoshi OMORI, Hiroyuki MIURA
  Dental Materials Journal.2017; 36(6): 798.     CrossRef
• Restorative treatment of traumatic dental injuries. Report of three clinical cases
  Johann Vladimir Uzcátegui Quintero, Alinne Hernández Ayala, Ricardo González Plata, Enrique Ríos Szalay
  Revista Odontológica Mexicana.2017; 21(3): e179.     CrossRef

The purpose of this study was to determine the effect of post types and sizes on fracture resistance in immature tooth model with various restorative techniques. Bovine incisors were sectioned 8 mm above and 12 mm below the cementoenamel junction to simulate immature tooth model. To compare various post-and-core restorations, canals were restored with gutta-percha and resin core, or reinforced dentin wall with dual-cured resin composite, followed by placement of D.T. LIGHT-POST, ParaPost XT, and various sizes of EverStick Post individually. All of specimens were stored in the distilled water for 72 hours and underwent 6,000 thermal cycles. After simulation of periodontal ligament structure with polyether impression material, compressive load was applied at 45 degrees to the long axis of the specimen until fracture was occurred.

Experimental groups reinforced with post and composite resin were shown significantly higher fracture strength than gutta-percha group without post placement (p < 0.05). Most specimens fractured limited to cervical third of roots. Post types did not influence on fracture resistance and fracture level significantly when cement space was filled with dual-cured resin composite. In addition, no statistically significant differences were seen between customized and standardized glass fiber posts, which cement spaces were filled with resin cement or composite resin individually. Therefore, root reinforcement procedures as above in immature teeth improved fracture resistance regardless of post types and sizes.

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• Effect of Dental Posts used in Restoring Badly Broken Primary teeth
  Tebra Alkayakh, Abdulrahim Aldarewesh
  Libyan Journal of Medical Research.2024; 18(1): 65.     CrossRef
• An in vitro comparison of fracture resistance of immature teeth subjected to apexification using three different bioactive materials
  Aarshati Vyas, Shilpa Shah, Nishtha K Patel, Krushnangi Yagnik, Vyoma Hirpara, Rajvi Shah
  IP Indian Journal of Conservative and Endodontics.2023; 7(4): 172.     CrossRef
• Comparative Evaluation of the Fracture Resistance of Simulated Immature Teeth Reinforced with a Novel Anatomic Post and MTA or Biodentine as an Apical Barrier: An In Vitro Study
  Shivani H Dholakia, Mrunalini J Vaidya
  Journal of Operative Dentistry & Endodontics.2020; 4(2): 62.     CrossRef
• Fracture resistance of upper central incisors restored with different posts and cores
  Maryam Rezaei Dastjerdi, Kamran Amirian Chaijan, Saeid Tavanafar
  Restorative Dentistry & Endodontics.2015; 40(3): 229.     CrossRef
• Retentive strength of different intracanal posts in restorations of anterior primary teeth: anin vitrostudy
  Mahtab Memarpour, Fereshteh Shafiei, Maryam Abbaszadeh
  Restorative Dentistry & Endodontics.2013; 38(4): 215.     CrossRef

The purpose of this study was to investigate the fracture resistance of crown-root fractured teeth repaired with dual-cured composite resin and horizontal posts. 48 extracted human premolars were assigned to control group and three experimental groups. Complete crown-root fractures were experimentally induced in all control and experimental teeth. In the control group, the teeth (n=12) were bonded with resin cement and endodontically treated. Thereafter, the access cavities were sealed with dual-cured composite resin. In composite resin core - post group (n=12), the teeth were endodontically treated and access cavities were sealed with dual-cured composite resin. In addition, the fractured segments in this group were fixed using horizontal posts. In composite resin core group (n=12), the teeth were endodontically treated and the access cavities were filled with dual-cured composite resin without horizontal posts. In bonded amalgam group (n=12), the teeth were endodontically treated and the access cavities were sealed with bonded amalgam. Experimental complete crown-root fractures were induced again on repaired control and experimental teeth. The ratio of fracture resistance to original fracture resistance was analyzed with Kruskal-Wallis test. The results showed that teeth in control and composite resin core - post group showed significantly higher resistance to re-fracture than those in amalgam core group (p < 0.05). The resistance to refracture was high in the order of composite resin - post group, control group, composite resin group and bonded amalgam group. Within the scope of this study, the use of horizontal post could be beneficial in increasing the fracture resistance of previously fractured teeth.