Conservative endodontic cavity (CEC) may improve fracture resistance of teeth but compromise instrumentation of canals. Extracted human intact maxillary incisors, mandibular premolars and molars were imaged with micro-CT and assigned to CEC or traditional endodontic cavity (TEC) groups (n=10/group/type). Canals were prepared and post-treatment micro-CT images obtained. These teeth along with the negative controls were then loaded to fracture. Mean proportion of untouched canal-wall was significantly higher only in distal canals of molars with CEC compared to TEC. Mean dentin volume removed was significantly smaller for CEC in all tooth types. Mean load-at-fracture for CEC was significantly higher in premolars and molars without differing significantly from the negative controls. While CEC was associated with compromised canal instrumentation only in the distal canals of molars, it conserved coronal dentin in all three tooth types and increased resistance to fracture in the mandibular molars and premolars.iii ACKNOWLEDGEMENTS

The prognosis of root‐filled teeth depends not only on the success of the endodontic treatment but also on the amount of remaining dentine tissue, and the nature of final restoration. Fractures of restored endodontically treated teeth are a common occurrence in clinical practice. This article outlines the mechanisms and risk factors for fracture predilection in endodontically treated teeth. Different mechanisms of fracture resistance in dentine and the biomechanical causes of fracture predilection in restored endodontically treated teeth are described. Furthermore, dentinal, restorative, chemical, microbial, and age‐induced factors that predispose restored endodontically treated teeth to fracture are also reviewed.

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In maxillary molars tested in vitro, CECs did not impact instrumentation efficacy and biomechanical responses compared with TECs.

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