Impact of Traditional Access Cavity and Conservative Access Cavity on Root Canal Therapy Outcome: Review of the Literature

Abstract

There has been a renewed emphasis on conservative access cavity designs in endodontics in recent years, given such designs' large contribution to tooth structure conservation, especially pericervical dentin, and potentially leading to improved fracture resistance of endodontically treated teeth. This study aims to highlight the effects of different access cavity preparation techniques on the results of root canal treatment, including fracture resistance, efficacy of cleaning and disinfection, procedural errors, root canal location, and quality of root canal fill. An extensive literature review was performed to find relevant published articles on various access cavity preparation techniques and how these affect root canal treatment results, particularly fracture resistance, cleaning and antimicrobial treatment, procedural errors, root canal location, and root canal obturation within endodontics. This search was performed on articles of all languages and was conducted on some of the most utilized electronic databases, including PubMed, ResearchGate, Web of Science, ScienceDirect, Wiley Online Library, and Google Scholar.  Many studies have been carried out to evaluate the impact of conservative access cavity preparation, comparing its efficiency and efficacy with conventional access cavity preparation. There was a total of 41 articles on which the studies were based. Out of these, 30 articles were aimed at determining the effect of access cavity preparation on fracture resistance of remaining tooth structure, 12 were on root canal instrumentation, 7 were on the incidence of procedural error during treatment, 3 were on root canal detection, and another 3 were on the quality of root canal obturation. In summary, access cavity preparation for fracture resistance is still somewhat restrained and controversial. Conservative access cavities can include endodontic therapy regarding instrument size, canal orientation, and obturation of canals; in addition, it could also prolong treatment and create iatrogenic complications.