Fracture-Resistant Endodontic and Restorative Preparations by Drs' Clark, Khademi and Herbranson
By Dr. David Clark, Dr. John Khademi, and Dr. Eric Herbranson | Dentistry Today, 2013
Click here to download the full article
This landmark article calls for a shift away from outdated, aggressive techniques in endodontic and restorative dentistry. Instead, it promotes a modern, biomechanically sound approach that preserves tooth structure and significantly reduces the risk of fracture. The authors introduce a philosophy rooted in conservation—rethinking endodontic access, shaping, and restorative design.
Key Takeaways
Why Traditional Techniques Often Lead to Fractures
- G.V. Black's preparation principles—developed over a century ago—are still widely used, despite modern advances.
- Excessive removal of enamel and dentin weakens the natural structure, increasing susceptibility to fracture.
- Long mesial-distal cavity cuts and aggressive endodontic shaping compromise the tooth’s biomechanical integrity.
A New Strategy: Preserve, Don’t Weaken
- Minimal Cutting: Maintaining as much natural dentin as possible reduces flexure and preserves strength.
- Interrupted Preparations: Small, strategically placed cavities avoid the structural compromise caused by traditional box preparations.
- Selective Shaping: Gentle shaping of canals using ultrasonics and conservative burs protects root strength.
Clinical Applications
- Composite Cuspal Coverage: Applying 2 mm of direct composite immediately post-endodontics helps prevent catastrophic fractures.
- Respecting Natural Canal Form: Preserving ovoid shapes instead of forcing round canals reduces internal stress points.
- Improved Long-Term Outcomes: Conserved dentin, conservative access, and immediate strengthening all lead to longer-lasting restorations.
Why It Matters
- Reduces the risk of post-treatment fractures and early tooth loss.
- Supports the long-term success of restorations—without relying on crowns or indirect restorations.
- Follows biomimetic dentistry principles—working with the tooth, not against it.
Conclusion
This article champions a more respectful and forward-thinking approach to tooth preservation. By adopting conservative shaping, composite onlays, and immediate protection, clinicians can dramatically improve outcomes and extend the life of endodontically treated teeth.
