Comparison of minimally invasive access cavity designs using finite element analysis and long-term clinical outcomes

Abstract

Minimally invasive access cavity designs have emerged as an important advancement in
endodontics, aiming to preserve maximum tooth structure while maintaining adequate access
for effective root canal treatment. Various designs, including conservative, ninja, and truss
access cavities, have been proposed to enhance the biomechanical integrity of treated teeth
without compromising clinical outcomes. Finite element analysis (FEA) has become a valuable
computational tool for evaluating stress distribution, fracture resistance, and structural behavior
under simulated functional loading conditions. This review examines the biomechanical
performance of different minimally invasive access cavity designs through FEA and compares
these findings with available long-term clinical outcomes. The relationship between tooth
structure preservation, canal accessibility, instrumentation efficiency, and restorative success
is critically discussed. Clinical evidence indicates that while conservative access designs may
improve fracture resistance by preserving pericervical dentin, their effectiveness depends
on appropriate case selection, operator expertise, and the ability to achieve thorough canal
debridement and disinfection. Long-term treatment success is influenced by multiple factors,
including restoration quality, occlusal loading, and patient-specific characteristics, in addition
to cavity design. Integrating computational modeling with clinical follow-up provides a
more comprehensive understanding of the strengths and limitations of minimally invasive
approaches, supporting evidence-based decision-making and guiding future innovations in
endodontic treatment planning and restorative strategies.