Stress Distribution in Immature Incisors with Regenerative Endodontic Treatment: Which Coronal Restoration Performs Best? An FEA Study

Purpose: This study aimed to evaluate the effect of different coronal restoration methods on stresses in immature central incisors with regenerative endodontic treatment and excessive loss of coronal structure. Methods: A three-dimensional (3D) Finite Element Analysis (FEA) model of a maxillary central incisor treated with a 3 mm MTA coronal plug after regenerative endodontic treatment was created. Six different models were simulated: (1) intact immature tooth (control), (2) direct composite resin build-up, (3) fibre-reinforced composite build-up, (4) hybrid ceramic endocrown, (5) LiSi ceramic endocrown, and (6) endocore and ceramic crown restoration. Analyses were performed with SolidWorks/CosmosWorks, and a 150 N load was applied at a 135° angle. Results: Maximum tensile stresses were concentrated in the cervical region (4.577 MPa). Direct composite and fibre-reinforced restorations showed high stress in root dentin (3.891 and 3.841 MPa, respectively). The endocore/ceramic crown restoration (1.578 MPa) provided the closest stress distribution to the natural tooth (1.322 MPa). Conclusions: The biomechanical performance of the restoration–tooth complex depends on both the restorative material and the restoration design. In immature teeth undergoing regenerative endodontic treatment, the most biomechanically favourable restoration option was an endocore/ceramic crown.