Objective: To evaluate the resistance to fracture of endodontically treated teeth restored with combined composite-amalgam restorations in comparison to all-amalgam restorations. Method and Materials: Forty-eight human premolar teeth were equally divided into 4 groups. Mesio-occlusodistal (MOD) cavities were prepared in 3 groups, and in the fourth group, a modified MOD preparation was designed with an additional buccolingual groove. All teeth were endodontically treated and restored using 1 of several restorative modalities: all amalgam (AM), all amalgam plus dentin adhesive (ADA), amalgam plus dentin adhesive plus composite resin (ADAC), and amalgam plus dentin adhesive plus composite resin with a modified preparation design (ADACM). Specimens were tested in a universal testing machine (Instron). The load (in kilonewtons) at fracture was recorded and statistically analyzed using a Bonferroni one-way statistical analysis (significance: P ? .01). Results: The teeth restored with a combined composite-amalgam restoration were significantly more resistant to fracture (P ? .01) than teeth restored with amalgam alone. The modification with an additional horizontal buccolingual cavity preparation groove did not significantly increase resistance to fracture, nor did the addition of a bonding material to the amalgam restorations. Mean resistance to fracture (in kilonewtons) of each group was as follows: group AM, 0.31; group ADA, 0.34; group ADAC, 0.45; and group ADACM, 0.47. Conclusions: Restoration of endodontically treated teeth with combined composite-amalgam materials increased tooth resistance to fracture up to 51% when compared to teeth restored with amalgam alone. (Quintessence Int 2008;39:179.e58–62)

Key words: composite-amalgam restorations, endodontically treated teeth, modified preparations, resistance to fracture