In this study a restored mandibular molar with different Class II amalgam preparations was examined to analyze the potential for restoration failure attributed to cyclic fatigue crack growth. A finite element analysis was used to determine the stress distribution along the cavo-surface margin which results from occlusal loading of each restoration. The cyclic crack growth rate of sub-surface flaws located along the dentinal cavo-surface margin were determined utilizing the Paris law. Based on similarities in material properties and lack of fatigue property data for dental biomaterials, the cyclic fatigue crack growth parameters for engineering ceramics were used to approximate the crack growth behavior. It was found that flaws located within the dentine along the buccal and lingual margins can significantly reduce the fatigue life of restored teeth. Sub-surface cracks as short as 25 microm were found capable of promoting tooth fracture well within 25 years from the time of restoration. Furthermore, cracks longer than 100 microm reduced the fatigue life to less than 5 years. Consequently, sub-surface cracks introduced during cavity preparation with conventional dental burrs may serve as a principal source for premature restoration failure.