Interventions in root-filled teeth identified in general dental practice: A 6-year longitudinal observational study.

AIM: To investigate what happens to cross-sectionally identified root-filled teeth over a 6-year period, regardless of the time that elapsed since primary root canal treatment, in a cohort of adult patients regularly attending a Public Dental Service. A secondary aim was to investigate how the cumulative events affecting root-filled teeth over the same time were associated with variables obtained from a baseline examination. METHODOLOGY: Adult patients with ≥1 previously root-filled tooth and regularly attending the Public Dental Service in Örebro County were enrolled for study participation in 2015. General dental practitioners examined all identified root-filled teeth in this cohort at baseline using a standardized protocol and were also responsible for further decision-making and treatments. After six years, information on events of the root-filled teeth was collected from dental records. The highest rating (most invasive treatment) on a 5-point ordinal scale was used in the analyses. Regression analyses with stepwise selection were performed for associations between patient- and tooth-related factors and events. RESULTS: A total of 445 patients with 1007 root-filled teeth were followed the entire observation time. Twenty (2.0%) of the root-filled teeth had endodontic retreatment and 150 (14.9%) were extracted over six years. Among teeth with periapical radiolucency or pain, the majority did not undergo retreatment or extraction; however, the multivariate analysis demonstrated that retreatment or extraction was associated with baseline recordings of teeth with periapical radiolucency (p < .0001), tenderness to percussion (p < .0001), and poor coronal restoration (p < .0001). CONCLUSIONS: This study corroborates the notion that in general dentistry, root-filled teeth with radiological signs of apical disease often remain untreated over time. Furthermore, it also reveals that root-filled teeth presenting with mild pain do not necessarily receive any intervention. However, teeth with baseline signs of apical periodontitis, pain, or inadequate coronal restoration were more likely to have received intervention during the six-year period.

Postoperative pain after total pulpotomy and root canal treatment in mature molars according to the new and traditional classifications of pulpitis: a prospective, randomized controlled trial.

BACKGROUND: The aim of this study was to compare postoperative pain following total pulpotomy (TP) and root canal treatment (RCT) in mature molar teeth with irreversible pulpitis. To compare the traditional pulpitis classification system with the Wolters system in evaluating postoperative pain. METHODS: Eighty mandibular molars with irreversible pulpitis were included and classified according to the Wolters (moderate/severe pulpitis). The teeth were randomly assigned to two groups (RCT or TP). RCT was performed following standardized protocols. TP was performed to the level of the canal orifices, and hemostasis was achieved with 2.5% sodium hypochlorite. A 3 mm layer of MTA was placed as the pulpotomy material. The teeth were restored with glass ionomer cement followed by composite. Pain scores were recorded preoperatively and, at 6, 12, 24, 48, and 72 h and 7 days after the interventions. The data were statistically analyzed using the Mann-Whitney U test, the Friedman test, the Wilcoxon signed-rank test, and the Spearman's correlation test. The significance level was set at 0.05. RESULTS: Sixty-four patients were analyzed at the one-week follow-up and all were diagnosed as irreversible pulpitis according to the AAE; 22 teeth were classified as moderate and 42 teeth were classified as severe pulpitis according to Wolters. There was no significant difference between TP and RCT in pain scores in moderate pulpitis patients (p > 0.05). There was a significant difference between TP and RCT at 24 and 72 h of severe pulpitis; higher pain scores were observed in the RCT (p < 0.05). CONCLUSIONS: In patients with moderate pulpitis, the TP procedure allowed symptom relief more quickly than RCT. In patients with severe pulpitis, TP provided for significantly lower pain scores compared to RCT at both 24 and 72 h. CLINICAL TRIAL REGISTRATION: The study was retrospectively registered with ClinicalTrials.gov (NCT05923619). Date of Registration: 06/16/23.

Segmental root development of immature necrotic permanent teeth following regenerative endodontic procedures: a case series.

Regenerative endodontic procedures (REPs) are frequently utilized to treat immature permanent teeth with necrotic or inflamed pulps. In most instances, these treatments successfully result in the resolution of apical periodontitis and continued root maturation. However, after reviewing over 180 REP cases treated in the Endodontics Department of Stomatology Hospital at Zhejiang University School of Medicine over the past seven years, we identified an unusual root development pattern in ten cases, characterized by root tips detached from the root body. We conducted a comprehensive analysis of the patients' demographic information, dental histories, and therapeutic efficacy, and identified five potential etiological factors for this rare phenomenon, including external force, prolonged extensive periapical inflammation, iatrogenic factors, traumatic history of primary teeth, and excessive tooth mobility. In our study, we observed that therapeutic failure was more likely in patients with initially separated root tips, while those with initially normal teeth demonstrated significantly better prognoses. We hypothesize that the initial root condition may exert a considerable influence on treatment outcomes.

Research progress of dental pulp regeneration treatment. / å†ç”Ÿæ€§ç‰™é«“æ²»ç–—çš„ç ”ç©¶è¿›å±•.

The dental pulp is the only soft tissue structure within the tooth, serving functions such as sensation and nutrition. However, the dental pulp is highly susceptible to necrosis due to external factors. Currently, root canal therapy is the most commonly used treatment for pulp necrosis. Nevertheless, teeth treated with root canal therapy are prone to secondary infections and adverse outcomes like vertical root fractures. Regenerative endodontic therapy has emerged as a solution, aiming to replace damaged tooth structures, including dentin, root structure, and the pulp-dentin complex cells. This approach demonstrates significant advantages in addressing clinical symptoms and achieving regeneration of the root and even the pulp. Since the discovery of dental pulp stem cells, regenerative endodontic therapy has gained new momentum. Advances in cell transplantation and cell homing techniques have rapidly developed, showing promising potential for clinical applications.

CBCT assessment of mandibular molar furcation following root canal retreatment using engine-driven instruments.

This study employed e-Vol DXS cone beam computed tomography (CBCT) software to assess dentin remnants in the furcation area of mesial canals in mandibular molars during root canal retreatment (RCR). Four groups (Reciproc®, ProTaper Next®, Race Evo®, Protaper Gold®) were subjected to RCR, and CBCT images were captured before (T1) and after (T2) treatment. Measurements of remaining dentin thickness at 1 mm and 3 mm below the furcation were scrutinized. Results revealed no significant differences in mean thicknesses of mesiobuccal (MB) and mesiolingual (ML) canals at 1 mm and 3 mm from the furcation pre-treatment (T1). Post-treatment (T2) showed analogous findings, with no significant differences in mean thicknesses. However, disparities were found between MB and ML canals at both distances, both before and after retreatment. In essence, the evaluated instruments exhibited safety in RCR, implying that they are appropriate for use in critical areas of mandibular molars without inducing excessive wear. This study underscores the reliability of these instruments in navigating danger zones during RCR, and contributes valuable insights for dental practitioners who handle complex root canal scenarios in mandibular molars.

Impact of different activation procedures on sodium hypochlorite penetration into dentinal tubules after endodontic retreatment via confocal laser scanning microscopy.

BACKGROUND: Infected dentinal tubules are a possible source of bacteria that are responsible for the failure of root canal treatment. Therefore, disinfection of dentinal tubules by increasing the penetration of the irrigation solution is important for success in retreatment cases. This study utilized confocal laser scanning microscopy (CLSM) to assess and compare the impact of XPR, ultrasonic irrigation (UI) and sonic activation (SA) on NaOCl penetration into dentinal tubules following endodontic retreatment. METHODS: A total of forty mandibular premolars were enrolled in this investigation. Following root canal preparation up to ProTaper X3 file (30/0.07), root canals were obturated with gutta-percha and bioceramic root canal sealer with single cone technique. The root canal filling materials were removed using ProTaper nickel-titanium rotary retreatment files until the working length was reached. The retreatment procedure was finalized using the ProTaper Next X4 (40/0.06). The teeth were divided into four groups based on the irrigation activation technique: control (conventional needle irrigation), SA, UI and XPR. During the final irrigation procedure, Rhodamine B dye was introduced to 5% NaOCl for visualization via CLSM. Subsequent to image acquisition, the maximum penetration, penetration percentage, and penetration area were calculated. Data were statistically analyzed using the Kruskal-Wallis, Friedman, and Bonferroni Dunn multiple comparison tests through R software (p < 0.05). RESULTS: In the middle third, UI yielded a significantly higher penetration percentage than the control group (p < 0.05). The UI and XPR groups showed increased penetration percentages in the coronal and middle thirds compared with the apical third (P < 0.05). Maximum penetration was notably reduced in the apical third than in comparison with the coronal and middle thirds in all groups (p < 0.05). In the control, SA and XP groups, the penetration area was ranked in descending order as coronal, middle and apical (p < 0.05). Conversely, in the ultrasonic group, the penetration area was significantly lower in the apical third than in the middle and coronal thirds (p < 0.05). CONCLUSIONS: UI enhanced the penetration percentage in the middle third of the root compared with that in the control group. XPR and SA showed no significant effect on NaOCl penetration following retreatment.

Comparative evaluation of antimicrobial efficacy of various intracanal medicament in young permanent teeth: An in vivo study.

INTRODUCTION: Bacteria and their byproducts are key contributors to the onset and perpetuation of pulpoperiapical pathosis. Intracanal medication is vital in achieving successful endodontic outcomes as it targets and eradicates remaining microorganisms following biomechanical preparation. AIM AND OBJECTIVE: The aim of the study was to compare and evaluate the antimicrobial efficacy of calcium hydroxide (CH) paste, triple antibiotic paste (TAP), and probiotics (PBs) as intracanal medicament in 12-17-year-old children undergoing root canal treatment for the management of infected pulpal tissues in young permanent teeth. MATERIALS AND METHODS: A total of 30 patients aged 12-17 years indicated for endodontic therapy in maxillary incisors and with no systemic complications were selected. They were randomly divided into three groups, i.e., Group I - CH group, Group II - TAP, and Group III - PB allocating 10 teeth in each group. After access opening, the first sample (S1) was collected by inserting a paper point into the root canal, the second sample (S2) was collected immediately after biomechanical preparation, and the third sample (S3) was collected after 7 days, i.e., postintracanal medication. Samples were sent for microbiological analysis to assess the microbial count, and statistical analysis was done for the obtained data. RESULTS: The three intracanal medicaments were successful in reducing the microbial counts of Enterococcus faecalis in the infected root canals. However, according to the results of the study, the PB group demonstrated greater effectiveness against E. faecalis compared to the CH group and displayed similar antimicrobial efficacy as the TAP group. CONCLUSION: PB exhibited antimicrobial efficacy comparable to TAP but greater than Ca (OH) 2 paste. Hence, PB can be utilized as an intracanal medicament in young permanent teeth.

Importance of 3D imaging in the evaluation of root formation following regenerative endodontic procedures: a case series.

The follow-up of teeth that have undergone regenerative endodontic procedures through radiographic imaging is crucial for evaluating their success and determining their future prognosis. The periapical radiographs stand out as the primary tool for this task and are also recommended by the existing guidelines. However, two-dimensional (2D) imaging may not reveal the findings accurately, mimicking the root formation success which may not be true otherwise when assessed using cone beam CT (CBCT) imaging. This case series featuring two instances underscores the significance of CBCT in identifying such signs of failure, particularly when they might be obscured in 2D imaging.

Comprehensive Analysis of Mandibular First Molar Root and Canal Morphology in Saudi Patients Using Cone Beam Computed Tomography (CBCT).

BACKGROUND The goal of conventional endodontic therapy is to clean the root canal system thoroughly, restore tooth function, and prevent re-infection. Success depends on understanding root canal morphology, resolving apical periodontitis, and using proper techniques. Studies highlight variations in root canal anatomy, with cone-beam computed tomography (CBCT) being crucial for accurate diagnosis despite its high cost and limited availability. MATERIAL AND METHODS This retrospective study reviewed CBCT images of 1820 (907 male, 913 female) patients aged 18 to 78 years. Analysis included 2081 mandibular first molars for variations in root and canal morphology and right- and left-side symmetry. Inter-orifice distance was measured, along with distance from the cementoenamel junction (CEJ) to the level of canal bifurcation. RESULTS In this study, 96.01% of teeth had 2 roots and 3.89% had 3 roots. The percentages of canal configuration were 77.70% for 3 canals, 21.58% for 4 canals, 0.67% for 2 canals, and 0.05% for 1 canal. The inter-orifice distance was 2.07 mm for 2 canals in 1 root and 2.86 mm for 2 canals in separate distal roots. Distance from the CEJ to canal bifurcation varied significantly between 2 canals within 1 distal root (3.35 mm), 2 canals in separate distal roots (1.60 mm), as well as between distal (3.35 mm) and mesial roots (1.10 mm). CONCLUSIONS In mandibular first molars, only 3.89% have additional distolingual roots. Sex and ethnicity showed no influence on number of roots and canals. Distal canals showed a deeper bifurcation and greater inter-orifice distance than did mesial canals.

Nonsurgical management of large periapical lesions: case reports and review of the literature.

The objectives of this article are to report 2 cases of nonsurgical endodontic treatment for the management of periapical lesions associated with large cortical bone perforations and review the literature on the clinical efficacy of nonsurgical endodontic treatment to draw insights from published case reports. Large, cyst-like periapical lesions in 2 patients were successfully treated with combined modalities of root canal treatment, antimicrobial therapy (calcium hydroxide and triple antibiotic paste [TAP]), and mineral trioxide aggregate (MTA) obturation of the canal space. In both cases, instrumentation was extended 1 mm beyond the apical foramen to facilitate drainage through the root canal, because it was assumed that the periapical lesion could be cystic. After instrumentation, TAP was placed within the canal space to aid in disinfection and healing of the dental, pulpal, and periapical conditions. In both patients, the teeth were asymptomatic and functional at follow-up examinations (case 1, 3 years; case 2, 30 months). Supporting the positive outcomes in the 2 clinical cases, the published literature suggests that the use of biocompatible materials such as MTA, which can promote the deposition of hydroxyapatite, has the potential to contribute to tissue regeneration and the healing of large periapical lesions.

Endo-Perio Lesions and Dentists' Treatment Approach: A Survey.

BACKGROUND Endo-perio lesions are a great challenge for dentists. The aim of this study was to evaluate the treatment approach of dental practitioners to endo-perio lesions by considering the current endo-perio classification. MATERIAL AND METHODS An online survey was prepared, consisting of questions about the treatment approach to 3 simulated cases with endo-perio lesions, shown on periapical radiography. Details of the patient's age, presence of systemic disease, smoking, and how the single- or multi-rooted tooth would affect the treatment plan were also included in the simulated cases presented in the survey. The survey was sent to 1500 dentists via e-mail, WhatsApp, and social media platforms. The chi-square test was used for comparison of data. Significance was evaluated at P<0.05. RESULTS In total, 338 dentists participated in the survey, including general dentists, endodontists, and periodontists. Fifty-three percent of participants stated that they would perform root canal treatment and initial periodontal treatment simultaneously, when both treatments were required. In cases classified as grade 3, most general dentists, endodontists, and periodontists answered that they would prescribe systemic antibiotics if there was diffuse extra-oral swelling (P<0.05). Moreover, in grade 3 cases, more general dentists chose the option "extraction" as the best choice, compared with endodontists and periodontists, who did not choose extraction as often (P<0.05). CONCLUSIONS According to the results of this study, general dentists, endodontists, and periodontists generally follow different approaches to endo-perio lesions. A consensus is needed on this issue to develop a successful multidisciplinary approach to endo-perio lesions.

Normal Saline or Sodium Hypochlorite Irrigation for Vital Pulp Therapy? A Non-Inferiority Randomized Controlled Trial.

criteria were randomized to each irrigant, 65 in the NaOCl and 60 in the NSS groups. ProRoot® MTA was used as a pulp dressing material in both groups and teeth were followed for 12 months. The primary outcome was the success of VPT; requiring both clinical and radiographic success to be considered as success. The hypothesis was that the absolute difference of VPT success in the NSS group was not worse than that in the NaOCl group, by a margin of 5%. The secondary outcome was discoloration; percentages of discolorations between both groups were compared. Results: Using a per protocol analysis, the absolute difference of VPT success between the NSS and NaOCl groups was 2.08% (95% CI: -1.95, 6.1). Perceptible gray discolorations were 80% and 63% in NaOCl and NSS groups (difference -17%; 95% CI: -40.0, 6.2; p=0.15). Conclusions: For MTA-VPT procedure, irrigation with NSS was not worse than that with NaOCl. However, both irrigants caused discoloration. (EEJ-2023-05-065).

Clinical outcome of non-surgical root canal treatment using different sealers and techniques of obturation in 237 patients: A retrospective study.

OBJECTIVES: The aim of this retrospective study was to compare the clinical results of two root canal sealers and three obturation techniques used for non-surgical root canal treatment. MATERIALS AND METHODS: A total of two hundred eighty-three root canal treated teeth in two hundred thirty-seven patients with minimum a 6-month follow-up was included for this study. The canals were filled with three different modes: 1) cold lateral condensation (CLC) and AH Plus Sealer; 2) continuous wave condensation technique (CWC) and AH Plus Sealer, and 3) sealer-based obturation technique (SBO) and AH Plus Bioceramic Sealer. The treatment outcome was analysed based on clinical signs and symptoms, and periapical radiograph (periapical index, PAI). RESULTS: There were no significant differences in treatment outcome between various sealers and filling techniques applied. The sealer extrusion was found most frequently in the CWC group (60.67%), followed by SBO (59.21%) and CLC (21.19%) with statistically significant differences (p < .05). The initial diagnosis, previous treatment and sealer extrusion (p < .05) were prognostic factors that affected treatment outcome. CONCLUSIONS: Based on the findings of this study, neither the sealer type nor the filling technique affected the treatment success while preoperative diagnosis, previous treatment and sealer extrusion had significant effect on the outcome. CLINICAL RELEVANCE: A bioceramic sealant applied along with the single-cone technique might be considered as an alternative method in root canal obturation.

Assessment of Treatment Quality Risk Factors Influencing the Radiographic Detection of Apical Periodontitis in Root-Filled Teeth: A Retrospective CBCT Analysis.

OBJECTIVE: This study aimed to assess the treatment quality factors associated with the risk of radiographic detection of apical periodontitis (AP) in root-filled teeth (RFT) on CBCT images. METHODS: Two hundred eighty-five CBCT scans of patients (range 18-60, mean 35.1) years old were selected from a pool of CBCT scans which were taken from 2016-2022. Gender and age were recorded. The presence/absence of AP, unfilled canal, perforation, zipping and ledge and homogenous/nonhomogeneous root canal filling (RCF), adequate/inadequate coronal restoration and under/over filled RCF and those within 0-2 mm from the radiographic apex were recorded for RFTs. Kappa was used to assess intra-consensus reliability. Chi-square and Binary logistic regression were used to assess and predict risk factors related to the detection of AP. A significant difference was set at p<0.05. RESULTS: AP was present in 81.5% of RFTs. No significant difference was present in the AP prevalence in RFT between males and females, maxilla and mandible, right and left sides, RFT with adequate and inadequate coronal restoration and RFT with/without zipping and ledge and between RFT with overfilled and those with RCF end within 0-2 mm from the radiographic apex (p>0.05), respectively. Significantly higher AP prevalence was present in RFT with unfilled canal, perforations, non-homogenous and underfilled RCF (p<0.05), respectively. The odds of AP detection were 2.02, 5.5, 2 and 1.98 times higher in RFT with unfilled canal, perforations, non-homogenous and underfilled RCF, respectively. Intra-consensus reliability was (0.98, 0.95, 0.85, 0.81, 0.88, 0.85 and 0.92) for AP, unfilled canal, perforation, zipping and ledge, homogeneity of RCF, coronal restoration and length of RCF, respectively. CONCLUSION: The vast majority of teeth with previous root fillings presented with AP. AP detection risk was significantly higher in root-filled teeth with perforation, non-homogeneous, and underfilled root canal filling. Other factors do not influence the radiographic detection of AP in CBCT images. (EEJ-2024-02-042).

Negotiating and Treating Lateral Canals: Report of 7 Cases.

This is a series of 7 cases in which the operator penetrated lateral canals with instruments. Two teeth presented with irreversible pulpitis, 4 with necrotic pulps, and 1 with previous treatment. Except for the teeth with pulpitis, all the others were associated with apical periodontitis. The main root canal was always relatively straight, with the lateral canals at the middle third of the root. Suggestive images of lateral canal presence were seen on periapical radiographs in five cases. The clinician introduced intentionally small hand instruments in the lateral canal in 5 cases, while the penetration was fortuitous in the others. The lateral canals were obturated in all cases. Follow-up examination was possible in five cases, all of them showed evidence of successful clinical and radiographic outcomes. Introducing files into lateral canals may permit some preparation and penetration of irrigant solution, favoring disinfection and, consequently, enhancing the treatment outcome. (EEJ-2023-05-063).

Efficacy of preoperative and postoperative medications in reducing pain after non-surgical root canal treatment: an umbrella review.

OBJECTIVE: This study analyzed, using an umbrella review, existing systematic reviews on medications to prevent and control postoperative endodontic pain to guide professionals in choosing the most effective drug. MATERIALS AND METHODS: An electronic search in the PubMed (MEDLINE), LILACS, SciELO, EMBASE, Scopus, Web of Science, Cochrane Reviews, and Data Archiving and Networked Services (DANS) databases retrieved 17 systematic reviews. The study included only systematic reviews of clinical trials with or without meta-analyses evaluating effectiveness of medications in reducing pain after non-surgical endodontic treatment. RESULTS: The evidence showed that steroidal and non-steroidal anti-inflammatory drugs and opioids effectively controlled pain within six to 24 h. CONCLUSIONS: Dexamethasone, prednisolone, paracetamol, and mainly ibuprofen provided higher postoperative pain relief. The quality of evidence of the reviews ranged from very low to high, and the risk of bias from low to high, suggesting the need for well-designed clinical trials to provide confirmatory evidence. CLINICAL RELEVANCE: This review emphasizes the efficacy of developing protocols for pain control after endodontic therapy.

The effect of intracanal cryotherapy with and without foraminal enlargement on pain prevention after endodontic treatment: a randomized clinical trial.

This randomized clinical trial aims to evaluate cryotherapy as a therapeutic option for pain prevention after endodontic treatment with and without foraminal enlargement, in patients with asymptomatic apical periodontitis.120 teeth of patients with preoperative Visual Analogue Scale score indicating zero were treated. Specimens were randomly allocated into 4 groups: Control, Cryotherapy (ICT), Foraminal Enlargement (FE), and Cryotherapy and Foraminal Enlargement (ICT + FE). Working length was determined with an Electronic Apex Locator (EAL). Cryotherapy groups passed through a final irrigation protocol using 20 ml (2.5 â„ƒ) of cold saline solution delivered at working length for 5 min. In FE groups a #40 K-file was used up to the 0.0 mark on the EAL display. Obturation was performed and postoperative pain was checked at 6, 12, 24, 48, and 72 h and 7 days after endodontic treatment.All experimental groups showed an increase in the level of postoperative pain, which started to decrease after 12 h. Foraminal enlargement caused a statistically significant increase in postoperativepain compared to ICT and control groups within the first 6 h (p < 0.05). Cryotherapy did not influence postoperative pain, regardless of whether or not foraminal enlargement was performed.

Influence of Cavity Designs on Fracture Resistance: Analysis of the Role of Different Access Techniques to the Endodontic Cavity in the Onset of Fractures: Narrative Review.

Objectives: In recent years, new endodontic access techniques have been proposed with the aim of preserving as much dental tissue as possible for subsequent prosthetic rehabilitation. It has indeed been demonstrated that the success of this therapy is essential and dependent on the proper execution of endodontic cavity access. The main objective is to provide a comprehensive and up-to-date overview of the new access techniques in endodontics in order to guide clinical practice toward a more precise and qualitative approach. As of today, there is still no universally standardized and recognized taxonomy for the different access cavity designs described in the literature. It has been observed that there are various nomenclatures in the literature. The cavity access designs described mainly in the literature can be categorized into six groups: Traditional Access Cavity (TradAC), Conservative Access Cavity (ConsAC), Ultra-Conservative Access Cavity (UltraAC), Truss Access Cavity (TrussAC), Caries-Guided Access Cavity (CariesAC), and Restoration-Guided Access Cavity (RestoAC). Materials and Methods: The drafting of this narrative review followed the indications of the SANRA (Scale for the Assessment of Narrative Review Articles). A search for scientific articles was conducted on the PubMed and SCOPUS databases, using the following search query: ((truss) OR (conservative) OR (ninja) OR (traditional)) AND access AND endodontic. Results: The initial search yielded a total of 941 articles. After removing duplicates using EndNote X8 software, the number of articles decreased to 785. By applying the inclusion and exclusion criteria, a total of 64 articles were obtained. Among these, 20 articles were finally selected for the purposes of this review, 11 literature reviews and 9 ex-vivo studies. Conclusion: Studies on fracture resistance have yielded heterogeneous results. For anterior teeth, studies do not find a significant relationship between different endodontic access cavities and fracture resistance. However, in the posterior sector, there is more discrepancy and many positive results for minimally invasive access cavities seem to relate to molars. Therefore, it can be concluded that the evidence supporting the influence of endodontic preparations on dental fracture resistance is still limited. Research on new endodontic access techniques holds significant clinical relevance in contemporary endodontics. The evolution of dental technologies, including cone beam computed tomography (CBCT) and computer-guided cavity preparation, has ushered in the era of minimally invasive endodontics. This shift aims to enhance the precision and quality of endodontic treatments while preserving maximum healthy dental tissue for subsequent prosthetic rehabilitation. The success of endodontic therapy is closely tied to the proper execution of access to the endodontium, influencing all phases of endodontic treatment and playing a role in determining fracture resistance for subsequent rehabilitation phases. The dichotomy between traditional and minimally invasive approaches has spurred clinical investigations. Specifically, within the scientific community, doubts have been raised about the potential limitations of minimally invasive access cavities. Concerns include their impact on canal orifice localization and raise questions about their influence on the overall success of endodontic treatment. This review holds clinical significance as it sheds light on the evolving landscape of endodontic access techniques, analyzing the anatomical trajectory, carefully examines the transition to minimally invasive approaches, and critically assesses existing scientific evidence and concerns surrounding these developments, contributing to an informed decision-making process in clinical practice.