Minimally Invasive Access in Endodontics: A National Survey of Brazilian Specialists

This study aims to evaluate Brazilian endodontists' perceptions of minimally invasive access cavities, characterize access-design choices, and identify the information sources informing these decisions. This cross-sectional survey randomly sampled endodontists registered with the Federal Council of Dentistry in 2021. Consenting participants completed a previously validated questionnaire. A minimum sample of 376 was calculated (assumed proportion 50%; margin of error 5%). Descriptive statistics summarized responses, and Pearson's chi-square tested associations between access type and covariates (α = 0.05). Of 378 respondents, most reported using traditional access for anterior (55.8%) and posterior teeth (66.4%). On a 0-5 scale, the modal self-rated knowledge of minimally invasive access cavities was 4 (28%). Most agreed/strongly agreed that minimally invasive access cavities: increases fracture resistance (49.5%); hinders canal location (84.4%); impairs instrument centering during preparation (73.5%); raises the risk of apical transportation (43.4%) and iatrogenic deviations (63.0%); contributes to debris accumulation (60.1%); compromises pulp-chamber cleaning (74.6%); elevates the likelihood of instrument fracture (68.3%); and increases the risk of coronal discoloration (57.6%). Scientific articles were the most frequently cited source of professional updating (44.2%). Brazilian endodontists perceived multiple procedural risks associated with minimally invasive access cavities and often believed it improves fracture resistance, a view not supported by current evidence. These findings reveal a perception-evidence gap and underscore the need to strengthen critical appraisal and evidence integration in education and clinical decision-making on access cavity design.