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A cavidade de acesso é a etapa inicial do tratamento endodôntico e desempenha um papel crucial na eficácia e longevidade do dente tratado. A presente estudo tem como objetivo comparar os diferentes designs de cavidade de acesso, tradicional (TradAC), conservadora (ConsAC) e ultraconservadora (UltraAC) quanto à preservação estrutural do dente e o risco de fraturas dentárias pós-tratamento endodôntico. Por meio de uma revisão integrativa da literatura científica publicada entre 2015 e 2025, foram analisados 45 artigos, onde foram priorzados estudos in vitro, revisões sistemáticas e meta-análises que abordassem a relação entre o design da cavidade de acesso e fatores como resistência à fratura, eficácia da instrumentação e qualidade da obturação. Os resultados demonstraram que cavidades minimamente invasivas (ConsAC e UltraAC) preservam melhor a estrutura dentária e contribuem para maior resistência à fratura, principalmente em dentes com estrutura coronária remanescente reduzida. No entanto, esse benefício estrutural pode vir acompanhado de desafios clínicos, como a dificuldade na localização dos canais e maior risco de insucesso da instrumentação e obturação, o que pode comprometer o selamento e favorecer a reinfeção. A literatura também revela que o uso de tecnologias auxiliares, como microscópio operatório e instrumentos ultrassónicos, é essencial para superar as limitações dos acessos conservadores. Além disso, a técnica restauradora empregada após o tratamento endodôntico influencia significativamente a resistência final do dente, sendo muitas vezes mais determinante do que o tipo de cavidade utilizado. Embora a cavidade de acesso tradicional ofereça previsibilidade e facilidade de execução, sua abordagem mais invasiva compromete a integridade biomecânica do dente a longo prazo. Por outro lado, a UltraAC apresenta grande potencial em termos de preservação, mas requer maior precisão técnica e suporte tecnológico para garantir sua eficácia clínica. Conclui-se que, embora os acessos conservadores ofereçam vantagens biomecânicas claras, ainda são necessários mais estudos clínicos robustos para validar sua superioridade e viabilidade em longo prazo. A escolha do design ideal deve considerar não apenas a anatomia dentária e o caso clínico, mas também os recursos disponíveis e a experiência do profissional.
The access cavity is the initial step in endodontic treatment and plays a crucial role in the effectiveness and longevity of the treated tooth. The present study aims to compare different access cavity designs—traditional (TradAC), conservative (ConsAC), and ultraconservative (UltraAC)—in terms of structural preservation of the tooth and the risk of post-endodontic treatment fractures. Through an integrative review of the scientific literature published between 2015 and 2025, 45 articles were analyzed, prioritizing in vitro studies, systematic reviews, and meta-analyses that addressed the relationship between access cavity design and factors such as fracture resistance, instrumentation efficacy, and obturation quality. The results demonstrated that minimally invasive cavities (ConsAC and UltraAC) better preserve tooth structure and contribute to greater fracture resistance, especially in teeth with reduced remaining coronal structure. However, this structural benefit may come with clinical challenges, such as difficulty in locating the canals and increased risk of failure in instrumentation and obturation, which may compromise sealing and favor reinfection. The literature also reveals that the use of auxiliary technologies, such as the operating microscope and ultrasonic instruments, is essential to overcome the limitations of conservative access cavities. Furthermore, the restorative technique employed after endodontic treatment significantly influences the final strength of the tooth and is often more decisive than the type of cavity used. Although the traditional access cavity offers predictability and ease of execution, its more invasive approach compromises the long-term biomechanical integrity of the tooth. On the other hand, the UltraAC shows great potential in terms of preservation but requires greater technical precision and technological support to ensure clinical effectiveness. It is concluded that, although conservative accesses offer clear biomechanical advantages, more robust clinical studies are still needed to validate their superiority and long-term feasibility. The choice of the ideal design should consider not only tooth anatomy and the clinical case but also the available resources and the professional’s experience.
The access cavity is the initial step in endodontic treatment and plays a crucial role in the effectiveness and longevity of the treated tooth. The present study aims to compare different access cavity designs—traditional (TradAC), conservative (ConsAC), and ultraconservative (UltraAC)—in terms of structural preservation of the tooth and the risk of post-endodontic treatment fractures. Through an integrative review of the scientific literature published between 2015 and 2025, 45 articles were analyzed, prioritizing in vitro studies, systematic reviews, and meta-analyses that addressed the relationship between access cavity design and factors such as fracture resistance, instrumentation efficacy, and obturation quality. The results demonstrated that minimally invasive cavities (ConsAC and UltraAC) better preserve tooth structure and contribute to greater fracture resistance, especially in teeth with reduced remaining coronal structure. However, this structural benefit may come with clinical challenges, such as difficulty in locating the canals and increased risk of failure in instrumentation and obturation, which may compromise sealing and favor reinfection. The literature also reveals that the use of auxiliary technologies, such as the operating microscope and ultrasonic instruments, is essential to overcome the limitations of conservative access cavities. Furthermore, the restorative technique employed after endodontic treatment significantly influences the final strength of the tooth and is often more decisive than the type of cavity used. Although the traditional access cavity offers predictability and ease of execution, its more invasive approach compromises the long-term biomechanical integrity of the tooth. On the other hand, the UltraAC shows great potential in terms of preservation but requires greater technical precision and technological support to ensure clinical effectiveness. It is concluded that, although conservative accesses offer clear biomechanical advantages, more robust clinical studies are still needed to validate their superiority and long-term feasibility. The choice of the ideal design should consider not only tooth anatomy and the clinical case but also the available resources and the professional’s experience.
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Palavras-chave
Cavidades de acesso Endodontia Cavidade de acesso conservadora Cavidadede acesso minimamente invasiva Cavidade de acesso ultraconservadora Access cavities Endodontics Conservative access cavity Minimally invasive access cavity Ultraconservative access cavity