Evaluation of approaches to endodontic surgery practices in Turkey: A survey study

This study aims to examine Turkish dentists' knowledge, attitudes, and practices regarding endodontic surgery—particularly micro-endodontic surgery—together with educational, equipment, and institutional determinants shaping clinical decision-making. Designed as a cross-sectional, descriptive survey, it collected data from 433 actively practicing clinicians via online and paper questionnaires, covering demographics; endodontic treatment/surgery status; preferred techniques and materials; equipment access and training exposure; case selection/referral; and perceived barriers. Responses were summarized with descriptive statistics, and associations were evaluated using chi-square/Fisher's exact tests where appropriate. Findings indicate that participation in endodontic surgery is sensitive to institutional setting and access to advanced technology, with availability of dental operating microscopes, ultrasonic tips, CBCT, and piezosurgery facilitating transition to microsurgical practice. In clinical decision pathways, non-surgical retreatment is commonly prioritized for previously treated but unsuccessful cases; preference for microsurgery increases with higher training levels and sufficient equipment. Contemporary bioceramic materials (e.g., MTA/Biodentine) were perceived to enhance apical sealing and predictability. Principal barriers included limited hands-on training and microsurgical experience, constraints in equipment procurement and maintenance, workload/time pressures, and institution-driven procedural limitations. The results support strengthening hands-on microsurgical competencies within specialty and postgraduate curricula, broadening continuing professional development opportunities, and improving access to advanced equipment to promote standardization and wider adoption of micro-endodontic surgery. Clarifying intra-institutional workflows and referral pathways may further increase appropriate indications for microsurgery and improve clinical outcomes.