The primary goal of endodontic therapy is the long-term retention of a functional tooth by preventing or treating apical periodontitis. However, there are many other factors that impact endodontic outcomes such as the quality of the restoration and structural integrity of the tooth after root canal preparation. Contemporary research efforts are currently directed to better understanding dentin behaviour and structure during aging and function. An alternative approach is to minimise structural changes during root canal therapy, which may result in a new strategy that can be labelled 'minimally invasive endodontics'. This review addresses current clinical and laboratory data to provide an overview of this new endodontic paradigm.