Background <p>Preclinical education plays a critical role in helping dental students transform theoretical knowledge into psychomotor skills and prepare for clinical practice. In endodontics, access cavity preparation is one of the most fundamental yet technically sensitive procedures, requiring manual precision, anatomical understanding, and self-confidence. Haptic virtual reality simulation (HVRS) has emerged as a promising educational tool that may enhance students’ technical skills and preparedness before treating real patients.</p> Objective <p>This study aimed to evaluate the effect of HVRS training provided during the preclinical period on dental students’ performance in endodontic access cavity preparation on real patients, and to examine students’ perceptions of this training.</p> Materials and methods <p>Thirty fourth-year dental students who would be treating patients for the first time in the endodontics clinic were included in the study. The students were randomly assigned to either an experimental group or a control group. The experimental group (<i>n</i> = 15) received HVRS training before clinical practice, whereas the control group (<i>n</i> = 15) followed only the routine training process. All students performed endodontic access cavity preparation on single-rooted permanent teeth in real patients. Clinical performance was evaluated according to criteria related to access cavity preparation and was analyzed in terms of cavity score and cavity classification. In addition, procedure time was recorded in seconds. The opinions of the students in the experimental group regarding HVRS training were assessed using a 10-item Likert-type questionnaire. The data were analyzed statistically.</p> Results <p>The mean cavity score of the experimental group was significantly higher than that of the control group (<i>p</i> &lt; 0.05). In terms of procedure time, the experimental group also completed the procedure in a significantly shorter time than the control group (<i>p</i> &lt; 0.05). Regarding cavity classification, no poor performance was observed in the experimental group, and the proportions of moderate and good performance were higher than those in the control group; however, the difference between the groups was not statistically significant (<i>p</i> &gt; 0.05). Questionnaire results showed that students generally found HVRS training useful and expressed a desire for HVRS to be used in other endodontic procedures and incorporated into the curriculum.</p> Conclusion <p>The results of this study indicate that preclinical HVRS training positively affected students’ endodontic access cavity preparation performance on patients. Higher cavity scores, shorter procedure times, and positive student feedback suggest that HVRS is an effective complementary educational tool that supports clinical skill development.</p>