Comparison between the Effectiveness of Rotary and Manual Instrumentation in Primary Teeth: A Systematic Review

Comparative Evaluation of Cutting Efficiency of Three File Systems-Kedo-SH Manual, Pedoflex Rotary, and Manual K File: An In Vitro Study

Aims

The purpose of this study was to comparatively evaluate the cutting efficiency of Pedoflex rotary, Kedo SH manual file, and manual K file systems used in root canal instrumentation while performing pulp therapy of deciduous teeth with a stereomicroscope.

Materials and Methods

Forty-five extracted primary human root canals were chosen, and following the removal of pulp tissue, the canals were dyed with Indian ink and left to dry for 2 h. The samples were randomly divided into three groups, Group A: Kedo SH manual file system (n = 15), Group B: Pedoflex rotary file system (n = 15), and Group C: Manual K files (n = 15). After root canal instrumentation, all the root canals were cleared to make them transparent. The teeth after clearing were observed under stereomicroscope and scored according to the amount of dye present in the root canals. The data were tabulated and statistically analyzed with SPSS version 16 using Chi-square, Kruskal-Wallis, and Dunn's test (post-hoc).

Results

With regards to cutting efficiency, there was a statistically noteworthy difference among groups A and C [P = 0.000] and groups B and C [P = 0.000]. Furthermore, groups A and B did not differ statistically significantly [P = 0.950].

Conclusions

Cutting efficacy of the Pedoflex rotary files was seen to be superior to that of Kedo SH and manual K files.

Clinical Significance

Rotary files in deciduous teeth have various benefits over manual files, resulting in a noticeable reduction in working time, which has aided in maintaining patient participation by reducing the risk for fatigue. We conclude that NiTi rotary devices result in a superior cutting efficiency and, as a result, greater clinical success.

Comparative assessment of cleaning efficacy of two exclusive paediatric rotary files in root canals of primary teeth: An in vitro study

BACKGROUND

Paediatric rotary file systems have recently been developed for primary teeth use.

AIM

To study the cleaning efficacies of two paediatric rotary endodontic files, the Prime PedoTM , and the Kedo-SG BlueTM against the standard H files.

DESIGN

This in vitro study included 54 freshly extracted primary molars, which were randomised into three groups (n = 18 each) and were prepared using either Kedo-SG BlueTM , Prime PedoTM or hand H files after injecting methylene blue dye into the canals. Pre- and post-operative cone beam computerised tomography (CBCT) was performed to assess change in root canal volumes. Methylene blue dye removal from canals was assessed using stereomicroscopy, and canal cleanliness was examined by scanning electron microscopy (SEM).

RESULTS

Both Prime PedoTM and Kedo-SG BlueTM files reduced significantly less dentine when compared with conventional hand filing with Prime PedoTM removing the least amount of dentine. No significant difference was found in median SEM scores among the groups in the cervical, middle and apical thirds of the roots. Stereomicroscopic assessment of root canal cleanliness using dye removal technique shows a statistically significant difference existing between Kedo-SG BlueTM and hand H files groups.

CONCLUSION

Prime PedoTM removed the least amount of dentine. Kedo-SG BlueTM performed significantly better than conventional hand filing with H files when the root canal cleanliness was assessed.

Evaluation of Mechanical Versus Manual Root Canal Preparation in Primary Molars-A Comparative In Vitro Study

The endodontic treatment of primary teeth is to maintain the function of the tooth free of symptoms until its physiological exfoliation. A critical factor for success is how quickly and effectively the root canal preparation can be performed. Therefore, the aim of this comparative in vitro study was to analyze the efficiency of two mechanical root canal preparation systems FM (FlexMaster) and HF (HyFlex EDM) to manual KF (K-file) on extracted primary molars. A total of 45 teeth were divided into three groups (n = 15): KF (#15-35), FM (04#30) and HF (25/~ OneFile). Root canal preparation was performed, and the preparation time was measured. All root canals were non-destructively analyzed by micro-computed tomography in the cervical, middle and apical thirds before and after preparation with regard to the parameters of canal transport (in μm) and centering ratio (0-1). Statistical analysis was performed at a 5% significance level using non-parametric tests. HF caused the lowest canal transport in the apical third (p = 0.008). The centering ratio value of HF was significantly higher in the middle third of the root canals than in the other two groups (p < 0.01). The mean instrumentation time was significantly higher for KF (6.67 min) than for FM (4.69 min) and HF (4.03 min, p < 0.01). HF can be recommended for primary molar root canal treatment.

Comparative Evaluation of Single Rotary File System and Sequential Multi-file Rotary Systems on Time for Biomechanical Preparation and Obturation Quality in Single-visit Pulpectomy Protocol: A Double-blind Randomized Clinical Trial

Background

Single-visit pulpectomy (SVP) protocol with rotary files is highly recommended for the treatment of teeth with irreversible pulpitis. Various rotary endodontic files specially designed for use in the pediatric population are available. The aim is to clinically assess the parameters related to the time required for biomechanical preparation (TBMP) and quality of filling using a single file system vs a sequential multi-file system in infected primary mandibular molars.

Materials and methods

A total of 45 infected primary molars were allocated to three groups (two experimental groups (n = 15) and a control group. The first experimental group was instrumented using NiTi K-Flex files, the second group with a single file rotary system with variably variable (VV) taper, and the third with a sequential multi-file system with constant taper. Biomechanical preparation time was recorded and standardized digital radiograph (RVG) were taken pre- and postinstrumentation. The data recorded was sent for statistical analysis.

Conclusion

There is a substantial reduction of TBMP in primary molars using single file VV taper and multi-sequential file constant taper. Obturation time for all three file systems was comparable and there were no differences between the three file systems used (p > 0.05). Multi-sequential file constant taper files showed a higher probability of optimal obturations and minimal voids followed by NiTi "K-Flex" files and single file system but the difference was nonsignificant (p > 0.05). However, using a rotary in primary teeth results in better canal shape, and less TBMP leading to a better quality of treatment in less time.

How to cite this article

Shetty B, Singh R, Patil V, et al. Comparative Evaluation of Single Rotary File System and Sequential Multi-file Rotary Systems on Time for Biomechanical Preparation and Obturation Quality in Single-visit Pulpectomy Protocol: A Double-blind Randomized Clinical Trial. Int J Clin Pediatr Dent 2023;16(S-3):S247-S252.

Exploring a Paradigm Shift in Primary Teeth Root Canal Preparation: An Ex Vivo Micro-CT Study

Traditional hand instrumentation is a commonly used technique to perform pulpectomy in deciduous teeth by most specialists in pedodontics. Lately, dentists have embraced rotary instrumentation as a safe and effective alternative. This study aimed to compare the efficacy of root canal preparation in extracted primary molars between manual and two rotary file systems using micro-CT. Thirty-six extracted human second primary mandibular molars were divided into three groups according to the instrumentation method: (1) Manually instrumented (MI) group (n = 9) in which the teeth were treated using K-files up to size 30; (2) Kedo-Ssystem (KS) group (n = 9); (3) ProTaper Gold system (PTG) group (n = 10) and control group (n-8). Each tooth was scanned before and after the retrograde root canal preparation. Residual dentin volume was calculated using micro-CT scans to evaluate the technique's efficacy. Additionally, the preparation time and procedural errors were recorded for each tooth preparation. A one-way ANOVA test was carried out to compare the groups' dentin volume and preparation time. The mean preparation time using the manual method (13.14 min) was more than two times longer than that of the rotary techniques (4.62 min and 6.45 min). The manual preparation method using a K-file removed almost half the root canal material when compared with the rotor method (p = 0.025). Conclusion: our results suggest that rotary instrumentation is more efficient for root canal preparation in primary teeth than the traditional manual method. This finding may call for a paradigm shift in current clinical practices, where manual instrumentation is still commonly preferred.

Comparative Evaluation of Apically Extruded Debris during Pulpectomy Procedure in Primary Molar Teeth Using Two Different Rotary Systems and Hand Files: An In Vitro Study

Background

Successful outcome of endodontic treatment depends on chemomechanical preparation of the tooth. However, during canal preparation, debris may extrude through the apical foramen causing postoperative complications. The aim of this study is to evaluate and compare the amount of apically extruded debris during the pulpectomy procedure in primary molar teeth using two different rotary files and hand files.

Materials and Methods

Distal roots of sixty extracted primary molars were divided into three groups: group A: Prime Pedo™ pediatric rotary files, group B: DXL-Pro Pedo™ pediatric rotary files, and group C: hand files. Myers and Montgomery experimental model was used. Preweighed Eppendorf tubes were used to collect apically extruded debris. The tubes were then placed in an incubator at 70°C for 5 days. The weight of the debris attained was determined. The data were analyzed using ANOVA and post hoc Bonferroni test.

Results

Hand files produced more apical debris extrusion (P < 0.05). Prime Pedo™ pediatric rotary files produced the least debris (P < 0.05).

Conclusion

Prime Pedo™ and DXL-Pro Pedo™ pediatric rotary files extruded significantly lower amount of debris apically during pulpectomy as compared to hand files. Rotary files can be considered an alternative to hand files in pediatric endodontics.

Comparison between the rotary (Hyflex EDM®) and manual (k-file) technique for instrumentation of primary molars: a 12-month randomized clinical follow-up study

OBJECTIVES

Rotational instrumentation is an alternative for the clinical practice of pediatric dentists. However, there are few records in the literature on the clinical and radiographic aspects of treated teeth over time. Compare instrumentation time and filling quality between manual (k-file) and rotary (Hyflex EDM®) files, and clinically and radiographically follow-up the treated teeth for 12 months. Moreover, the characteristics of glass ionomer restorations and their interference in the treatment prognosis over time were evaluated.

METHODOLOGY

In total, 40 children with pulp involvement in primary molars received treatment with Hyflex EDM® or manual rotary files, performed by an operator. Clinical and radiographic aspects were observed at different times to determine the effectiveness of each technique.

RESULTS

The rotary system reduced instrumentation time when compared to the use of manual files (p≤0.05), but there was no difference in filling quality between the groups (p≥0.05). Moreover, both types of instrumentation were effective for 12 months (p≥0.05), and restoration retention influenced the emergence of periapical lesions (p≤0.05).

CONCLUSION

Although rotary files reduce clinical time, the clinical and radiographic aspects of both techniques were similar over 12 months. Moreover, restoration retention has been shown to be related to treatment prognosis.

Micro-CT evaluation of 'danger zone' and microcrack formation in mesial root canals of primary teeth with single-file rotary and reciprocating systems

BACKGROUND

Although single-file rotary systems are accepted in the field of paediatric dentistry in terms of providing time advantage, research works continue due to the variable anatomical structure of the root canal.

AIM

This study aimed to evaluate rotary systems in different kinematics in terms of microcracks and the shaping of the danger zone in primary molars by micro-CT.

DESIGN

The mesial canals of primary molars (n = 30) were used. Root canals in each group (n = 10) were prepared with single-file rotary systems (One Shape®, OS; XP-endo® Shaper, XP-ES; WaveOne Gold, WOG). The images were evaluated for dentin thickness in the danger zone and microcrack formation.

RESULTS

WOG caused the highest dentin reduction in the danger zone area. OS led to significantly less dentin reduction than XP-ES and WOG (P < .05). The XP-ES showed the highest number of microcracks (P < .05). No statistically significant difference was found between WOG and OS (P > .05). In all systems, more microcracks were observed in the middle third than coronal and apical.

CONCLUSION

Within the limitations of this study, the rotary systems were superior to reciprocating in terms of shaping ability in the danger zone. It is thought that further studies with different systems should be designed considering the anatomical variations and chemical composition of primary teeth.

Micro-CT evaluation of root canal preparation with rotary instrumentation on prototyped primary incisors

This study aimed to evaluate the endodontic instrumentation outcomes with asymmetrical files compared to reciprocating and hand files (HFs) in 3D-printed prototypes of upper primary incisors using micro-computed tomography (micro-CT). For this purpose, 50 prototypes were randomly divided (n = 10) according to the instrumentation technique as follows: HFs, a reciprocating file (WaveOne® Gold [WOG]), and three asymmetrical movement files: XP-Endo® Shaper (XPS), XP-Endo® Finisher (XPF), and XP Clean (XPC). The specimens were scanned and, after registration of the baseline and instrumented volumes, changes in the root canal volume (RCV), debris accumulation, removed root material volume (RRMV), non-instrumented areas, and the presence of cracks/perforations were quantified. Data were analyzed by analysis of variance and Student's t-test, while the effect size was calculated for statistically significant outcomes. All groups showed an increase in RCV after instrumentation (p < 0.05), but this was higher with HFs (p < 0.05). Accumulated debris was higher for WOG and XPS (p < 0.05), but WOG exhibited more in the medium and apical third areas. HFs showed the highest RRMV (p < 0.05), especially at the apical third. The non-instrumented areas were lower for HFs and XPC than for the other systems (p < 0.05). Cracks were present in a few WOG (n = 2) and HF specimens (n = 3) and in this group, one of the cracked specimens and two others showed perforations. The asymmetric systems resulted in conservative dentin removal and fewer cracks/perforations as compared to HFs and a reciprocation file in prototyped primary upper incisors. XPC showed the best compromise between RRMV and non-instrumented areas with a low accumulation of debris.

Comparison of two pediatric rotary file systems and hand instrumentation in primary molar: An ex vivo cone-beam computed tomographic study

Background

Pulpal involvement, secondary to dental caries, is not uncommon and is a challenging task for pediatric dentists. Morphological differences in root canal of deciduous teeth increases the complexity of management. The aim of this study was to compare two rotary file systems and hand instrumentation for root canal preparation in regard to canal transportation, centering ability ratio, and dentin thickness using cone-beam computed tomography (CBCT).

Methods

A total of 72 canals from 24 freshly extracted mandibular deciduous second molars were divided into a set of 8 teeth, then prepared using 2 rotary files systems: the Kedo-S pediatric file system (Group A) and Pro AF Baby Gold file system (Group B) were compared to hand instrumentation (Group C). CBCT scans before and after root canal preparation were used to evaluate tested parameters. Instrumentation time for all three techniques was also measured using a chronometer.

Results

Although rotary file systems have shown superior results in root canal preparation as compared to hand instrumentation, no significant differences were observed between all the groups for canal transportation and dentin thickness at all three levels of prepared canals. A comparison of centering ability ratio between all the groups was found to be statistically significant only at the cervical level. A significant difference was observed between hand instrumentation using K-files (117.3 s) and both rotary systems (Kedo-S (81 s) and Pro AF Baby Gold (81.5 s)) in terms of canal preparation time (P < 0.001).

Conclusions

Both tested rotary systems and hand instrumentation demonstrated comparable canal preparation results, with differences that were statistically non-significant in most tested parameters, without shaping errors. However, both the rotary systems were more efficient and faster than hand instrumentation.

A Letter Regarding Recently Published Systematic Review Comparing the Effectiveness of Manual and Rotary Root Canal Instrumentation in Primary Teeth

How to cite this article: Rahul M, Tewari N, Gowthaman K. A Letter Regarding Recently Published Systematic Review Comparing the Effectiveness of Manual and Rotary Root Canal Instrumentation in Primary Teeth. Int J Clin Pediatr Dent 2020;13(3):310.