Effect of Adaptive, Rotary, and Manual Root Canal Instrumentation in Primary Molars: A Triple-Armed, Randomized Controlled Clinical Trial

Abstract

This clinical trial focused on collating the instrumentation time and quality of root canal obturation in primary molars treated with three instrumentation techniques: adaptive, rotary, and manual. A triple-armed, randomized controlled clinical trial was performed on 75 primary molars requiring pulpectomy treatment, divided into three groups (n = 25 per group). The teeth in Group 1 were instrumented with an adaptive technique (XP-endo Shaper, FKG Dentaire, La Chaux-de-Fonds, Switzerland), Group 2 with pediatric rotary files (Kedo-S; D1 and E1), and Group 3 with a manual technique (hand K-files). The apical size of the final instrumentation was maintained at #30 for all groups. Instrumentation time and the grade of the root canal obturation were evaluated. Instrumentation duration was recorded, employing a digital stopwatch from the insertion of the first file until the completion of final irrigation. Obturation quality was assessed using radiographs. The criteria taken as a reference for obturation were: optimal (1 mm short of the apex), underfilled (2 mm short of the apex), or overfilled (beyond the apex). The use of an adaptive technique was associated with the lowest instrumentation time (p < 0.0001) when used for instrumenting primary molars and with the highest root canal filling quality of the three groups. The application of the new concept of adaptive instrumentation for pulpectomy of primary molars was a favorable technique, considering the significant reduction in instrumentation time and better obturation.

Deficiencies in Root Canal Fillings Subsequent to Adaptive Instrumentation of Oval Canals

“…There are several anatomic complications that reflect physical restrictions that make proper root canal instrumentation, disinfection, and subsequent three-dimensional obturation difficult. Manual and motorised instruments use a similar theory of root canal filing and tend to leave more than half of the root canal area unaltered, especially in root canals with oval cross-sections [ 13 , 14 , 15 ]. Furthermore, rotary, or reciprocating files cut the radicular dentin, resulting in chips and tissue debris that are easily driven toward the isthmus or canal recesses rather than auguring coronally or becoming clogged within the instrument flutes that can be cleaned [ 13 ].…”

“…The XP-endo Shaper is a snake-like file that generates a space that symbolises the “envelope of motion” of the spinning file. As its motion envelope is dynamic and may contract and expand as needed in a particular canal, the XP-endo Shaper file can adapt to any cross-sectional shape of root canals [ 15 , 28 ]. The XP-endo Shaper differs from typical rotary files in its operation.…”

“…The XP-endo Shaper differs from typical rotary files in its operation. Although NiTi rotary files have become more flexible over time, they still have a fixed core shape and taper, making them more likely to produce an area space that resembles a “circular bore.” This works effectively in narrow canals with a circular cross-section, but it has not worked well in irregularly shaped or oval root canals [ 15 , 28 ]. The circular whip-shape XP-endo Finisher file (#25/0.00) was first supplied as a compatible tool that could be used after any file system following root canal preparation.…”

Pediatric Rotary Files: Evolution to Revolution

“…21 Based on their clinical trial, Haseeb Ahmed et al ., summed up that Kedo-S rotary files had better patient acceptance and produced better clinical outcomes. 22…”

Uso de sistemas rotatórios no tratamento endodôntico em odontopediatria

“…Nos casos de lesões com comprometimento pulpar, torna-se necessário intervenções pulpares, como capeamento pulpar, pulpotomia, que consiste na retirada da porção coronal da polpa, ou a pulpectomia, que retira toda a polpa dentária. (Natchiyar et al, 2021;Pawar et al, 2021).…”