A systematic review and meta‐analysis of randomized clinical trials comparing rotary canal instrumentation techniques with manual instrumentation techniques in primary teeth

Abstract

Background Use of rotary instruments in the root canals of permanent teeth is well known; however, there are no evidence‐based recommendations on the effectiveness of rotary canal instrumentation techniques over manual instrumentation techniques during root canal treatment in primary teeth. Aim To appraise the current literature on the effectiveness of rotary canal preparation techniques compared to manual techniques during root canal treatment in primary teeth. Data sources MEDLINE, Embase, Cochrane Library, Scopus, PubMed and Web of Science (1 January 1991 to 3 January 2019). Study eligibility criteria, participants and interventions Population: Children with primary teeth; Intervention: Rotary canal instrumentation; Control: Manual canal instrumentation; Outcomes: Success rates (clinical and/or radiographic), quality of root filling, instrumentation and root filling time, postoperative pain, cleaning effectiveness. Study appraisal and synthesis methods Cochrane risk of bias tool 2.0 was used to ascertain the validity across five domains. Risk ratio (RR) for dichotomous variables and weighted mean difference for continuous variables were used as summary measures. The GRADE approach was used to assess the certainty of evidence using GRADE‐pro software. Results A total of 13 trials were selected of 2471 records after screening of the databases. The RR of clinical success in rotary versus manual canal preparation technique was 1.01 (95% CI: 0.91–1.12; P = 0.913) at 6 months. The RR of radiographic success in rotary versus manual techniques was 0.97 (95% CI: 0.74–1.27; P = 0.805) at 6 months. The quality of root filling was not significantly different between the two groups (P = 0.062). The weighted mean difference of instrumentation time and canal filling time was significantly less with rotary techniques (P < 0.001); however, postoperative pain was non‐significant across both techniques at 12, 24 and 72 h but significantly less with rotary techniques at 6 h (P < 0.001) and 48 h (P = 0.023). Limitations Inclusion of only English literature. Conclusions and implications of key findings Rotary canal instrumentation had a similar clinical and radiographic success rate, less postoperative pain (at 6 and 48 h), and took less instrumentation time compared to manual instrumentation techniques (moderate level of evidence).

Clinical differences of hand and rotary instrumentations during biomechanical preparation in primary teeth—A systematic review and meta‐analysis

“…Therefore, the chance of subjective bias toward rotary instrumentation with regard to instrumentation time cannot be excluded as the assessment of outcome is not objective (Figure 2). The present review results contradict the observations of the previous systematic review 30 where the low risk of bias was ascertained to the bias in the measurement of outcome. The variation in the observations might be because the present review primarily focuses on the observation of instrumentation time in the included trials and the risk of bias was also assessed for the same.…”

“…Similarly, except for one trial, 20 none of the included trials have mentioned regarding the allocation concealment in the trial, which shows 'some concerns' in domain 1 of the RoB 2 tool. Similar findings were observed in the previously reported systematic review 30 where similar concerns were observed in the randomization procedure.…”

Influence of glide path kinematics during endodontic treatment on the occurrence and intensity of intraoperative and postoperative pain: a systematic review of randomized clinical trials

“…In the study by Pasqualini et al, the manual glide path procedure probably increased analgesic consumption compared with the continuous rotary glide path procedure by extruding more contaminated debris into the periapex [17,18]. Pulpal and periodontal diagnoses, pre-operative pain and intraoperative factors such as irrigation solution and system, instrumentation technique, use and type of medicament, root canal filling technique and occlusal reduction have been previously shown to influence post-operative pain and could justify differences between study results [3,[69][70][71][72].…”

Tratamento endodôntico mecanizado em dentição decídua

“…No intervalo de 24, 48 e 72 horas não foi observada nenhuma diferença significativa entre os grupos de instrumentação com limas rotativas e manual. Resultados semelhantes foram observados porManchanda et al 2020, no entanto, no estudo realizado não foi possível concluir que a limpeza do sistema de canais radiculares é mais eficiente quando comparada a instrumentação manual.Os instrumentos rotatórios modelam melhor o canal radicular, no entanto, este ponto pode não ser relevante para dentes decíduos, uma vez que os canais são mais delgados e precisamos ter mais cuidado ao realizar o desgaste. No entanto paraPrabhakar et al 2016, os instrumentos rotatórios reduzem o tempo de trabalho, sendo este o mais adequado para o tratamento de dentes decíduos, pois aumenta a cooperação da criança durante o procedimento endodôntico.…”