Cone–Beam Computed Tomography Evaluation of Rotary MM Files vs Manual K Files in Primary Molars: An In Vitro Study
Reem Mahmoud, Noha Kabil, Mariem Wassel
Cone–beam computed tomography, K files, MM rotary file, Primary molars, Primary teeth, Pulpectomy, Randomized controlled trial, Rotary instrumentation
Citation Information :
Mahmoud R, Kabil N, Wassel M. Cone–Beam Computed Tomography Evaluation of Rotary MM Files vs Manual K Files in Primary Molars: An In Vitro Study. J Contemp Dent Pract 2023; 24 (5):285-295.
Aim: Rotary instrumentation in pediatric dentistry is an emerging concept, thus this study was performed to evaluate the remaining dentine thickness (RDT), canal transportation, centering ability, quality of obturation using cone–beam computed tomography (CBCT), and the time efficiency of rotary versus manual instrumentation in mandibular second primary molars.
Materials and methods: Forty mandibular primary second molars (160 canals) were randomly and equally allocated to four groups. Instrumentation was done using K files in groups I and II; in each group, the obturation was done by two different obturation techniques; incremental technique and disposable syringe technique, respectively. MM rotary files (Innovative Material and Devices, Inc. [IMD], Shanghai, China) were used in groups III and IV; in each group, the obturation was done by incremental technique and disposable syringe technique. Preoperative and postoperative CBCT scans were performed and evaluated for the RDT, centering ability, canal transportation, and the canal filling quality, which was assessed as (underfill, optimal fill, and overfill). Instrumentation time was recorded for groups I and II collectively (manual instrumentation), and groups II and III collectively (rotary instrumentation). Statistical analysis was done using Chi-square, ANOVA, and post hoc Tukey tests, at p < 0.05).
Results: The MM rotary file removed a significantly less amount of dentine at all levels specifically at the middle section (p = 0.003). The canal transportation was significantly higher in the manual group at the cervical level (p = 0.022). In all sections, the rotary group had significantly higher values of centering ratio than the manual group (p < 0.05), which means a lower deviation of rotary instruments. For both types of files, there was no significant difference between different obturation techniques (p > 0.05). Instrumentation time was significantly lower in the rotary group (p < 0.001).
Conclusion: Regarding the dentine removal and the shaping ability of MM files acceptable results were obtained; however, no significant difference between the different obturation techniques. Notable time efficiency was reported in the rotary files as well.
Clinical significance: The use of rotary files resulted in better conservation of tooth structure, better canal centering, and obturation quality as well as less canal transportation and less instrumentation time compared to manual K files.
Fuks A, Kupietzky A, Guelmann M. Pulp therapy for the primary dentition. In: Nowak AJ, Christensen JR, Mabry TR, Townsend JA, et al., editors. Pediatric Dentistry: Infancy through Adolescence, 6th edition. St. Louis, MO, USA: Elsevier–Saunders Co., 2019. pp. 329–351.
Uribe SE, Innes N, Maldupa I. The global prevalence of early childhood caries: A systematic review with meta-analysis using the WHO diagnostic criteria. Int J Paediatr Dent 2021;31(6):817–830. DOI: 10.1111/ipd.12783.
Soh NH, Jeevanandan G, Balasubramaniam A, et al. Prevalence of irreversible pulpitis among male and female children-a retrospective study. J Contemp Iss Business Gov 2021;27(2):2551. DOI: 10.47750/cibg.2021.27.02.264.
Camp JH, Fuks AB. Pediatric endodontics: Endodontic treatment for the primary and young permanent dentition. In: Cohen S, Hargreaves KM, editors. Pathways of the Pulp, 10th edition. St. Louis, MO, USA: Mosby Elsevier; 2011:808–857.
American Academy of Pediatric Dentistry. Pulp therapy for primary and immature permanent teeth. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2021:399–407.
Coll JA, Dhar V, Vargas K, et al. Use of non-vital pulp therapies in primary teeth. Pediatr Dent 2020;42(5):337–349. PMID: 33087217.
Ahmed HM. Anatomical challenges, electronic working length determination and current developments in root canal preparation of primary molar teeth. Int Endod J 2013;46(11):1011–1022. DOI: 10.1111/iej.12134.
Gutmann JL, Gao Y. Alteration in the inherent metallic and surface properties of nickel–titanium root canal instruments to enhance performance, durability and safety: A focused review. Int Endod J 2012;45(2):113–128. DOI: 10.1111/j.1365-2591.2011.01957.x.
Barr ES, Kleier DJ, Barr NV. Use of nickel–titanium rotary files for root canal preparation in primary teeth. Pediatr Dent 2000;22:77–78. PMID: 10730297.
Haralur SB, Al-Qahtani AS, Al-Qarni MM, et al. Influence of remaining dentin wall thickness on the fracture strength of endodontically treated tooth. J Conserv Dent 2016;19(1):63–67. DOI: 10.4103/0972-0707.173201.
Aly Ahmed HM. Pulpectomy procedures in primary molar teeth. Eur J Gen Dent 2014;3(1):3–10. DOI: 10.4103/2278-9626.126201.
Dalsania R, Arora A, Singla K, et al. Obturating techniques in pediatric dentistry: Literature Review. J Curr Med Res Opin 2020;3(8):589–596. DOI: 10.15520/jcmro.v3i08.326.
Asif A, Emg S. Obturation techniques in primary teeth. International Journal of Research in Pharmaceutical Sciences, 2020;11(4):5956–5959. DOI: 10.26452/ijrps.v11i4.3254.
Chavhan P, Somvanshi Y, Kumar D. Different obturating techniques used in primary teeth: A review. Eur J Mol Clin Med 2021;8(3): 958–965.
Alamri HM, Sadrameli M, Alshalhoob MA, et al. Applications of CBCT in dental practice: A review of the literature. Gen Dent 2012;60(5): 390–400. PMID: 23032226.
Grande NM, Plotino G, Pecci R, et al. Micro-computerized tomographic analysis of radicular and canal morphology of premolars with long oval canals. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:e70–e76. DOI: 10.1016/j.tripleo.2008.04.022.
Shahriari S, Abedi H, Hashemi M, et al. Comparison of removed dentin thickness with hand and rotary instruments. Iran Endod J 2009;4:69–73. PMID: 23940489.
El-Din MS, Saber M. Comparison of the effect of six orifice shapers on the cervical dentine thickness of mandibular molars using multislice computed tomography. ENDO (Lond Engl) 2011;5:201–207.
Barbosa–Ribeiro M, Albergaria SJ, de Fátima Gesteira Malvar M, et al. Canal transportation and centering ability of curved root canals prepared using rotary and reciprocating systems. Braz J Oral Sci 2015;14(3):214–218. DOI: 10.1590/1677-3225v14n3a08.
Torres MGG, Campos PSF, Segundo NPN, et al. Evaluation of referential dosages obtained by cone–beam computed tomography examinations acquired with different voxel sizes. Dent Press J Orthod 2010;15:42–43.
Musale PK, Jain KR, Kothare SS. Comparative assessment of dentin removal following hand and rotary instrumentation in primary molars using cone-beam computed tomography. J Indian Soc Pedod Prev Dent 2019;37(1):80–86. DOI: 10.4103/JISPPD.JISPPD_210_18. PMID: 30804312.
Malur MH, Chandra A. Curvature height and distance of MB canal of mandibular molar with Schneider angle and its comparison with canal access angle. J Oral Biol Craniofac Res 2018;8(3):212–216. DOI: 10.1016/j.jobcr.2017.07.002.
Tomer AK, Miglani A, Chauhan P, et al. An in vitro evaluation of remaining dentine thickness through CBCT using different files. IOSR J Dent Med Sci 2017;16(2):121–124. DOI: 10.9790/0853-160201121124.
Faul F, Erdfelder E, Lang A-G, et al. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007;39(2):175–191. DOI: 10.3758/bf03193146.
Prabhakar AR, Yavagal C, Dixit K, et al. Reciprocating vs rotary instrumentation in pediatric endodontics: Cone beam computed tomographic analysis of deciduous root canals using two single-file systems. Int J Clin Pediatr Dent 2016;9(1):45–49. DOI: 10.5005/jp- journals-10005-1332.
Brueton VC, Tierney J, Stenning S, et al. Strategies to improve retention in randomised trials. Cochrane Database Syst Rev 2013;(12):MR000032. DOI: 10.1002/14651858.MR000032.pub2.
Priyadarshini P, Jeevanandan G, Govindaraju L, et al. Clinical evaluation of instrumentation time and quality of obturation using paediatric hand and rotary file systems with conventional hand K-files for pulpectomy in primary mandibular molars: A double-blinded randomized controlled trial. Eur Arch Paediatr Dent 2020;21(6): 693–701. DOI: 10.1007/s40368-020-00518-w.
Govindaraju L, Jeevanandan G, Subramanian EM. Comparison of quality of obturation and instrumentation time using hand files and two rotary file systems in primary molars: A single blinded randomized controlled trial. Eur J Dent 2017;11:376–379. DOI: 10.4103/ejd.ejd_345_16.
Chandrasekhar S, Prasad MG, Radhakrishna AN, et al. A comparative in vivo efficacy of three spiral techniques versus incremental technique in obturating primary teeth. J Indian Soc Pedod Prev Dent 2018;36(1): 71–75. DOI: 10.4103/JISPPD.JISPPD_365_16.
Nagarathna C, Vishwanathan S, Krishnamurthy NH, et al. Primary molar pulpectomy using two different obturation techniques: A clinical study. Contemp Clin Dent 2018;9(2):231–236. DOI: 10.4103/ccd.ccd_826_17.
Coll JA, Sadrian R. Predicting pulpectomy success and its relationship to exfoliation and succedaneous dentition. Pediatr Dent 18: 57–63:1996. PMID: 8668572.
Delgoshayi N, Abbasi M, Bakhtiar H, et al. Canal transportation and centering ability of ProTaper and SafeSider in preparation of curved root canals: A CBCT evaluation. Iran Endod J 2018;13(2):240–245. DOI: 10.22037/iej.v13i2.19200.
R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. 2021 Available at: https://www.R-project.org/
Akhil JEJ, Prashant B, Shashibushan KK. Comparative evaluation of three obturation techniques in primary incisors using digital intra-oral receptor and CBCT an in vitro study. Clin Oral Investig 2019;23(2): 689–696. DOI: 10.1007/s00784-018-2484-0.
Hülsmann M, Peters OA, Dummer PM. Mechanical preparation of root canals: Shaping goals, techniques and means. Endod Top 2005;10: 30–76. DOI: 10.1111/j.1601-1546.2005.00152.x.
Mohamed RH, Abdelrahman AM, Sharaf AA. Evaluation of rotary file system (Kedo-S-Square) in root canal preparation of primary anterior teeth using cone beam computed tomography (CBCT): In vitro study. BMC Oral Health 2022;22(1):13. DOI: 10.1186/s12903-021-02021-0.
Islam A, Ünsal G, Almashharawi A. Canal transportation and volumetric dentin removal abilities of Ni–Ti rotary file systems in curved primary root canals: CBCT study. Appl Sci 2021;11(19):9053. DOI: 10.3390/app11199053.
Ozcan G, Sekerci AE, Cantekin K, et al. Evaluation of root canal morphology of human primary molars by using CBCT and comprehensive review of the literature. Acta Odontol Scand 2016;74(4):250–258. DOI: 10.3109/00016357.2015.1104721.
Radhika E, Reddy ER, Rani ST, et al. Cone beam computed tomography evaluation of hand nickel–titanium K-files and rotary system in primary teeth. Pediatr Dent 2017;39:319–323. PMID: 2912207.
Seema T, Ahammed H, Parul S, et al. Comparative evaluation of dentin removal and taper of root canal preparation of hand K file, ProTaper rotary file, and Kedo S rotary file in primary molars using cone-beam computed tomography. Int J Clin Pediatr Dent 2020;13:332–336. DOI: 10.5005/jp-journals-10005-1787.
Shaikh SM, Goswami M. Evaluation of the effect of different root canal preparation techniques in primary teeth using CBCT. J Clin Pediatr Dent 2018;42(4):250–255. DOI: 10.17796/1053-4628-42.4.2.
Fayyad D, Sabet N, Abd El-Hafiz E. Computed tomographic evaluation of the apical shaping ability of Hero Shaper and Revo-S. Endodontic Practice Today 2012;6(2):119–124.
Manker A, Solanki M, Tripathi A, et al. Biomechanical preparation in primary molars using manual and three NiTi instruments: A cone–beam-computed tomographic in vitro study. Eur Arch Paediatr Dent 2019;21(2):203–213. DOI: 10.1007/s40368-019-00474-0.
Selvakumar H, Anandhan V, Thomas E, et al. Evaluation of canal transportation and centering ability of K3 (0.02%) and K3 (0.04%) with hand K files in primary teeth using spiral computed tomography. J Indian Soc Pedod Prev Dent 2014;32(4):286–291. DOI: 10.4103/0970-4388.140943.
Silva LA, Leonardo MR, Nelson–Filho P, et al. Comparison of rotary and manual instrumentation techniques on cleaning capacity and instrumentation time in deciduous molars. J Dent Child 2004;71(1): 45–47. PMID: 15272656.
Itzhak JB, Solomonov M, Lvovsky A, et al. Comparison between stainless steel and nickel–titanium rotary preparation time for primary molar teeth by endodontists and pedodontist. Turkish Endod J 2018;3(1):1–4. DOI: 10.14744/TEJ.2018.81300.
Mehlawat R, Kapoor R, Gandhi K, et al. Comparative evaluation of instrumentation timing and cleaning efficacy in extracted primary molars using manual and NiTi rotary technique: In Vitro study. J Oral Biol Craniofacial Res 2019;9(2):151–155. DOI: 10.1016/j.jobcr.2019.03.003.
Bhandari SK, Prajapati U. Root canal obturation of primary teeth: Disposable injection technique. J Indian Soc Pedod Prev Dent 2012;30(1):13–18. DOI: 10.4103/0970-4388.95566.