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 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 12  |  Issue : 2  |  Page : 95-100

Literature review on rotary endodontics in primary teeth


People's College of Dental Sciences and Research Center, Bhopal, Madhya Pradesh, India

Date of Submission10-Dec-2020
Date of Decision08-Mar-2021
Date of Acceptance09-Mar-2021
Date of Web Publication30-Jun-2021

Correspondence Address:
Dr. Tiwari Shilpi
Department of Pedodontics and Preventive Dentistry, People's College of Dental Sciences and Research Center, Bhopal, Madhya Pradesh
India
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DOI: 10.4103/srmjrds.srmjrds_132_20

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  Abstract 


Primary teeth retention is of utmost importance till the occurrence of the physiological exfoliation. One of the most eminent ways of preserving a necrotic primary teeth is by performing the pulpectomy procedure. The biomechanical preparation of the canal has got a crucial role in the pulpectomy procedure. Manual method is considered to be the standard method of biomechanical preparation but still has certain drawbacks which lead to introduction of rotary instrumentation as this method is more viable and less time consuming. However, the application of rotary instrumentation technique in the pediatric dentistry is not extensive due to limited information regarding the usage of the technique in the field of pediatric dentistry. The present review focuses on rotary instrumentation and various rotary systems and their application in the pediatric dentistry.

Keywords: Biomechanical preparation, preservation, primary teeth, pulpectomy, rotary instrumentation


How to cite this article:
Parimala K, Singh TN, Shilpi T, Barkha C. Literature review on rotary endodontics in primary teeth. SRM J Res Dent Sci 2021;12:95-100

How to cite this URL:
Parimala K, Singh TN, Shilpi T, Barkha C. Literature review on rotary endodontics in primary teeth. SRM J Res Dent Sci [serial online] 2021 [cited 2021 Jul 31];12:95-100. Available from: https://www.srmjrds.in/text.asp?2021/12/2/95/319867




  Introduction Top


The sustainment of the teeth present in primary dentition becomes utmost important till it goes through the process of physiological exfoliation as it aids in the following functions such as maintenance of the arch integrity, helping with adequate masticatory load bearing forces, speech function, esthetics, and prevents the child from developing deleterious habits which may result in malocclusions.[1] Primary teeth also help with the guidance of permanent successors. If these teeth remain untreated the further sequelae may be the damage of the permanent successor (e.g., enamel hypo-mineralization or hypoplasia) causing hindrance in maintaining the good oral health of the child, thereby affecting their normal day-to-day functioning (e.g., discomfort, preferences in food consumption, and quantity of intake).[2]

Dental caries is considered to be the most chronic disease of irreversible nature which acts on the intact areas of the tooth bringing about a direct influence on the child's normal functioning.[3],[4] Primary tooth decay is restored normally by means of various restorative materials when caries encroach both enamel and dentin.[5] However, if there is pulpal involvement of caries associated with the primary teeth, it requires to be pulpally treated in order to resolve the pain and functional preservation of the teeth until it exfoliates physiologically.[6] The preferable choice of treatment for primary teeth with pulpal infection is pulpectomy, in which the pulpal tissue is entirely removed, debridement and canal preparation, followed by obturation utilizing an appropriate resorbable material.[7] In the pulpectomy procedure, the preparation of the canal plays a crucial part in achieving a successful outcome of the procedure as adequate shaping of the canal system, thereby removes entire contaminated pulpal tissue, giving adequate path for the irrigation in the radical third portion hence providing the successful obturation of the prepared root canals.[8]

Manual instrumentation with a hand file is the standardized method for preparing the canals of the primary teeth.[8] Files, reamers, and ultrasonic instruments were used for the preparation. Although the manual preparation techniques still remain the standard measure of biomechanical preparation, it has certain shortcomings such as several iatrogenic errors including the ledging, zipping, canal transportation, and apical blockage.[9] The nickel–titanium (NiTi) rotary instruments came into existence in the field of endodontics to overcome these shortcomings of conventional manual file system and have presented desired outcome with their efficient cleaning of the root canal maintaining the original canal space during BMP procedure.[10] Thus, the present review focuses on the various rotary file systems used in pediatric dentistry.

Rotary systems in pediatric dentistry

Barr et al. first described the rotary biomechanical preparation in primary teeth using ProFile system and found it to be expeditious and cost–effective, leading to a homogenous and uniform obturation.[11]

The proved efficiency of the NiTi rotary files lead to acceptability of various file systems in the canals of primary teeth. These file systems have varying designs of taper, blades, grooves, and tips that provide adequate preparation of canals with an added advantage of reduction in chairside time, a factor essential for working in younger individuals.[12]


  Various Rotary Systems Applied in Primary Teeth:  Top


ProTaper, FlexMaster, Hero 642, Mtwo, and K3rotary files are among the primary rotary system as suggested by various authors.

The ProTaper system

Introduced by Dr. Cliff Ruddle, Dr. John West, and Dr. Pierre Machtou. ProTaperNiTi instruments (DentsplyMaillefer, Ballaigues, Switzerland) belong to new generation of instruments for root canal shaping.[13],[14] The design of this system convex triangular-shaped cross-section having sharp working edges, absence of radial lands, noncutting type of tip, varying taper, balanced helical angle, and pitch is designed to prevent “screwing in” effect.[15] Set of six instruments, three shaping files, and three finishing files are included in the system.[13],[14]

Method of application of ProTaper in primary teeth

After the visual access is established, abrupt cervical constriction is removed. The sequence of application begins with SX file placement within the canal at 3 mm farther to the orifice, S2 file (tip size of 20 and 4% tapering, with approximation of the canal size of primary teeth). S1 file is skipped as its smaller size causes hindrance in the efficient preparation of primary molar canals. Excessive apical dentin removal may occur as the taper (7%–9%) in tip size is increased, and hence the F series is avoided. Due to the greater taper (8%–5.5%) in the physiological resorption cases, F2 file is chosen over S2.[16]

Increase the cutting efficiency, lowered probability of instrument separation, and selective dentin removal are the advantages of system.[16] Lateral perforation is among disadvantage of the system.[17]

The flexmaster system

FlexMaster (FM) NiTi files also belong to the new generation of rotary system. The convex triangular-shaped cross-section incorporating sharp working edges and absence of radial lands, noncutting type of tip, taper is fixed, and in dependent helical angles are incorporated so that the “screwing in” effect is avoided.[18]

Method of application of flexmaster system in primary teeth

The method of application of this system begins with “Introfile” to enlarge the orifices that extends to the middle third of the root canal and regarded as orifice shaper. This is followed by application of 25/0.04 taper until the resistance is experienced later on, 25/0.02 taper is applied till the working length.[19]

Reduction in the chair-side duration, infrequent instrument fracture, minimized canal transportation, fewer canal aberrations, and curved canals preparation are the advantages.[20],[21]

The hero shapers

This system belongs to second-generation rotary system. Recently introduced system HERO shapers have triple-helical cross-sectional design. The adapted pitch concept is a crucial modification seen in this system that provides increased flexibility.[22]

Method of application of the hero shapers system in primary teeth

Preparation is performed with the length 21 mm instruments, varying taper of 2, 4% maintaining a constant rotation speed not exceeding beyond 600 rpm The working depth must not exceed for the 0.04 files 0.04 at WL.[23],[24]

The advantages such as reduction in number of files, ease of use, minimized operating time, removal of interferences, treatment facilitation, consistent removing of dentin and symmetrical canal shapes, and antibreakage control feature allowing the unwinding of the instrument, by constantly maintaining the rotation speed.[25],[26] Disadvantages are fixed rotation intensity, high cost, and higher chances of breakage is seen; hence excessive force not be applied on the head of the handpiece.[23],[24]

The Mtwo nickel–titanium rotary system

Current generation system having “italic S” cross-section and double cutting blades, tip is noncutting type, taper is fixed, and variable pitch.[27]

Method of application of the Mtwo nickel–titanium rotary system in primary teeth

The preparation is initiated with 21 mm long Mtwo NiTi rotary files functions with fixed torque at a highest speed of 280 rpm. 10/0.04, 15/0.05, 20/0.06, and 25/0.06 are the four rotary instrument sequence followed till entire working length.[8],[27]

Higher instrument stability with efficient dentin removal, splendid lateral cutting ability, absence of screw-in effect, and shorter working time are the advantages. Deformation rate is higher, instrument fractures, and high cost are disadvantages of the system.[28]

The K3 rotary system

Introduced by Dr. John McSpadden (Lookout Mountain, Georgia). Asymmetrical design with a positive rake angle aids in efficient preparation, three radial lands with, taper is maintained constant, noncutting tip, and variable pitch.[29],[30]

Method of application of K3 system in primary teeth

The instrumentation is initiated with the 0.06 taper file followed by cleansing and shaping of the canals with three progressively increased taper of files, utilizing “crown down” method; every instrument is changed according to the manufacturer's recommendation.[31]

This system shows advantages such as splendid cutting characteristics, higher flexibility, canal tracking, avoids screwing in effect, reduced time duration, minimizes canal transportation, resists torsional and cyclic fatigue, reduces patient's fatigue, and tactile control. Disadvantages are high cost, requirement to work at particular speed (300–350 rpm), handling is to be gentle and not to be forced.[30],[31]


  Novel File Systems Of Pediatric Endodontics Top


Numerous file systems have been lately introduced and are designed especially for pediatric patients.

Kedo file system

The Kedo files systems are among the pioneer files designed exclusively in canal preparation of primary teeth. They include file Hand type (Kedo-SH) and rotary type (Kedo-S, Kedo-SG).

Kedo-S pediatric rotary file system

The Kedo-S file system includes three NiTi rotary files. The entire length is of 16 mm. The sequencing includes D1, E1, U1, files, respectively. Variable taper is incorporated for corresponding to its utilization in primary teeth.

  • The taper is designed in accordance with deciduous tooth. This rotary file system is used at low speed constant-torque handpiece. The optimum rotation speed of 150–300 rpm is maintained.[32] They include a gradual taper providing simplified widening of the coronal portion and straight line access. This system has got lesser instrumentation time than ProTaper system. The reduced flute length makes its usage more feasible for the dentist in the child patient.[33]<


Kedo SG blue (controlled memory files)

It includes sequence of three files. The complete length of 16 mm is present. The files are identified as D1, E1, and U1, respectively. Heat treatment and controlled memory provide a variably variable taper making it appropriate for usage in primary teeth. Features include greater flexibility and higher resistance from cyclic fatigue of about 75%, rotational speed is ideal that is 250–300 rpm with a necessary torque of 2.2–2.4 Ncm.

PRO AF baby gold file advanced pediatric rotary endodontic file system

It is a 5-file system manufactured with NiTi CM wire-Flexible with Consistent taper of 4%, 6%.

Characteristics

  • Exclusively designed and certified shorter 17 mm file
  • Greater safety and ease for dentist and patient as well
  • Cervical ledging is avoided by an uniquely designed short orifice enlarger
  • Advanced NiTi M wire with heat treatment providing improved canal centricity
  • Flexibility is enhanced along with minimized instrument separation
  • This rotary file system is appropriate for conservative approach of canal preparation
  • Shaping of canals is enhanced owing to sequential combination of files from orifice enlarger, 4% and 6% taper files
  • Number of files per canal are reduced, two files are mostly required for the complete preparation.


Indications

  • Specially for pediatric rotary endodontic treatment
  • Adult rotary endodontic in conditions of restricted opening of mouth and third molar root canals.


Instructions for use

  • The files should be instrumented at 2N 300 rpm
  • The file is to be used alongside 18% EDTA gel with a brushing motion
  • Manual canal preparation up to 20/02
  • For calcified canals orifice enlarger to be placed up to 4 mm.[33]



  Success Rate of Rotary System in Primary Teeth Top


  1. Vieyra and Enriquez (2014)[34] compared the instrumentation time efficiency of rotary and hand instrumentation performed on necrotic human primary teeth comparing manual K files with ProTaper file. They concluded that, clinically, time efficacy in primary molar endodontic treatment of rotary system, especially to withstand difficulty of canal morphology, is invaluable. Rotary files usage in primary teeth has got various advantages on comparison to the manual K files
  2. Morankar et al. (2018)[35] made a comparison distinguishing conventional and rotary methods of the deciduous molars and their effect on the successful outcome with follow-up of 2 years among the conventional group (Stainless steel files 2% taper) and rotary (Hyflex CM NiTson); there was a significant reduction in time with rotary in comparison to manual. No variation with duration of obturation time, efficacy, and rate of success were observed.



  Postoperative Pain After Rotary Instrumentation of the Primary Teeth Top


  1. Vieyra and Enriquez (2014)[34] compared instrumentation time between manual K files and rotary Light Speed LSX instruments and ProTaper time efficiency were compared performed on necrotic deciduous teeth. They concluded that the root canal is mostly conical in shape, which favors a greater quality of the canal obturation and shows better outcome in clinical circumstances
  2. Nair et al. (2018)[36] have done a comparison evaluating postoperative pain treated by pulpectomy with K-files, Kedo-S files, and MTwo files in primary molars – a randomized clinical trial and concluded that chemomechanical preparation utilizing Kedo-S and MTwo rotary systems resulted in reduced postoperative pain in comparison with the hand file system.



  Comparison of Instrumentation Period Between Rotary Versus Conventional in Primary Teeth Top


  1. Ochoa-Romero et al. (2011)[37] made the comparison of duration of instrumentation, obturation time, and quality of canal filling among rotary and conventional methods of deciduous teeth utilizing K3 rotary system and K hand files, respectively. The conclusion was made that rotary technique utilization minimizes the instrumentation time to 63%
  2. Makarem et al. (2014)[38] have done the comparison assessing working time for the rotary instruments during pulpectomy of primary second molar utilizing hand instruments (K files) and Rotary FM System and made a conclusion that mean instrumentation time was significantly greater in comparison to rotary instruments system
  3. Govindaraju et al. (2017)[39] had clinically evaluated the Quality of filling and Instrumentation period utilizing different Rotary Systems alongside conventional instrumentation in deciduous teeth which were ProTaper universal file and 0.25 tip 4% tapering K3 rotary system, k-hand files, respectively. Conclusion of this study was there was a significant difference with both the methods
  4. Govindaraju et al. (2018)[40] compared and evaluated the working time and filling quality among Kedo-S and conventional method in deciduous molars making the use of Kedo-S and hand K-files, respectively. The Kedo-S showed reduced instrumentation time.



  Quality of Canal Filling (Overfilled/Underfilled/Optimum Filled) Top


  1. Ochoa-Romero et al. (2011)[37] had done a Comparison between Rotary and Manual Techniques on Duration of Instrumentation and Obturation Times in Primary Teeth using K3 rotary system and hand K–files, respectively. Rotary technique displayed an improvement in the quality of the root canal filling
  2. Makarem et al. (2014)[38] have done the comparison for radiographical assessing and clinical working time of rotary instruments in the pulpectomy of deciduous second molar teeth using hand instruments (K files) and Rotary FM System. Significant difference was found among the two groups with respect to the level of filling of the canal
  3. Govindaraju et al. (2017)[39] had clinically evaluated of obturation efficacy and Instrumentation period between Two rotary Systems and conventional technique of instrumenting in deciduous Teeth using ProTaper universal file, 0.25 tip 4% taper K3 rotary file and k-hand files, respectively, and observed that the manual system, S2 ProTaper system along with K3 systems showed similar effect with respect to the quality of obturation
  4. Jeevanandan and Govindaraju (2018)[40] compared and evaluated the instrumentation time and quality of obturation between pediatric rotary file (Kedo-S) and manual instrumentation techniques in primary molars with Kedo-S and hand K-files, respectively. They found that Kedo-S to be efficient in preparing canals of deciduous teeth and had better quality of obturation.



  Cleaning Effectiveness (Microbial Reduction) Top


Manchanda et al. (2013) assessed the reduction in microbes in the canals of deciduous molars among rotary and manual NiTi using Rotary NiTi files HERO Shaper, hand NiTi K files, respectively, and concluded that rotary system had better efficacy over the manual system and caused insignificant microbial reduction.[41]


  Advantages and Disadvantages of Rotary System Used in Pediatric Dentistry Top


Advantages

  • NiTi alloy instruments have their unique designing with flexibility which enhances the preservation of the natural morphology of curvature of canals, thereby reducing the procedural errors with respect to deciduous teeth
  • Cooperative behavior from the patient can be achieved as the chair side time decreases. The shorter duration helps in maintaining the quality aiding in reduction of fatigue for both patient and professional
  • Irrespective of the irregular walls in the canal system of deciduous teeth, the rotary system enables efficient debris removal with their clockwise functioning
  • As the canal preparation is in a conical manner, the obturation material can be placed with ease and excessive overfilling can be avoided.


Disadvantages

The following characteristics interfere with the thorough application of the Niti rotary system in the deciduous teeth.

  • The dentin in the deciduous teeth is softer, roots being thin and short in comparison to permanent teeth; hence, there is an increased risk of perforation
  • Chances for separation of the instrument within the canal when instrumented aggressively and in dry field
  • Overfill of the obturation paste occurs as the apical overextension of the instrument enlarges the apical foramen.


The uncertainty of all rotary instruments lies around the point that, during rotary instrumentation, certain unclean areas may be left behind in the canals containing potentially infected tissue along the isthmus area of primary teeth. Efficient training of the operator in rotary instrumentation becomes essential to control the working length because there is reduction in tactile sensitivity during apical preparation compared with manual mechanical preparation.[12]

The field of rotary endodontic instruments is under ongoing research. The newer systems with better efficiencies are being introduced. NiTi rotary system in pediatric dentistry has got both advantages and disadvantages. Hence, adequate training of the operator in rotary instrumentation is essential.[42]

Despite the challenges that are present with the rotary system usage in pediatric practice, there are certainly advantages and factors that overweigh the disadvantages making it essential to bring its usage in day-to-day practice by utilizing the required considerations such as appropriate case selection.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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