Comparative evaluation of clinical efficacy and volumetric changes in pulpectomized primary molars using hand K-file, ProTaper rotary file, and Kedo-SG blue file: an in-vitro cone beam computed tomography analysis

The accomplishment of a successful pulpectomy depends on multiple factors that involve targeted removal of the causative irritants and soft and hard tissue debris by mechanical and chemical means. Compare and evaluate the efficacy of canal preparation and volumetric filling using conventional files and two rotary file systems using cone beam computed tomography (CBCT). Thirty freshly extracted human primary second molars were randomly divided into three groups of 10 teeth each. After access opening and working length determination, pre-operative volume analysis was done using CBCT. The canals were then instrumented by either hand K-files, ProTaper rotary files or Kedo-SG Blue rotary files. Post-operative volume analysis was performed using CBCT. All the canals were obturated using Metapex and scanned again using CBCT. Mean values of the pre- and post-operative canal volumes were analyzed using one-way Analysis of Variance (ANOVA). Inter- and intra-group volumetric changes were analyzed statistically using a post hoc test. The mean difference in volume after canal preparation and obturation was the highest in the Kedo-SG Blue group, followed by the ProTaper group and the least in the hand K group (p = 0.001). Inter-group comparison showed statistically significant differences between the hand K group and ProTaper group (p = 0.001), the ProTaper group and Kedo-SG Blue group (p = 0.001), and the hand-K group and Kedo-SG Blue group (p = 0.02). The volume of preparation and obturation was the highest using Kedo-SG Blue, followed by the ProTaper file systems.

Cone beam computed tomography; Post obturation volume; Primary molar; Rotary files

[1] Jeevanandan G, Thomas E. Volumetric analysis of hand, reciprocating and rotary instrumentation techniques in primary molars using spiral computed tomography: an in vitro comparative study. European Journal of Dentistry. 2018; 12: 21–26.

[2] Kim S. Modern endodontic practice: instruments and techniques. Dental Clinics of North America. 2004; 48: 1–9.

[3] Crespo S, Cortes O, Garcia C, Perez L. Comparison between rotary and manual instrumentation in primary teeth. Journal of Clinical Pediatric Dentistry. 2008; 32: 295–298.

[4] Nagaratna PJ, Shashikiran ND, Subbareddy VV. In vitro comparison of NiTi rotary instruments and stainless-steel hand instruments in root canal preparations of primary and permanent molar. Journal of Indian Society of Pedodontics and Preventive Dentistry. 2006; 24: 186–191.

[5] Silva LAB, Leonardo MR, Nelson-Filho P, Tanomaru JMG. Comparison of rotary and manual instrumentation techniques on cleaning capacity and instrumentation time in deciduous molars. Journal of Dentistry for Children. 2004; 71: 45–47.

[6] Yang S, Rivera EM, Walton RE, Baumgardner KR. Canal debridement: effectiveness of sodium hypochlorite and calcium hydroxide as medicaments. Journal of Endodontics. 1996; 22: 521–525.

[7] Mohammadzade Akhlaghi N, Khalilak Z, Baradaran Mohajeri L, Sheikholeslami M, Saedi S. Comparison of canal preparation pattern of K3 and ProTaper rotary files in curved resin blocks. Iranian Endodontic Journal. 2008; 3: 11–16.

[8] Nazari Moghaddam K, Mehran M, Farajian Zadeh H. Root canal cleaning efficacy of rotary and hand files instrumentation in primary molars. Iranian Endodontic Journal. 2009; 4: 53–57.

[9] Singh P, Saha S, Tripathi AM, Yadav G, Dhinsa K. Cone-beam computed tomographic analysis of deciduous root canals after instrumentation with different filing systems: an in vitro study. International Journal of Clinical Pediatric Dentistry. 2022; 15: S22–S29.

[10] Musale PK, Jain KR, Kothare SS. Comparative assessment of dentin removal following hand and rotary instrumentation in primary molars using cone-beam computed tomography. Journal of Indian Society of Pedodontics and Preventive Dentistry. 2019; 37: 80–86.

[11] Musale PK, Mujawar SAV. Evaluation of the efficacy of rotary vs. hand files in root canal preparation of primary teeth in vitro using CBCT. European Archives of Paediatric Dentistry. 2014; 15: 113–120.

[12] Peedikayil FC, Nabeeh PK, Premkumar CT, Kottayi S, Narasimhan D. Comparison of volumetric changes in primary molar root canals by four different file systems: a cone-beam computed tomography study. Journal of South Asian Association of Pediatric Dentistry. 2021; 4: 112–116.

[13] Swaminathan K, Rakkesh KM, Haridoss S. Computed tomographic assessment of remaining dentin and risk of perforation after Kedo-S and Mtwo rotary instrumentation in root canals of primary teeth: an in vitro study. International Journal of Clinical Pediatric Dentistry. 2022; 15: S87–S91.

[14] Jayam C, Thakur S, Ahammed H. 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. International Journal of Clinical Pediatric Dentistry. 2020; 13: 332–336.

[15] Panchal V, Jeevanandan G, Subramanian E. Comparison of instrumentation time and obturation quality between hand K-file, H-files, and rotary Kedo-S in root canal treatment of primary teeth: a randomized controlled trial. Journal of Indian Society of Pedodontics and Preventive Dentistry. 2019; 37: 75.

[16] Agarwal N, Kalita S. Comparative evaluation of cleaning capacity and efficiency of Kedo-S pediatric rotary files, rotary ProTaper, and Hand K files in primary molar pulpectomy. International Journal of Clinical Pediatric Dentistry. 2021; 14: 383–387.

[17] Hargreaves KM and Berman LH. Cohen’s pathways of the pulp. South Asia edition e-book. Elsevier Health Sciences: RELX india Pvt. Ltd. New Delhi, India. 2021.

[18] Patloth T, Vaishali Naidu D, Sharada Reddy J, Suhasini K, Hema Chandrika I, Shaik H. Cone-beam computed tomographic evaluation of the quality of obturation using different pediatric rotary file systems in primary teeth. International Journal of Clinical Pediatric Dentistry. 2021; 14: 542–547.

[19] Abdelkafy H, Eldehna AM, Salem NA. Canal transportation and centering ratio of paediatric vs regular files in primary teeth. Int Dentistry Journal. 2023; 73: 423–429.

[20] Todd R. Cone beam computed tomography updated technology for endodontic diagnosis. Dental Clinics of North America. 2014; 58: 523–543.

[21] Borges CC, Estrela C, Decurcio D de A, PÉcora JD, Sousa-Neto MD, Rossi-Fedele G. Cone-beam and micro-computed tomography for the assessment of root canal morphology: a systematic review. Brazilian Oral Research. 2020; 34: e056.

[22] Deshpande AN, Joshi NH, Naik KS. Comparative evaluation of cleaning efficacy and volumetric filling in primary molars: cone beam computed tomography evaluation. Contemporary Clinical Dentistry. 2017; 8: 33–37.

[23] Jeevanandan G, Govindaraju L. Clinical comparison of Kedo-S paediatric rotary files vs manual instrumentation for root canal preparation in primary molars: a double blinded randomised clinical trial. European Archives of Paediatric Dentistry. 2018; 19: 273–278.

[24] Garg N, Jaiswal J, Samadi F, Chowdhary S, Samadi F, Tripathi VP. A comparative evaluation of efficacy of different obturation techniques used in root canal treatment of anterior teeth: an in vitro study. International Journal of Clinical Pediatric Dentistry. 2014; 7: 1–5.

[25] Hegde J, Kumar K, Chikkamallaiah C, Bashetty K. Comparative evaluation of the sealing ability of different obturation systems used over apically separated rotary nickel-titanium files: an in vitro study. Journal of Conservative Dentistry. 2013; 16: 408.

[26] Barr ES, Kleier DJ, Barr NV. Use of nickel-titanium rotary files for root canal preparation in primary teeth. Pediatric Dentistry. 2000; 22: 77-78.

[27] Priyadarshini P, Jeevanandan G, Govindaraju L, Subramanian EMG. 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. European Archives of Paediatric Dentistry. 2020; 21: 693–701.