Simplify pulpectomy in primary molars with a single-file reciprocating system: a randomized controlled clinical trial

  • Kaewta Boonchoo
  • Pattarawadee LeelataweewudEmail author
  • Kallaya Yanpiset
  • Varangkanar Jirarattanasopha
Original Article



To compare the clinical use of a single-file NiTi reciprocal system (sNiTi) to that of stainless steel hand file (SSH) instrumentation in primary tooth pulpectomy.

Materials and methods

A prospective randomized clinical trial was conducted in 34 healthy children aged 3–7 years. Thirty-seven mandibular primary molars were randomly assigned to two groups: sNiTi and SSH. Instrumentation time, obturation time, quality of obturation, and 6- and 12-month clinical and radiographic outcomes were compared between the two groups.


The median instrumentation time using sNiTi (3.23 min) was significantly shorter than that for SSH (7.38 min). Obturation times were not different. The quality of obturation was significantly different only in the mesial root canals; overfilling was seen more in the sNiTi group, while underfilling occurred more in the SSH group. At 6 and 12 months, both groups showed comparable clinical and radiographic success regardless of the type of instrumentation.


sNiTi shortens instrumentation time with comparable obturation time, overall quality of obturation, and clinical and radiographic outcomes with SSH.

Clinical relevance

Pulpectomy is indicated to prevent premature loss of primary teeth with irreversible inflamed or infected pulp. However, it is complicated and time-consuming. sNiTi reciprocating system is an alternative to hand filing technique, avoiding multiple steps and simplifying pulpectomy procedures.


Pulpectomy Deciduous molar Nickel-titanium rotary system Stainless-steel hand files 



The authors would like to acknowledge all staff in Phakpayoon Hospital, Phattalung Province, Southern Thailand and Asst. Prof. Dr. Chulaluk Komoltri, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, for valuable statistic consultation.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board, Faculty of Dentistry and the Faculty of Pharmacy, Mahidol University COA.No.MU-DT/PY-IRB 2016/056.1210, Bangkok, Thailand, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Nagaratna PJ, Shashikiran ND, Subbareddy VV (2006) In vitro comparison of NiTi rotary instruments and stainless steel hand instruments in root canal preparations of primary and permanent molar. J Indian Soc Pedod Prev Dent 24:186–191. CrossRefPubMedGoogle Scholar
  2. 2.
    Crespo S, Cortes O, Garcia C, Perez L (2008) Comparison between rotary and manual instrumentation in primary teeth. J Clin Pediatr Dent 32:295–298. CrossRefPubMedGoogle Scholar
  3. 3.
    Musale PK, Jain KR, Kothare SS (2019) Comparative assessment of dentin removal following hand and rotary instrumentation in primary molars using cone-beam computed tomography. J Indian Soc Pedod Prev Dent 37:80–86. CrossRefPubMedGoogle Scholar
  4. 4.
    Kummer TR, Calvo MC, Cordeiro MM, Vieira RDS, Rocha MJDC (2008) Ex vivo study of manual and rotary instrumentation techniques in human primary teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 105:e84–e92. CrossRefPubMedGoogle Scholar
  5. 5.
    Santhosh D, Devadathan A, Mathew J, Nair M, James B (2019) Comparative evaluation of efficiency of single-file rotary and reciprocating systems in instrumenting severely curved mesial root canals of extracted mandibular first molars: a morphometric study using cone-beam computed tomography. Saudi Endod J 9:19–25. CrossRefGoogle Scholar
  6. 6.
    Sahu G, Consul S, Nandakishore K, Shubhashini N, Geeta I, Idris M (2016) Rotary endodontics or reciprocating endodontics: which is new and which is true? J Health Sci Res 7:51–57CrossRefGoogle Scholar
  7. 7.
    Barr ES, Kleier DJ, Barr NV (1999) Use of nickel-titanium rotary files for root canal preparation in primary teeth. Pediatr Dent 21:453–454PubMedGoogle Scholar
  8. 8.
    George S, Anandaraj S, Issac JS, John SA, Harris A (2016) Rotary endodontics in primary teeth - a review. Saudi Dent J 28:12–17. CrossRefPubMedGoogle Scholar
  9. 9.
    Ochoa-Romero T, Mendez-Gonzalez V, Flores-Reyes H, Pozos-Guillen AJ (2011) Comparison between rotary and manual techniques on duration of instrumentation and obturation times in primary teeth. J Clin Pediatr Dent 35:359–363. CrossRefPubMedGoogle Scholar
  10. 10.
    Hargreaves KM, Cohen S, Berman LH (2011) Cohen's pathways of the pulp. St. Louis, 10th edn. Mosby Elsevier, Missouri, 834-835. CrossRefGoogle Scholar
  11. 11.
    Coll JA, Sadrian R (1996) Predicting pulpectomy success and its relationship to exfoliation and succedaneous dentition. Pediatr Dent 18:57–63PubMedGoogle Scholar
  12. 12.
    Trairatvorakul C, Chunlasikaiwan S (2008) Success of pulpectomy with zinc oxide-eugenol vs calcium hydroxide/iodoform paste in primary molars: a clinical study. Pediatr Dent 30:303–308PubMedGoogle Scholar
  13. 13.
    Prabhakar AR, Yavagal C, Dixit K, Naik SV (2016) 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 9:45–49. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Citak M, Ozyurek T (2017) Effect of different nickel-titanium rotary files on dentinal crack formation during retreatment procedure. J Dent Res Dent Clin Dent Prospects 11:90–95. CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Ozyurek T, Uslu G, Yilmaz K (2017) Effect of different nickel-titanium rotary files on dentinal crack formation during root canal preparation in primary molars: a laboratory study. Turk Endod J 2:30–42. CrossRefGoogle Scholar
  16. 16.
    Makarem A, Ravandeh N, Ebrahimi M (2014) Radiographic assessment and chair time of rotary instruments in the pulpectomy of primary second molar teeth: a randomized controlled clinical trial. J Dent Res Dent Clin Dent Prospects 8:84–89. CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Kuo C, Wang Y, Chang H, Huang G, Lin C, Guo M (2006) Application of Ni-Ti rotary files for pulpectomy in primary molars. J Dent Sci 1:10–15Google Scholar
  18. 18.
    Vieyra J, Enriquez F (2014) Instrumentation time efficiency of rotary and hand instrumentation performed on vital and necrotic human primary teeth: a randomized clinical trial. Dentistry 4:214. CrossRefGoogle Scholar
  19. 19.
    Mokhtari N, Shirazi A-S, Ebrahimi M (2017) A smart rotary technique versus conventional pulpectomy for primary teeth: a randomized controlled clinical study. J Clin Exp Dent 9:e1292–e1296. CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Morankar R, Goyal A, Gauba K, Kapur A, Bhatia SK (2018) Manual versus rotary instrumentation for primary molar pulpectomies- a 24 months randomized clinical trial. Pediatr Dent J 28:96–102. CrossRefGoogle Scholar
  21. 21.
    Ramezanali F, Afkhami F, Soleimani A, Kharrazifard MJ, Rafiee F (2015) Comparison of cleaning efficacy and instrumentation time in primary molars: Mtwo rotary instruments vs. hand K-files. Iran Endod J 10:240–243. CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Musale PK, Mujawar SA (2014) Evaluation of the efficacy of rotary vs. hand files in root canal preparation of primary teeth in vitro using CBCT. Eur Arch Paediatr Dent 15:113–120. CrossRefPubMedGoogle Scholar
  23. 23.
    Ahmad IA, Pani SC (2015) Accuracy of electronic apex locators in primary teeth: a meta-analysis. Int Endod J 48:298–307. CrossRefPubMedGoogle Scholar
  24. 24.
    Buldur B, Hascizmeci C, Aksoy S, Aydin MN, Guvendi ON (2018) Apical extrusion of debris in primary molar root canals using mechanical and manual systems. Eur J Paediatr Dent 19:16–20. CrossRefPubMedGoogle Scholar
  25. 25.
    Topcuoglu G, Topcuoglu HS, Akpek F (2016) Evaluation of apically extruded debris during root canal preparation in primary molar teeth using three different rotary systems and hand files. Int J Paediatr Dent 26:357–363. CrossRefPubMedGoogle Scholar
  26. 26.
    Topcuoglu G, Topcuoglu HS, Delikan E, Aydinbelge M, Dogan S (2017) Postoperative pain after root canal preparation with hand and rotary files in primary molar teeth. Pediatr Dent 39:192–196PubMedGoogle Scholar
  27. 27.
    Singbal K, Jain D, Raja K, Hoe TM (2017) Comparative evaluation of apically extruded debris during root canal instrumentation using two Ni-Ti single file rotary systems: an in vitro study. J Conserv Dent 20:64–67. CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Subramaniam P, Tabrez TA, Babu KL (2013) Microbiological assessment of root canals following use of rotary and manual instruments in primary molars. J Clin Pediatr Dent 38:123–127. CrossRefPubMedGoogle Scholar
  29. 29.
    Azar MR, Safi L, Nikaein A (2012) Comparison of the cleaning capacity of Mtwo and pro taper rotary systems and manual instruments in primary teeth. Dent Res J (Isfahan) 9:146–151. CrossRefGoogle Scholar
  30. 30.
    Pinheiro SL, Araujo G, Bincelli I, Cunha R, Bueno C (2012) Evaluation of cleaning capacity and instrumentation time of manual, hybrid and rotary instrumentation techniques in primary molars. Int Endod J 45:379–385. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Pediatric Dentistry, Faculty of DentistryMahidol UniversityBangkokThailand
  2. 2.Department of Operative Dentistry and Endodontics, Faculty of DentistryMahidol UniversityBangkokThailand

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