Efficacy of Pediatric Rotary File System Versus Hand Instrumentation for Root Canal Preparation in Primary Teeth
Condition: Pulpitis
MeSH terms: Pulpitis
Study type: Interventional

Summary: 
      The teeth were randomly allocated in two equal groups :

      Control group (A):- included 20 mandibular primary molars in which pulpectomy were performed
      by hand instrumentation system using K- File from size 15 to size 35.

      Experimental Group (B):- included 20 mandibular primary molars in which pulpectomy were
      performed by rotary system using Kedo-SG rotary file system according to manufacturer's
      instructions

      Methods of Evaluation

      Stage I :- During and after canal preparation:- The following parameters were evaluated for
      all cases in both groups:- A- The instrumentation and canal filling time were recorded for
      both groups using stopwatch. B- Radiographic assessment for filling were done immediately
      postoperative to record :-

        1. Distance between the apex to filling level of the mesial and distal roots .

        2. Obturation form

      Stage II : Follow up :

      The follow up were carried out by clinical and radiographic evaluation for all cases in both
      groups:-

      The clinical evaluation were carried out at (0 base line = after 7 days ) then after 1 , 3 ,
      6 and 12 months .

      Radiographic evaluation were performed immediately postoperative as (0 baseline ) after
      cementation of stainless steel crowns for assessment of filling quality. Radiographs will be
      used for comparison for consequent radiographs . Follow ups were performed after 6 and 12
      months.
    

Detailed description: 
      The planned study is a randomized clinical controlled trial including apparently healthy
      children who were selected from the patients attending the Out- Patient Clinic , Pediatric
      Dentistry Department, Faculty of Dentistry, Suez Canal University. Informed written consent
      were obtained from parents or guardians of the children after full explanation of clinical
      procedures and detailed treatment plan.

      The teeth were randomly allocated in two equal groups :

      Control group (A):- included 20 mandibular primary molars in which pulpectomy were performed
      by hand instrumentation system using K- File from size 15 to size 35.

      Experimental Group (B):- included 20 mandibular primary molars in which pulpectomy were
      performed by rotary system using Kedo-SG rotary file system according to manufacturer's
      instructions

      Clinical procedures :

        1. Preoperative digital periapical radiograph were taken using standardized paralleling
           technique using XCP device .

        2. Local anesthesia were administered to the patient.

        3. The tooth were isolated using rubber dam .

        4. Caries were removed by large spoon excavator.

        5. The cavities were cleaned by thoroughly rinsing with chlorohexidine 0.2% .

        6. Access cavity were done under constant water cooling and suction using high speed round
           bur No.330 .

        7. Pulp chamber were completely deroofed .

        8. No .10 size K file were used to determine patency of canals.

        9. The working length were determined by apex locator & periapical radiograph.

       10. Depending on the group allocation , the canal instrumentation were done by step back
           technique using K- file (Mani ) from size 15 to size 35 in quarter pull turn motion
           apically or by crown down technique using Kedo-SG file rotary system using endodontic
           motor.

      11 - After each instrumentation , the canal were irrigated by 1% sodium hypochlorite .

      12- The canal were dried with paper points( #30 &#35) 13- Then canal were filled with creamy
      mix of Zinc oxide & Egenol. 14-Zinc phosphate cement were placed over Zinc oxide & Egenol
      then finally restored by Stainless steel crown .

      15-Postoperative digital periapical radiographs were taken using standardized paralleling
      technique using XCP device .

      Methods of Evaluation

      Stage I :- During and after canal preparation:- The following parameters were evaluated for
      all cases in both groups:- A- The instrumentation and canal filling time were recorded for
      both groups using stopwatch. B- Radiographic assessment for filling were done immediately
      postoperative to record :-

        1. Distance between the apex to filling level of the mesial and distal roots .

        2. Obturation form

      Stage II : Follow up :

      The follow up were carried out by clinical and radiographic evaluation for all cases in both
      groups:-

      The clinical evaluation were carried out at (0 base line = after 7 days ) then after 1 , 3 ,
      6 and 12 months .

      The following clinical criteria were evaluated: -

        -  Spontaneous pain as described by Oginin and Undoye ( 29)

        -  Sensitivity to percussion presence or absence.

        -  Tooth mobility presence or absence.

        -  Examination of any changes of the mucobuccal folds (presence or absence of swelling,
           sinus, draining fistula or abscess).

      If the tooth exhibits any of above clinical features, the pulpectomy was considered a failure
      (F); otherwise, it was regarded as clinical success (S).

      Radiographic evaluation were performed immediately postoperative as (0 baseline ) after
      cementation of stainless steel crowns for assessment of filling quality. Radiographs will be
      used for comparison for consequent radiographs . Follow ups were performed after 6 and 12
      months.

      The following radiographic criteria were evaluated :-

        -  Presence or absence of widening of apical periodontal membrane space .

        -  Presence or absence of furcation radioluency .

        -  Presence or absence of internal or external root resorption .

      All patients were examined using standardized intra oral paralleling periapical direct
      digital radiographs using the rinn (XCP) periapical film holder and a long cone. Radiometric
      and radiodensitometric analysis of the radiographs were carried out using the software of
      Digora (2.5) system.

      Dates of follow up visits were written on the patient 's recall card , parents were asked to
      call if any symptoms of pain or infection occurred at any time before recall visit .If there
      is any complications during follow up periods, different techniques of treatment were done
      according to the case.
    

Intervention name(s): rotary system; Manual files
Intervention type(s): Device; Device
Intervention description(s): crown down technique using Kedo-SG file rotary system using endodontic motor; instrumentation were done by step back technique using K- file (Mani ) from size 15 to size 35 in quarter pull turn motion apically
Other intervention name(s): rotary files; hand instrumentation
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment