Clinical comparison of the obturation quality of primary posterior maxillary teeth treated with pulpectomy using single rotary file, sequential rotary file, and manual file system: an observational study

Background: Pulpal involvement resulting from dental caries is a frequent occurrence and poses a formidable challenge for pediatric dentists. The success of endodontic treatment relies heavily on the quality of obturation. Previously, evaluation was based on the Coll and Sadrian criteria. However, with the introduction of the Kids Endodontic Obturation Quality (KEDOO) classification, a more detailed assessment is now possible. This classification considers various parameters including arch, segment and canal-specific factors, thus addressing previous limitations. The aim of this paper is to evaluate and compare the quality of obturation achieved by the Kedo S Plus, Pro AF Baby Gold and K-file systems in primary maxillary molars using the KEDOO classification system. Methods: In this observational study, thirty intraoral periapical (IOPA) radiographs were obtained for each group of primary maxillary molars treated with pulpectomy: Group A (Kedo S Plus), Group B (Pro AF Baby) and Group C (K-file), resulting in a total of ninety radiographs. The exclusive assessment of obturation quality was conducted utilizing the KEDOO classification system. Results: Statistical analysis was performed employing Kruskal Wallis and Analysis of Variance (ANOVA) tests. Kedo S Plus file system showed more number of optimal obturations (73.3%) in comparison with other groups. There was significant difference between the groups on comparison of quality of obturation. Conclusions: KEDOO classification system assesses outcomes based on the presence and location of voids as well as the extent of material fill. Kedo S Plus, Pro AF Baby file, and Hand K File systems each achieved varying levels of obturation quality. The single rotary file system (Kedo S Plus) is a promising alternative to sequential and manual instrumentation in achieving optimal obturation in primary maxillary molars. Clinical Trial Registration: The study was registered under the Clinical Trials Registry of India (CTRI) with the registration number CTRI/2024/06/069200.

Deciduous teeth; Rotary hand file; Pediatric endodontics; Pulpectomy

[1] Jiang R, Yu J, Islam R, Li X, Nie E. Dental caries prevention knowledge, attitudes, and practice among patients at a university hospital in Guangzhou, China. Medicina. 2023; 59: 1559.

[2] Di Stasio D, Lauritano D, Romano A, Salerno C, Minervini G, Minervini G, et al. In vivo characterization of oral pemphigus vulgaris by optical coherence tomography. Journal of Biological Regulators and Homeostatic Agents. 2015; 29: 39–41.

[3] Chauhan A, Saini S, Dua P, Mangla R. Rotary endodontics in pediatric dentistry: embracing the new alternative. International Journal of Clinical Pediatric Dentistry. 2019; 12: 460–463.

[4] Bose D, Singh G, Gupta S, Chanda A. Development of a novel customized insole for effective pressure offloading in diabetic patients. Prosthesis. 2024; 6: 341–356.

[5] Galey L, Fuentes O, Gonzalez RV. Transfemoral amputee stumble detection through machine-learning classification: initial exploration with three subjects. Prosthesis. 2024; 6: 235–250.

[6] Urkande NK, Mankar N, Nikhade PP, Chandak M. Beyond tradition: non-surgical endodontics and vital pulp therapy as a dynamic combination. Cureus. 2023; 15: e44134.

[7] Di Stasio D, Romano A, Paparella RS, Gentile C, Serpico R, Minervini G, et al. How social media meet patients questions: YouTube review for mouth sores in children. Journal of Biological Regulators and Homeostatic Agents. 2018; 32: 117–121.

[8] Fama F, Cicciu M, Sindoni A, Nastro-Siniscalchi E, Falzea R, Cervino G, et al. Maxillofacial and concomitant serious injuries: an eight-year single center experience. Chinese Journal of Traumatology. 2017; 20: 4–8.

[9] Tirupathi SP, Krishna N, Rajasekhar S, Nuvvula S. Clinical efficacy of single-visit pulpectomy over multiple-visit pulpectomy in primary teeth: a systematic review. International Journal of Clinical Pediatric Dentistry. 2019; 12: 453–459.

[10] Irzooqee AF, Al Haidar AHMJ, Abdul-Kareem M. The effect of different obturation techniques in primary teeth on the apical microleakage using endoflas: a comparative in vitro study. International Journal of Dentistry. 2023; 2023: 4982980.

[11] Khandelwal A, Janani K, Teja K, Jose J, Battineni G, Riccitiello F, et al. Periapical healing following root canal treatment using different endodontic sealers: a systematic review. BioMed Research International. 2022; 2022: 3569281.

[12] Seracchiani M, Reda R, Zanza A, D’Angelo M, Russo P, Luca T. Mechanical performance and metallurgical characteristics of 5 different single-file reciprocating instruments: a comparative in vitro and laboratory study. Journal of Endodontics. 2022; 48: 1073–1080.

[13] He SY, Li JY, Dai SS, Yang YH, Wen YF, Guo QY, et al. Survival analysis and risk factors of pulpectomy among children with severe early childhood caries treated under general anesthesia: a retrospective study. International Journal of Environmental Research and Public Health. 2023; 20: 1191.

[14] Mendoza-Mendoza A, Caleza-Jiménez C, Solano-Mendoza B, Iglesias-Linares A. Are there any differences between first and second primary molar pulpectomy prognoses? A retrospective clinical study. European Journal of Pediatric Dentistry. 2017; 18: 41–44.

[15] Zhang ZH, Yao HL, Zhang Y, Wang X. Endodontic management of the maxillary first molar with special root canals: a case report and review of the literature. World Journal of Clinical Cases. 2020; 8: 2590–2596.

[16] Yammine SD, Jabbour EA. Apically extruded debris following programmed over instrumentation of curved canals with three nickel titanium rotary instruments. European Journal of Dentistry. 2021; 15: 20–26.

[17] Lucchese A, Dolci A, Minervini G, Salerno C, DI Stasio D, Minervini G, et al. Vulvovaginal gingival lichen planus: report of two cases and review of literature. Oral & Implantology. 2016; 9: 54–60.

[18] Orhan AI, Tatli EC. Evaluation of root canal obturation quality in deciduous molars with different obturation materials: an in vitro micro-computed tomography study. BioMed Research International. 2021; 2021: 6567161.

[19] KN C, Eram A, Shetty N, Shetty DD, Futane M, Keni LG. Evaluating angled abutments: three-dimensional finite element stress analysis of anterior maxillary implants. Prosthesis. 2024; 6: 315–328.

[20] Fernández-Garrido P, Fernández-Dominguez P, Fernández De La Fuente L, Manso De Gustin B, Varona JF, Bosch BM, et al. Citric acid-based solutions as decontaminant mouthwash in titanium and dental prostheses materials in implantoplasty processes. Prosthesis. 2024; 6: 1211–1227.

[21] Kondratiev A, Demenko V, Linetskiy I, Weisskircher H-W, Linetska L. Evaluation of bone turnover around short finned implants in atrophic posterior maxilla: a finite element study. Prosthesis. 2024; 6: 1170–1188.

[22] 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.

[23] Paradowska-Stolarz AM, Wieckiewicz M, Mikulewicz M, Malysa A, Dus-Ilnicka I, Seweryn P, et al. Comparison of the tensile modulus of three 3D-printable materials used in dentistry. Dental and Medical Problems. 2023; 60: 505–511.

[24] Alshiddi IF. Survival rate and clinico-radiographic parameters around narrow-diameter dental implants for fixed dental prostheses in the posterior regions: a systematic review. Dental and Medical Problems. 2023; 60: 345–353.

[25] Aminabadi NA, Farahani RMZ, Gajan EB. Study of root canal accessibility in human primary molars. Journal of Oral Science. 2008; 50: 69–74.

[26] Zoremchhingi, Joseph T, Varma B, Mungara J. A study of root canal morphology of human primary molars using computerised tomography: an in vitro study. Journal of Indian Society of Pedodontics and Preventive Dentistry. 2005; 23: 7–12.

[27] Antonelli A, Bennardo F, Brancaccio Y, Barone S, Femiano F, Nucci L, et al. Can bone compaction improve primary implant stability? An in vitro comparative study with osseodensification technique. Applied Sciences. 2020; 10: 8623.

[28] Khasnis S, Kar P, Kamal A, Patil J. Rotary science and its impact on instrument separation: a focused review. Journal of Conservative Dentistry. 2018; 21: 116–124.

[29] Jeevanandan G, Govindaraju L, Kotian N, Maganur PC, Marwah N, Vishwanathaiah S. A new criteria to assess quality of obturation in primary teeth: KEDOO classification. International Journal of Clinical Pediatric Dentistry. 2023; 16: 376–379.

[30] Bagheri M, Khimani H, Pishbin L, Shahabinejad H. Effect of pulpotomy procedures with mineral trioxide aggregate and dexamethasone on post-endodontic pain in patients with irreversible pulpitis: a randomized clinical trial. European Endodontic Journal. 2019; 4: 69–74.

[31] Vijayan AK, Jo S, Mathew B, Vidyadharan M, Nair AM. Comparison of diagnostic ability of conventional film and storage phosphor plate in detecting proximal caries with direct measurements by stereomicroscope: a diagnostic test evaluation. Contemporary Clinical Dentistry. 2022; 13: 156–161.

[32] Bharuka S, Mandroli P. Single- versus two-visit pulpectomy treatment in primary teeth with apical periodontitis: a double-blind, parallel group, randomized controlled trial. Journal of Indian Society of Pedodontics and Preventive Dentistry. 2016; 34: 383–390.

[33] Girish Babu KL, Gururaj Hebbar K, Doddamani GM. Correlation between quality of obturation and outcome of pulpectomized primary molars following root canal instrumentation with pediatric rotary file systems. Pediatric Dental Journal. 2024; 34: 27–34.

[34] Coll JA, Sadrian R. Predicting pulpectomy success and its relationship to exfoliation and succedaneous dentition. Pediatric Dentistry. 1996; 18: 57–63.

[35] Bawazir OA, Salama FS. Clinical evaluation of root canal obturation methods in primary teeth. Pediatric Dentistry. 2006; 28: 39–47.

[36] Sarkar S, Rao AP. Number of root canals, their shape, configuration, accessory root canals in radicular pulp morphology. A preliminary study. Journal of Indian Society of Pedodontics and Preventive Dentistry. 2002; 20: 93–97.

[37] Ahmed HM. Anatomical challenges, electronic working length determination and current developments in root canal preparation of primary molar teeth. International Endodontic Journal. 2013; 46: 1011–1022.

[38] Lo Giudice A, Ronsivalle V, Santonocito S, Lucchese A, Venezia P, Marzo G, et al. Digital analysis of the occlusal changes and palatal morphology using elastodontic devices. A prospective clinical study including Class II subjects in mixed dentition. European Journal of Paediatric Dentistry. 2022; 23: 275–280.

[39] Merchan LP, Probst LF, Simões ACCD, Raimundo ACS, Cavalcanti YW, Cavalcante D de FB, et al. Economic analysis of the different endodontic instrumentation techniques used in the Unified Health System. BMC Oral Health. 2022; 22: 344.

[40] Kohli A, Chhabra J, Sharma K, Katyayan R, Bhatnagar P, Sharma A. Comparative evaluation of instrumentation time and quality of obturation amongst pediatric rotary endodontic system: an in vivo study. International Journal of Clinical Pediatric Dentistry. 2023; 16: 338–343.

[41] Shah HS, Patil VM, Kamath AP, Mathur AA. Comparative evaluation of instrumentation time, obturation time, and radiographic quality of obturation using two rotary systems and manual technique for primary molar pulpectomies—in vivo study. Contemporary Clinical Dentistry. 2021; 12: 55–62.

[42] Bagherian A, Kalhori KAM, Sadeghi M, Mirhosseini F, Parisay I. An in vitro study of root and canal morphology of human deciduous molars in an Iranian population. Journal of Oral Science. 2010; 52: 397–403.

[43] Bramanti E, Matacena G, Cecchetti F, Arcuri C, Cicciù M. Oral health-related quality of life in partially edentulous patients before and after implant therapy: a 2-year longitudinal study. Oral & Implantology. 2013; 6: 37–42.

[44] Isola G, Polizzi A, Ronsivalle V, Alibrandi A, Palazzo G, Lo Giudice A. Impact of matrix metalloproteinase-9 during periodontitis and cardiovascular diseases. Molecules. 2021; 26: 1777.