A Comparative Study of Four Rotary Endodontic File Systems: Assessing Canal Transportation and Centering Ability using Cone-beam Computed Tomography.

The complex root canal anatomy of primary root canals is considered to be most challenging. The quality of the root canal preparation plays a significant role in the success of endodontic treatment. Now, there are very few root canal instruments that are capable of cleaning the canal three dimensionally. To evaluate the efficacy of root canal instruments, various technologies have been used; one of the most reliable strategies was cone-beam computed tomography (CBCT). The aim of this study is to compare the centralization ability and canal transportation of three commercially available pediatric rotary file systems using CBCT analysis. Thirty-three extracted human primary teeth with a minimum 7 mm root length were randomly divided into three groups (group I - Kedo-SG Blue, group II - Kedo-S Square, and group III - Pro AF Baby Gold). Biomechanical preparation was done according to the manufacturers instructions. Pre- and postinstrumentation CBCT images were taken for each group to evaluate the remaining dentin thickness thereby assessing the centering ability and the canal transportation ability of different file systems. Significant difference was noticed in canal transportation and centering ability between the three tested groups. Mesiodistal canal transportation was significant at all three levels, whereas buccolingual canal transportation was significant only at the apical third of the root. However, Kedo-SG Blue and Pro AF Baby Gold showed lesser canal transportation compared to Kedo-S Square rotary file system. Mesiodistal centering ability was significant at cervical and apical thirds of the root with Kedo-S Square rotary file system maintaining less canal centricity. All three file systems tested in the study were effective in removing the radicular dentin. However, Kedo-SG Blue and Pro AF Baby Gold rotary file systems showed comparatively less canal transportation and more centering ability than Kedo-S Square rotary file system.

Aim The aim of the present study was to evaluate the in vitro comparative assessment of root canal centering ratio and canal transportation associated with ProTaper Universal (PTU) (Dentsply Maillefer, Ballaigues, Switzerland), ProTaper Next (PTN) (Dentsply Maillefer, Ballaigues, Switzerland), and ProTaper Gold (PTG) (Dentsply Tulsa Dental Specialties, Tulsa, OK, USA) rotary file systems, with or without glide-path preparation, using cone beam computed tomography (CBCT) analysis. Materials and methods A total of 120 mesial roots of extracted human mandibular first molar teeth were collected and randomly divided into three groups (n = 40) depending on the type of rotary file system used for mesiobuccal root canal instrumentation: Group 1: PTU, Group 2: PTN, and Group 3: PTGrotary file systems. Each group was further divided into two Sub-groups (a and b) with 20 specimens, depending on whether glide-path preparation was performed using the ProGlider (PG) file (Dentsply Maillefer, Ballaigues, Switzerland). Before the root canal instrumentation, mesiobuccal root canals of all specimens were first scanned using the NewTom Go CBCT machine (Cefla S.C., Imola, Italy), and all root canals were then instrumented according to their groups and sub-groups. All rotary files were used according to their manufacturer's guidelines. Post-instrumentation, CBCT images of all specimens were taken with the same exposure parameters as those used in pre-instrumentation CBCT imaging. The distance between the external root surface and the internal canal wall was measured in both bucco-lingual and mesio-distal planes at 3 mm, 5 mm, and 7 mm levels of the mesiobuccal root canal of all specimens, comparing the pre-instrumentation and post-instrumentation CBCT scans for the evaluation of canal centering ratio and canal transportation using NewTom NNT software (Cefla S.C., Imola, Italy). Data were analyzed using one-way analysis of variance (ANOVA), multiple pairwise Tukey post-hoc tests, and Student's t-tests; a p-value ≤ 0.05 was considered statistically significant. Results Canal centering ratio was significant bucco-lingually and mesio-distally at 3 mm and 5 mm levels between Groups 1a, 1b, and 3a, 3b (p < 0.05). However, at 7 mm bucco-lingually, a significant difference was observed between groups 3a and 3b, and mesio-distally between Groups 2a and 2b (p < 0.05). Canal transportation was significantly bucco-lingually at 3 mm, 5 mm, and 7 mm levels between Groups 3a and 3b (p < 0.05). However, mesio-distally, no statistically significant difference (p > 0.05) was seen between the groups at all three levels of the root canal. Conclusion The use of the PG/PTN rotary file system showed the maximum canal centering ratio at all three levels of the root canal compared to the PTU and PTG rotary file systems, whether used with or without a glide-path. The PG/PTN rotary file system showed the least canal transportation at the 3 mm level, while at the 5 mm and 7 mm levels, the PG/PTU rotary file system showed the least canal transportation.

To evaluate the canal transportation, canal-centering ability, and touched and untouched surfaces of the root canal dentin after instrumentation with various newer file systems in continuous rotation and reciprocating motion using cone-beam computed tomography (CBCT) imaging. This in vitro study was conducted on one hundred recently extracted human mandibular molars, which were selected and instrumented using the following rotary NiTi file systems: RaceEvo, R-Motion, Reciproc Blue, and ProTaper Gold. The canal preparations for all four (04) experimental groups were done according to the manufacturer's instructions; the CBCT imaging was done for all the teeth compared at different levels of 2 mm, 5 mm, 8 mm from the apex, before and after the canal preparations. The data thus collected were evaluated for variation where p <0.05 was calibrated as significant using "ANOVA and Mann-Whitney" statistical tests. When the file systems were compared at different levels of the canal i.e. 2 mm, 5 mm, 8 mm from the apex, we observed a statistically significant difference for all the experimental groups (p = 0.021, 0.023, 0.032) respectively for the canal transportation (CT), (p = 0.045, 0.040, 0.037) respectively for the canal centering ability (CCA), (p <0.001) respectively for the touched (TS) and untouched (US) surfaces. R-Motion showed the least CT, greater CCA, with maximum TS, and the least US dentinal surfaces in the root canal preparations followed by RaceEvo, Reciproc Blue, and ProTaper Gold. R-Motion exhibited better canal centering ability, lower canal transportation due to its improved cutting efficiency down to the apex while preserving the dentin of the root canal walls and also exhibits lesser stress on dentin. The newer rotary file systems of R-Motion and RaceEvo described in this study could be recommended for clinical use during endodontic treatment. The newly introduced R-Motion and RaceEvo showed better preparations of the root canal compared to other file systems and could be used as a reliable alternative to the ProTaper file systems which is considered as the gold standard in rotary endodontics.

Aim: The aim of the study was to determine the file system with best canal-centering ability (CA) and least canal transportation (CT) and which provides maximum resistance to vertical root fracture (VRF). Materials and Methods: Forty mesiobuccal roots of extracted maxillary molars were randomly divided into three experimental groups and one control group, with ten samples in each group. Group 1 samples were prepared with ProTaper file system, Group 2 samples were prepared with WaveOne single-file system, Group 3 samples were prepared with self-adjusting file (SAF) system, and Group 4 had no instrumentation. Pre- and post-instrumentation cone-beam computed tomography scans were done. CT and CA were evaluated at 3 mm, 6 mm, and 9 mm. Samples were subjected to load under Instron universal testing machine to determine VRF resistance. Data were analyzed using statistical analysis. Results: There was no statistical significance for CT, CA, and VRF resistance at all the three levels among the three groups; however, SAF system showed least CT and was more centered. Conclusion: SAFs produce less CT and more centered preparation compared to ProTaper file system and WaveOne file system.

ABSTRACTBackgroundThe complex morphology of primary root canals presents a major challenge in pediatric endodontics, making effective canal preparation crucial to treatment success. Only a limited number of instruments can achieve thorough three-dimensional canal cleaning.AimThe present in vitro, parallel-arm experimental study was designed to assess and compare canal transportation, centering ability, and volumetric changes following instrumentation with Kedo S-Plus and Baby Blue pediatric rotary file systems in primary teeth using cone-beam computed tomography (CBCT) analysis.Materials and methodsA total of 104 extracted primary molars with at least 7 mm of root length were randomly allocated into two groups: group A—Kedo S-Plus, and group B—Baby Blue rotary file systems. Pre- and postinstrumentation CBCT scans were obtained for each specimen. Data were analyzed to determine canal transportation, centering ability, and volumetric alterations in the root canal system.ResultsAt the apical third, statistically significant differences were observed between the two groups. The Kedo S-Plus system demonstrated superior centering ability and reduced canal transportation compared to the Baby Blue file system. Additionally, greater volumetric changes were associated with Baby Blue instrumentation.ConclusionThe Kedo S-Plus rotary file system was more effective in preserving the original root canal anatomy and induced fewer volumetric alterations than the Baby Blue rotary file system, suggesting its preferred use in primary root canal preparation.How to cite this articleBartakke RR, Bhattad MS, GV B, et al. Comparative analysis of Kedo S-Plus and Baby Blue Pediatric Rotary File Systems in Primary Molars for Canal Transportation, Canal Centricity, and Volumetric Changes using Cone-beam Computed Tomography. Int J Clin Pediatr Dent 2025;18(6):621–627.

AIM: The aim of the present study was to compare the canal transportation and centering ability of three rotary nickel-titanium file systems, HyFlex controlled memory, Revo-S, and Mtwo in moderately curved root canals using computed tomography (CT). MATERIALS AND METHODS: Thirty freshly extracted single-rooted teeth having curved root canals with at least 10°–20° of curvature were selected. The teeth were divided into three experimental groups of ten each. After preparation with HyFlex CM (Coltene-Whaledent, Allstetten, Switzerland), Revo-S (Micro-Mega, Besançon, France), and Mtwo (VDW, Munich, Germany) all teeth were scanned using CT to determine the root canal shape. Pre- and post-instrumentation images were obtained at three levels, 3 mm apical, 9 mm middle, and 15 mm coronal above the apical foramen were compared using CT software. Amount of transportation and centering ability were assessed. The three groups were statistically compared with analysis of variance and post-hoc Tukey’s honestly significant difference test. RESULTS: Least apical transportation and higher centering ability were seen in HyFlex CM file system in all the three sections followed by Revo-S, Mtwo file system showed maximum transportation. CONCLUSIONS: According to the present in-vitro study, we can conclude that HyFlex CM rotary file systems showed least canal transportation and highest centering ability as compared to Revo-S and Mtwo file system but there was no statistically significant difference among these file systems (p &gt; 0.05) at coronal, middle, and apical level of root canal.

Pulpal involvement, secondary to dental caries, is not uncommon and is a challenging task for pediatric dentists. Morphological differences in root canal of deciduous teeth increases the complexity of management. The aim of this study was to compare two rotary file systems and hand instrumentation for root canal preparation in regard to canal transportation, centering ability ratio, and dentin thickness using cone-beam computed tomography (CBCT). A total of 72 canals from 24 freshly extracted mandibular deciduous second molars were divided into a set of 8 teeth, then prepared using 2 rotary files systems: the Kedo-S pediatric file system (Group A) and Pro AF Baby Gold file system (Group B) were compared to hand instrumentation (Group C). CBCT scans before and after root canal preparation were used to evaluate tested parameters. Instrumentation time for all three techniques was also measured using a chronometer. Although rotary file systems have shown superior results in root canal preparation as compared to hand instrumentation, no significant differences were observed between all the groups for canal transportation and dentin thickness at all three levels of prepared canals. A comparison of centering ability ratio between all the groups was found to be statistically significant only at the cervical level. A significant difference was observed between hand instrumentation using K-files (117.3 s) and both rotary systems (Kedo-S (81 s) and Pro AF Baby Gold (81.5 s)) in terms of canal preparation time (P < 0.001). Both tested rotary systems and hand instrumentation demonstrated comparable canal preparation results, with differences that were statistically non-significant in most tested parameters, without shaping errors. However, both the rotary systems were more efficient and faster than hand instrumentation.

Current improvements in nickel-titanium (Ni-Ti) rotary file systems have created a paradigm shift in the root canal therapy of primary teeth. Therefore, it is necessary to perform a comprehensive evaluation regarding the efficiencies of newly manufactured instruments for different parameters. The current study was conducted to evaluate the abilities of RaceEvo, R-Motion, ProTaper Gold (PTG) systems in curved primary root canals with regard to the patterns of canal transportation and volumetric dentin removal by using cone-beam computed tomography (CBCT). Two experimental sets were designed following the determination of experimental groups by using pre- and post-operative CBCT data: canal transportation and volumetric dentin removal. The highest amount of canal transportation was significantly detected in the PTG group in comparison to RaceEvo and R-Motion groups. When the mean values of volumetric dentin removal data were analyzed across all groups, the PTG group again exhibited the significantly highest value of dentin removal volumetrically, compared to RaceEvo, R-Motion and manual instrumentation groups. It is possible to state that R-Motion and RaceEvo rotary systems could be used as reliable alternatives without causing adverse mechanical effects and maintaining the original root canal anatomy of curved primary root canal systems compared with PTG rotary systems and manual instrumentation, with a high diagnostic sensitivity of CBCT in pediatric endodontics when the alternative methods are not adequate.

This systematic review and meta-analysis aimed to answer the following focused question: Are rotary file systems more effective than hand file systems in terms of the quality of obturation and instrumentation time among primary teeth? The inclusion criteria comprised studies that compared the effect on quality of obturation and instrumentation time among primary teeth after using rotary and hand file systems for biomechanical preparation of the root canals. This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The searched databases included Medline (via PubMed), EBSCO, and Google Scholar. Articles published from January 2000 to December 2021, but only in English, were included. The search resulted in 8,003 published studies. After the removal of duplicate studies and full-text analysis, 9 studies were selected for systematic review, and 8 were selected for meta-analysis. Overall, the results demonstrated the promising effects of rotary file systems in reducing instrumentation time and improving obturation quality compared to hand files. Within the limitations of this review, it can be asserted that rotary file systems are superior to hand files in primary teeth for pulpectomy procedures. Rotary files, a more recent technique, are more efficient than traditional hand files in lowering the time required for instrumentation. Additionally, they provide superior obturation quality in primary molars, making them particularly beneficial for pediatric patients. Gala UP, Kalaskar R, Vinay V, et al. Comparative Evaluation of Effectiveness of Rotary and Hand File Systems in Terms of Quality of Obturation and Instrumentation Time among Primary Teeth: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Int J Clin Pediatr Dent 2024;17(8):962-969.

This study was carried out to compare canal transportation in three new rotary file systems, namely TruNatomy, ProTaper Gold, and Hyflex Electric Discharge Machining file system, using cone-beam computed tomography. The study was conducted on 105 extracted teeth consisting of 60 extracted mandibular first molars and 45 mandibular second premolars involving the mesiolingual canal of mandibular first molar and the root canal of second premolar. The teeth were randomly divided into three groups of 35 out of which each group consisted of 20 mandibular first molars and 15 mandibular second premolars. The TruNatomy rotary file was used in group I, ProTaper Gold was used in group II, and Hyflex Electric Discharge Machining was used in group III. Cone-beam computed tomography scan images were obtained both before and after instrumentation. Changes caused by preparation in the coronal, middle, and apical thirds were determined on cone-beam computed tomography scans and analyzed using the Kruskal-Wallis test at p ≤ 0.05 level of significance. TruNatomy showed least amount of canal transportation as compared with other two file systems at all the three levels of canals. ProTaper Gold showed maximum amount of canal transportation as compared with other two file systems at all the three levels of canals. The Hyflex EDM rotary file system showed transportation, which was more than the TruNatomy file system while it was less than that of ProTaper Gold. The difference was statically significant at the middle one-third level (p = 0.03) and at the coronal level (p = 0.02). The TruNatomy system has least amount of canal transportation as compared with ProTaper Gold and Hyflex EDM system. With potential to preserve tooth structure, this file has an added advantage over other rotary file systems. The TruNatomy file system has been recently introduced with good cyclic fatigue resistance. It is necessary to evaluate the root canal transportation caused by the TruNatomy file.

Background: This study compared the shaping ability of four nickel-titanium rotary file systems of varying metallurgy along curved canals. Aim: The aim of the present study is to compare the shaping ability of rotary systems of varying metallurgy in curved canals and its analysis using cone-beam computed tomography (CBCT). Materials and Methods: Forty mesiobuccal canals of mandibular first molars with an angle of curvature ranging from 20° to 40° were divided according to the instrument used in canal preparation into four groups of 10 samples each: Hyflex CM (Group I), Vortex Blue (Group II), Flexicon (Group III), and K3XF (Group IV). All samples were instrumented according to the manufacturer's guidelines and prepared to size 30, 0.06-taper master apical file. Canals were scanned and evaluated using an NNT CBCT unit before and after preparation at different levels from the apex. The data were subjected to statistical analysis. Statistical Analysis: The intergroup comparison in terms of canal transportation and the time taken for canal preparation was done by the one-way analysis of variance (ANOVA) test with Bonferroni post hoc test. The intragroup comparison in terms of canal transportation was done by the repeated measures ANOVA test with the post hoc Bonferroni test. For the canal-centering ability, the Kruskal–Wallis test with Mann–Whitney U-test was used for the intergroup comparison and the intragroup comparison was done by Friedman's test with Wilcoxon signed-rank test. Results: Hyflex CM and Vortex Blue files showed significantly least canal transportation and highest canal-centering ability values as compared to Flexicon and K3XF file systems. Conclusion: The metallurgy and file design of Hyflex CM and Vortex Blue file systems resulted in superior shaping ability, with the instruments remaining more centered in the canal than Flexicon and K3XF.

Evaluation of the shaping ability of different rotary file systems in severely and abruptly curved root canals using cone beam computed tomography

Determination of correlation between the quality of obturation and postoperative pain following root canal preparation with rotary and manual file systems in the primary molars-A comparative randomized clinical trial

The objective of the present research was to assess and compare the residual dentin thickness after biomechanical preparation of teeth using three distinct rotary nickel-titanium (Ni-Ti) file systems. In the current experimental study, a total of 45 single-rooted teeth were selected for the analysis. The cementoenamel junction of each tooth was decoronated using a diamond disc. The teeth were randomly allocated to three groups, with each group representing a different rotary file system: Group 1: Hero GOLD (Micro Mega), Group 2: One Curve (Micro Mega), and Group 3: HyFlex electro-discharge machining (EDM) (Coltene-Whaledent, Altstatten, Switzerland). To evaluate the initial condition of the teeth, cone-beam computed tomography (CBCT) scans were conducted before the biomechanical preparation. The teeth were positioned on a modeling wax sheet, and the CBCT scans provided baseline measurements. The biomechanical preparation of the root canals followed the manufacturer's recommended guidelines for each file system. After the completion of the canal preparation, follow-up CBCT scans were conducted. The postprocedure CBCT scans were then compared with the initial scans to assess any changes in the residual thickness of dentin in the teeth. Post hoc Tukey analysis of variance tests was utilized to examine differences between the groups. A statistically significant result was defined as P = 0.05 or less for every test. The comparison of preinstrumentation and postinstrumentation CBCT images showed that the HyFlex EDM group removed less dentin clinically compared to the other two groups, i.e., Hero GOLD and One Curve. No significant statistical difference was found between Hero GOLD versus One Curve, One Curve versus HyFlex EDM, and Hero GOLD versus HyFlex EDM. Based on the results of this study, the HyFlex EDM file system exhibited superior cutting efficiency at various levels. Nonetheless, additional investigations are required to comprehensively assess the influence of Ni-Ti rotary file systems on the remaining dentin thickness.

Root canal shaping is an important phase in endodontic treatment to preserve the integrity of root structures. This clinical study used cone-beam computed tomography (CBCT) to assess the shaping ability of Tornado compared to WaveOne (WO), and OneShape (OS) rotary systems. MesioBuccal canals of lower molars with curving angles ranging from 15° to 45° were used in 30 patients to evaluate the apical transportation and centering ability of Tornado, WO, and OS. The canals were divided into 3 groups according to the instrumentation system (n=10), which corresponded to the systems that were employed. Centering ratio and canal transportation were assessed at 2, 5, and 8 mm from the apical foramen using CBCT. Statistical analysis was conducted using the Kruskal-Wallis test and Mann-Whitney test at p-value = 0.05. All tested levels showed no statistically significant difference in transportation and centering ability (P>0.05). The Tornado file preserved the original canal curvature with no statistical significance compared to WO files and OS. The tornado file system was proven to provide an accepted quality of root canal shaping compared to WO and OS rotary systems. All systems maintained the original canal anatomy with appropriate centralization and no canal transportation. Key words:Canal Centering Ability, Canal Transportation, Cone-beam Computed Tomography, Nickel-Titanium Files, Tornado Rotary System.