Original Article

In Vitro Comparison of Instrumentation Time and Cleaning

Capacity between Rotary and Manual Preparation Techniques in Primary Anterior Teeth
Z. Bahrololoomi 1~, M. Tabrizizadeh 2, L. Salmani 3
1

Assistant Professor, Department of Pediatric Dentistry, School of Dentistry, Yazd University of Medical Sciences, Yazd , Iran
Assistant Professor, Department of Endodontics, School of Dentistry, Yazd University of Medical Sciences, Yazd , Iran
3
Dentist, Private Practice
2

Abstract:

Corresponding author:
Z. Bahrololoomi, Department
of Pediatrics Dentistry, School
of Dentistry, Yazd University
of Medical Sciences, Yazd,
Iran.
zbahrololoom@yahoo.com
Received: 14 July 2006
Accepted: 15 November 2006

Objective: The aim of this study was to evaluate and compare the cleaning ability and
instrumentation time of manual and rotary methods used for preparation of primary anterior teeth.
Materials and Methods: Forty-four primary anterior teeth were used in this experimental study. Access cavities were prepared and India ink was injected into the canals.
The samples were divided into three groups according to the instrument and preparation
technique. In group I the root canals were manually instrumented with K-files. Rotary
Flexmaster instruments were used for canal preparation in Group II, and the samples in
Group III (control) were not instrumented. After canal preparation, the teeth were
cleared with methyl salicilate and the removal of India ink was measured in the cervical,
middle and apical thirds. The incidence of file breakage and instrumentation time was
recorded in the three study groups. Statistical analysis was performed using MannWhitney and t-tests.
Results: There was no significant difference in cleaning capacity between the two techniques, but a significant difference was found between the experimental and control
groups. Working time was significantly shorter when using the rotary system. No file
fracture was observed during the study period.
Conclusion: Regarding the shorter working time for rotary instrumentation and the
similar cleaning ability of the two techniques, the application of the rotary system is
suggested for preparation of decidious root canals during pulpectomy.
Key Words: Root Canal Therapy; Tooth, Deciduous; Root Canal Preparation
Journal of Dentistry, Tehran University of Medical Sciences, Tehran, Iran (2007; Vol: 4, No.2)

INTRODUCTION
Endodontic treatment in primary teeth can be
challenging and time consuming, especially
during canal preparation which is considered
as one of the most important steps in root canal therapy [1]. Considering that rotary files
are more convenient to use and can facilitate
root canal treatment, their application may be
more appropriate in children with behavior
management problems [2,3].
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Manual and rotary instruments fabricated from

nickel-titanium (Ni-Ti) have been developed
and are known to improve the quality of the
final preparation [2,3].
Several investigators have reported the advantage of preparation with rotary Ni-Ti instruments over the manual method, for both experienced and inexperienced operators [4].
Since the early 1990s, different systems have
used Ni-Ti in endodontic instruments with
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various designs. Engine-driven rotary Ni-Ti

instruments have been suggested to offer safe
preparation of root canals and decrease the
working-time.
Flexmaster (VDW, Germany) rotary instruments have a modified cross sectional design
which is more similar to K-files. This is in
contrast to most rotary instruments that demonstrate a U-shape configuration. Rotary
Flexmaster instruments are claimed to cut dentin more effectively and may therefore decrease stress on the individual instruments.
Rotary instrumentation in permanent teeth has
proven to be efficient and provides reduced
working time, greater comfort for the patient
and lower risk of flare-ups. The introduction of
the rotary system with Ni-Ti files for preparation of primary teeth is recent, and so far there
are few studies on the efficiency of these instruments in deciduous teeth [4-9].
Mechanical preparation of primary teeth utilizing Ni-Ti rotary files was first described by
Barr et al [10]. The same principles of cleaning and shaping root canals of permanent teeth
should be applied to deciduous teeth. Curvatures and irregularities of the root canal walls
of primary teeth can be cleaned efficiently
with Ni-Ti instruments using clock-wise rotation resulting in removal of pulp tissue, dentin
and necrotic residues from the canals, similar
to manual filing [11,12].
The purpose of the present study was to compare the cleaning ability and instrumentation
time of rotary and manual instrumentation
methods in the preparation of primary anterior
teeth.
MATERIALS AND METHODS
Forty-four extracted anterior primary teeth
with intact roots and without internal/external
resorption were chosen for this investigation.
All specimens were radiographically evaluated
and stored in 0.5% sodium hypochlorite for 1
week. Coronal access was made with #08 diamond fissure burs (Tiscavan, Iran).

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Bahrololoomi et al.

After irrigation with saline, canal lengths were

determined at 1mm from the apex using Kfiles (Mani, Japan) with compatible diameters.
A #15 file was introduced into the root canal
on a vibrator and India ink was injected with a
30 gauge insulin syringe. The teeth were then
divided into 3 groups according to the instruments and preparation methods. In group I
(N=20), the root canals were instrumented
manually with K-files up to a # 40 and stepped
back to a # 55 file. Similar to Sonntag et al [4],
preparation of the 20 specimens in Group II
was performed with 25-mm-long flexmaster
Ni-Ti rotary files (VDW, Germany) driven by
an Endo IT control (VDW, Germany) very low
torque-controlled low speed motor adapted to
individual instruments using a modified crown
down technique with 35/0.06, 35/0.04, 30/0.06
and 40/0.02 tapers. Shaping was completed
with a gentle advance-and-withdraw motion.
Instruments were removed when resistance
was felt and changed for the next instrument.
Group III (control group) consisted of 4 samples and the root canals were not instrumented.
All root canals in groups I and II were prepared by the same operator who was an undergraduate student.
Normal saline (1.8 ml) was used for irrigation
and instrumentation time was measured by a
chronometer during both techniques. The duration of irrigation and file exchange was not
calculated. Therefore the active instrumentation time was recorded and the time consumed
for changing the sequence of the instruments
and irrigation was disregarded. In this manner
the results would actually reflect the quality of
canal preparation and the effect of operator
experience would be minimal.
The specimens were cleaned and placed separately in 7% chloridric acid for 2 days. The
acid solution was renewed every 24 hours, until the teeth were completely decalcified. All
samples were washed under running water for
8 hours and immersed in 70% alcohol for 16
hours (changed after 8 hours) followed by

2007; Vol. 4, No. 2

Bahrololoomi et al.

Comparison of Rotary and Manual Instrumentation Technique

80% alcohol for 8 hours, 90% alcohol for 8

hours and 100% alcohol for 24 hours (changed
every 8 hours).
After dehydration, the teeth were cleared in
methyl salicylate and India-ink was examined
in the cervical, middle, and apical thirds, by
two observers with a stereomicroscope (6
magnification, Nikon, Japan). A 4-point scoring scale was devised as follows: (0) total
clearing, the canal was completely clean and
without ink; (1) almost complete ink removal,
there were dots of ink in some areas of the canal; (2) partial ink removal, linear regions of
ink were observable in some areas of the canal; (3) no ink removal.
Statistical analysis was performed using Mann
Whitney and t-tests.
RESULTS
There was no significant difference (P>0.05)
among the cervical, middle and apical root
thirds after manual (group I) and rotary instrumentation (group II).
The mean (SD) time spent for instrumentation
was 100.95 S (31. 59) and 150.25 S (47.09) in
the rotary and manual methods, respectively
(P=0.0001). None of the files fractured during
the study period.
DISCUSSION
One of the most important objectives of endodontic treatment is the elimination of microorganisms from the root canal system which is
achieved through removal of vital tissues, residual necrotic material, infected dentin and
debris. In the current study, the cleaning efficacy of two instrumentation methods was examined in the coronal, middle and apical portions of the root canals, by means of microscopic evaluation.
We did not observe a significant difference in
cleaning capacity between the two instrumentation techniques, which was in agreement
with the results obtained by Silva et al [12]
and Barr et al [10]. File fracture did not occur

2007; Vol. 4, No. 2

in the present study, which may be due to the

use of Endo IT control motor (AEU, 25VDW,
USA). The unique feature of this device is
precise control of the speed and torque of individual files. It also provides reverse motion in
cases that a file becomes engaged in the canal
wall and thus protects it from fracture. The use
of such motors seems to offer the advantage of
reducing breakage and increasing working
safety [13]. Our results indicated a significantly shorter working time for the rotary system as compared to the manual technique.
Considering that preparation time is an important clinical factor in patient management, the
use of rotary instruments for pulpectomy of
primary teeth is recommended.
The experience of the operator and number of
instruments could be responsible for the various results reported by different investigators
[14]. The present study disregarded the time of
instrument exchange, thus the effect of operator experience was minimized. On the other
hand, rotary instrumentation in primary teeth
has several disadvantages such as higher cost
of Ni-Ti instruments and possibility of file
fracture. However, using the Endo IT control
system can help regulate the torque and speed
of the files, leading to a significant decrease in
fracture rate.
CONCLUSION
According to the findings obtained in the current study, root canals of anterior primary teeth
could be prepared effectively with rotary instruments. The cleaning ability of both techniques was similar, but working time was significantly shorter for the rotary instrumentation method. Further investigation should be
conducted to evaluate the effectiveness of rotary instruments in primary teeth.
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