A systematic review and meta‐analysis of randomized clinical trials comparing rotary canal instrumentation techniques with manual instrumentation techniques in primary teeth

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Abstract
Background: Use of rotary instruments in the root canals of permanent teeth is well known; however, there are no evidence‐based recommendations on the effectiveness of rotary canal instrumentation techniques over manual instrumentation techniques during root canal treatment in primary teeth.Aim: To appraise the current literature on the effectiveness of rotary canal preparation techniques compared to manual techniques during root canal treatment in primary teeth.Data sources: MEDLINE, Embase, Cochrane Library, Scopus, PubMed and Web of Science (1 January 1991 to 3 January 2019).Study eligibility criteria, participants and interventions: Population: Children with primary teeth; Intervention: Rotary canal instrumentation; Control: Manual canal instrumentation; Outcomes: Success rates (clinical and/or radiographic), quality of root filling, instrumentation and root filling time, postoperative pain, cleaning effectiveness.Study appraisal and synthesis methods: Cochrane risk of bias tool 2.0 was used to ascertain the validity across five domains. Risk ratio (RR) for dichotomous variables and weighted mean difference for continuous variables were used as summary measures. The GRADE approach was used to assess the certainty of evidence using GRADE‐pro software.Results: A total of 13 trials were selected of 2471 records after screening of the databases. The RR of clinical success in rotary versus manual canal preparation technique was 1.01 (95% CI: 0.91–1.12; P = 0.913) at 6 months. The RR of radiographic success in rotary versus manual techniques was 0.97 (95% CI: 0.74–1.27; P = 0.805) at 6 months. The quality of root filling was not significantly different between the two groups (P = 0.062). The weighted mean difference of instrumentation time and canal filling time was significantly less with rotary techniques (P < 0.001); however, postoperative pain was non‐significant across both techniques at 12, 24 and 72 h but significantly less with rotary techniques at 6 h (P < 0.001) and 48 h (P = 0.023).Limitations: Inclusion of only English literature.Conclusions and implications of key findings: Rotary canal instrumentation had a similar clinical and radiographic success rate, less postoperative pain (at 6 and 48 h), and took less instrumentation time compared to manual instrumentation techniques (moderate level of evidence).

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