UNIVERSIDADE ESTADUAL PAULISTA
“JÚLIO DE MESQUITA FILHO”
Instituto de Ciência e Tecnologia
Campus de São José dos Campos
ORIGINAL ARTICLE DOI: https://doi.org/10.4322/bds.2023.e3497
1
Braz Dent Sci 2023 Apr/Jun;26 (2): e3497
Comparison of obturation quality, instrumentation time and
post-operative pain using manual K-files and pediatric rotary files
in primary molars – a double blinded randomised clinical trial
Comparação da qualidade de obturação, tempo de instrumentação e dor pós-operatória usando Limas manuais K e Limas
rotativas pediátricas em molares decíduos – um estudo clínico randomizado duplo-cego
Lakshimi LAKSHMANAN
1
, Mahesh RAMAKRISHNAN
1
, Ganesh JEEVANANDAN
1
1 - Saveetha Institute of Medical and Technical Science, Saveetha Dental College, Department of Pediatric and Preventive Dentistry.
Chennai, Tamil Nadu, India.
How to cite: Lakshmanan L, Ramakrishnan M, Jeevanandan G. Comparison of obturation quality, instrumentation time and post-
operative pain using manual K-les and pediatric rotary les in primary molars – a double blinded randomised clinical trial. Braz Dent
Sci. 2023;26(2):e3497. https://doi.org/10.4322/bds.2023.e3497
ABSTRACT
Objective: to compare the quality of obturation, instrumentation time and post-operative pain after pulpectomy
in primary molars using manual K-les, Kedo-S and Kedo-S Square rotary le systems. Material and Methods:
a double blinded randomized control trial was conducted in 45 children, who were indicated for pulpectomy in
any one of the primary mandibular molars. The canal preparation was done using either hand K-les, Kedo-S
les, or Kedo-S Square les based on the groups assigned. The time taken for instrumentation was recorded using
a stopwatch. The quality of obturation was evaluated using post-operative radiograph and post-operative pain
was assessed with modied Wong-Baker Faces Pain scale. Results: instrumentation time was minimum in rotary
Kedo-S Square les (53.23 ± 9.60 seconds) followed by Kedo-S les (82.70 ± 11.86 seconds). The preparation
time was maximum with manual K-les (121.43 ± 20.18 seconds). Kedo-S square les provided a higher number
of optimally lled canals (66.4%). All the three instrumentations equally showed the tendency to produce voids
in the obturation. Rotary les Kedo-S Square followed by Kedo-S showed less post-operative pain compared to
K-les. Conclusion: the use of pediatric rotary instruments for canal preparation during pulpectomy will result
in better quality of obturation in reduced time with least post-operative pain.
KEYWORDS
Children; Hand les; Instrumentation; Pulpectomy; Rotary les.
RESUMO
Objetivo: comparar a qualidade de obturação, tempo de instrumentação e dor pós-operatória após pulpectomia
em molares decíduos usando limas manuais K, limas rotatórias Kedo-S e limas rotatórias Kedo-S Square.
Material e Métodos: um estudo clínico randomizado duplo-cego foi conduzido com 45 crianças que foram
submetidas à pulpectomia de algum molar decíduo indicado. A preparação do canal foi feita usando limas
manuais K, ou limas Kedo-S, ou ainda Limas Kedo-S Square, com base nos grupos que foram selecionados. O
tempo para a instrumentação foi registrado com um cronômetro. A qualidade de obturação foi avaliada por meio
de uma radiograa após o procedimento e a dor pós-operatória foi avaliada com a escala de dor Wong-Baker
Faces modicada. Resultados: o tempo de instrumentação foi mínimo para as limas rotatórias Kedo-S Square
(53,23 ± 9,60 segundos) seguido pelas limas Kedo-S (82,70 ± 11,86 segundos). O tempo de preparação foi maior
com as limas manuais K (121,43 ± 20,18 segundos). As limas Kedo-S Square promoveram um maior número de
canais otimamente obturados (66,4%). Todas as três instrumentações mostraram igualmente a tendência em se
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Braz Dent Sci 2023 Apr/Jun;26 (2): e3497
Lakshmanan L et al.
Comparison of obturation quality, instrumentation time and post-operative pain using manual K-files and pediatric rotary files in primary molars – a double blinded randomised clinical trial
Lakshmanan L et al.
Comparison of obturation quality, instrumentation time and post-
operative pain using manual K-files and pediatric rotary files in
primary molars – a double blinded randomised clinical trial
INTRODUCTION
Pulpectomy is the only viable option for
preserving a primary tooth with irreversible
pulpal pathosis in a symptom-free condition and
preventing it from being lost prematurely since a
natural tooth is considered to be the ideal space
maintainer [1].
The complex anatomical morphology,
dynamic alteration of canals at root apex and close
proximity of primary roots to the succedaneous
tooth bud added to difficulties in behavior
management in children, makes pediatric
endodontics a challenging task [2]. The favorable
outcome of pulpectomy is established by aseptic
canal preparation and three dimensional uid-
tight seal of the root canal system [3]. Effective
cleaning and shaping of root canals not only
facilitates the removal of infected tissue, but also
permits a pathway for the irrigants to reach the
apical third of root canals and provides space for
three-dimensional obturation [4].
A brief complication associated with
pulpectomy is the post-operative pain that
commences within a few hours or days following
treatment [5]. Post-endodontic pain debilitates
a patient’s trust in the clinician and mentality
towards endodontic treatment [6]. Post-operative
pain is considered to develop as a response to the
acute inammation caused by extrusion of dentinal
debris, microorganisms, pulpal tissue, and irrigants
into the periapical tissues during biomechanical
preparation [7]. Only limited studies have
evaluated the association of instrumentation
technique in causing post-operative pain following
pulpectomy in primary teeth [8].
Traditionally, hand instruments were
utilized for primary root canal preparation.
Though extensively used, hand instruments
resulted in iatrogenic errors such as lateral
perforation, zipping, ledge formation and
transportation during canal preparation and also
consumed more duration [9]. Rosa FM et al. [10],
have stated that the duration of appointment
is strongly associated with the behavior of
the child and reduced duration has a positive
inuence on the child’s behavior towards dental
treatment [10].
To overcome such hurdles, Barr et al. [11],
utilized nickel titanium (NiTi) rotary instrumentation
in primary root canals [11]. However, the rotary
files designed for permanent teeth resulted in
over-instrumentation when employed in relatively
thin root canals of primary teeth [12]. Further, the
longer length of adult rotary les made it difcult
to utilize in pediatric patients due to limited mouth
opening [13]. These necessitated the designing
of an exclusive pediatric rotary le system to be
utilized in children.
Kedo-S (KEDO Dental, India) is the first
generation rotary file system introduced in
pediatric endodontics with altered length, taper,
and tip diameter to accomplish pulpectomy in
an efcient and comfortable means. The Kedo-S
system consists of three NiTi files with a total
length of 16 mm and working length of 12mm
with gradual taper. The efcacy of other rotary
systems in primary teeth were compared with
Kedo-S les, considering it as a norm in pediatric
endodontics [14-16]. Latest to join the pediatric
rotary file series is the Kedo-S Square system
(KEDO Dental, India). It is a single le system for
primary molars with smaller tip diameter, variably
variable taper and dual cross-section introduced
with the notion of less root dentin preparation.
The purpose of the current study was to
compare the quality of obturation, instrumentation
time and post-operative pain after pulpectomy in
primary molars using manual K-les, Kedo-S and
Kedo-S Square rotary le systems.
MATERIAL AND METHODS
Study design
The present study was a double blinded
randomized clinical trial conducted in the
produzir vazios na obturação. As limas rotatórias Kedo-S Square seguidas pelas limas Kedo-S produziram menos
dor pós-operatória comparadas às limas manuais K. Conclusão: o uso de instrumentos rotatórios pediátricos para
a preparação do canal durante a pulpectomia resultará em melhor qualidade de obturação em tempo reduzido
e com menos dor pós-operatória.
PALAVRAS-CHAVE
Crianças; Limas manuais; Instrumentação; Pulpectomia; Limas rotatórias.
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Braz Dent Sci 2023 Apr/Jun;26 (2): e3497
Lakshmanan L et al.
Comparison of obturation quality, instrumentation time and post-operative pain using manual K-files and pediatric rotary files in primary molars – a double blinded randomised clinical trial
Lakshmanan L et al.
Comparison of obturation quality, instrumentation time and post-
operative pain using manual K-files and pediatric rotary files in
primary molars – a double blinded randomised clinical trial
Department of Paediatric and Preventive
Dentistry, Saveetha Dental College and
Hospitals, Tamil Nadu, India. Ethical approval
was acquired from the Institutional Ethical
Committee of Saveetha Institute of Medical
and Technical Sciences (SRB/SDC/PEDO-
1803/20/04) and registered the trial at clinical
trials.gov (CTRI/2021/02/031512) prior to the
commencement of the study.
Sample size calculation
Sample size was determined from a previous
study by Topçuoğlu et al. [17], using G power
analysis [17]. With 95% power, P ≤ 0.05 and
alpha error set at 5%, the minimum sample size
requirement was calculated to be 24. The total
sample size for the current study was set at
45 (15 per group) to account for the participant
dropouts during follow-up.
Study population
The target population was 4-8 years old
children visiting Saveetha Dental College &
Hospitals for pulpectomy in one of the primary
mandibular molars. Participation in the study
was voluntary. The participants’ parents were
explained about the complete study protocol and
a written informed consent was obtained prior
to the start of the study. The CONSORT criteria
for planning and reporting clinical trials were
followed throughout the investigation [Figure 1].
Inclusion criteria
● Healthy cooperative children aged between
4 and 9 years
● No intake of analgesics 12 hours prior to
treatment
Figure 1 - CONSORT flowchart describing the participant randomization and the parameters assessed during investigation.
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Braz Dent Sci 2023 Apr/Jun;26 (2): e3497
Lakshmanan L et al.
Comparison of obturation quality, instrumentation time and post-operative pain using manual K-files and pediatric rotary files in primary molars – a double blinded randomised clinical trial
Lakshmanan L et al.
Comparison of obturation quality, instrumentation time and post-
operative pain using manual K-files and pediatric rotary files in
primary molars – a double blinded randomised clinical trial
● Primary mandibular molars with signs
of chronic irreversible pulpitis and pulp
necrosis without sinus tract
● Tooth with adequate coronal structure and
minimum of 2/3
rd
root structure
Exclusion criteria
● Children with underlying systemic diseases
and requiring special health care needs
● Uncooperative children with “negative”
or “definitely negative” behavior rating
according to Frankel’s scale
● Parents/ guardians who were not willing to
participate and those who refused to sign
the informed consent
● Teeth with signs of internal / pathological
resorption
● Teeth which were unrestorable
Randomization and allocation concealment
The participants were equally distributed
and randomly assigned into three groups.
Randomization was performed according to
a computer generated sequence of random
numbers using Random Allocation Software
(Version 1.0). The sequence was numbered in
advance and was sealed in opaque envelopes to
ensure sufcient concealment.
Clinical procedure
Single visit pulpectomy was performed
in all the included teeth by a single pediatric
dentist, who could not be blinded. Topical
anesthetic agent (Precaine B, Pascal International,
USA) was applied, and inferior alveolar nerve
block was administered with local anesthetic
solution containing 2% lignocaine with
1:2,00,000 adrenaline (LOX* 2% ADRENALINE,
Neon Laboratories limited, India) using 2ml
syringe with 25 gauge needle (UNOLOCK single
use syringe, Hindustan Ltd., Chennai, India).
Rubber dam isolation (GDC Marketing, India) was
done after conrming the subjective and objective
signs of local anesthesia. The caries removal
and access opening was done using No.4 round
carbide bur in a high-speed handpiece. Roof
of the access cavity was removed using a safe
ended diamond tapered ssure bur. Coronal pulp
amputation was done with a spoon excavator.
No.15 size conventional K-le (Mani, Inc., Japan)
was used to determine the patency of all the
canals and working length was determined using
Ingle’s radiographic method.
Biomechanical preparation was carried out
based on the groups assigned:
Group I: The canals were prepared using
manual K-les (Mani, Inc., Japan) till No.30 size
le in quarter turn pull technique.
Group II: The root canals were instrumented
using Kedo-S file system (KEDO Dental, India)
according to the manufacturer’s instructions.
The mesial canals were instrumented using the
D1 le in a lateral brushing motion. The distal canals
were instrumented by D1 le followed by E1 le.
Group III: The canals were prepared using
the single file system Kedo-S Square (KEDO
Dental, India) in brushing motion.
All the rotary les were used with an X-Smart
endodontic motor (Dentsply Maillefer, OK, USA) at
250 rpm and 2.4 N/cm torque till the determined
working length. 17% EDTA (Endo Prep RC) was
utilized for lubrication during instrumentation
and intermittent irrigation was carried out
manually using normal saline (Fresenius Kabi
India Pvt. Ltd., India). After drying, the canals
were obturated with Metapex (Meta Biomed Co.,
Ltd., Korea). Following which, the access cavity
was sealed with type II glass ionomer cement (GC,
India). In the same appointment, the teeth were
restored with preformed stainless steel crowns
(3M ESPE, Germany).
Assessment of instrumentation time
The instrumentation time was recorded
in seconds using a digital stopwatch by an
investigator who was blinded to the study groups.
The recorded instrumentation time included only
the total instrumentation time of the used les
excluding the in-between irrigation protocol for
assessing the accurate time period needed for
instrumentation in each group.
Assessment of quality of obturation
The quality of obturation was assessed using
immediate post-operative radiographs based on
the criteria laid down by Coll and Sadrian [18]
as underlled, optimal lled or overlled [18]
Evaluation of voids was based on their presence/
absence in root canals. The quality of obturation
and evaluation of voids was assessed by a single
5
Braz Dent Sci 2023 Apr/Jun;26 (2): e3497
Lakshmanan L et al.
Comparison of obturation quality, instrumentation time and post-operative pain using manual K-files and pediatric rotary files in primary molars – a double blinded randomised clinical trial
Lakshmanan L et al.
Comparison of obturation quality, instrumentation time and post-
operative pain using manual K-files and pediatric rotary files in
primary molars – a double blinded randomised clinical trial
investigator who was blinded to the study groups.
The radiographs were examined three times with
a time interval of approximately 4 weeks. In case
of any discrepancy, that particular sample was
excluded from the study.
Assessment of post-operative pain
The post-operative pain was recorded using
Modied Wong-Baker Pain Rating Scale as utilized
by Topçuoğlu et al. [17]. This 4-point scale measures
pain as: (1) zero—no pain, (2) one—slight pain,
(3) two—moderate pain, (4) three—severe
pain [Figure 2]. All participants and their parents
who were blinded to the treatment protocol, were
instructed on how to use this pain scale, and were
advised to record the pain status every 6, 12, 24, 48,
72 hours and after a week. These data were veried
by the observer through telephonic communication
with the parents/ guardians.
Statistical analysis
The collected data were tabulated and
analyzed using SPSS software version 23.0 (SPSS
Inc., Chicago, IL, USA) with statistical signicance
set at p≤0.05. The instrumentation time between
the three groups were compared using ANOVA
test followed by Tukey post-hoc analysis to list out
the signicant groups. Chi square test was used
to assess the quality of root canal lling in the
primary molars. Non-parametric tests were used
to compare the intensity of pain and duration
of post-operative pain for the 3 groups at each
time interval.
RESULTS
General characteristics
A total of 45 children, comprising 23 males
and 22 females, participated in the study. The mean
ages of the participants were 5.3 ± 1.3 years in the
K-le group, 5.2 ± 1.3 years in the Kedo-S group
and 5.9 ± 1.3 years in the Kedo-S Square group.
Of the 45 included primary teeth, 19 (42.2%)
were mandibular 1
st
molars and 26 (57.8%)
were mandibular 2
nd
molars. Comparative
analyses using Chi square test reected an equal
distribution of participants between the three
groups with respect to age (P=0.215), gender
(P=0.315) and teeth (P=0.260) was observed
between the groups eliminating selection.
Instrumentation time
Time taken for canal preparation was recorded
and intergroup comparison was performed using
ANOVA test followed by Tukey post-hoc test.
Preparation with Kedo-S Square les consumed
least time (Mean= 53.2 seconds) followed by
Kedo-S files (Mean= 82.7 seconds). Whereas
preparation time was maximum with hand
K-les (Mean= 121.4 seconds). The results were
statistically highly signicant (P<0.05) [Table I].
Quality of obturation
66.6% (n=10) of teeth instrumented with
rotary Kedo-S Square les, 33.3% (n=5) of teeth
instrumented with Kedo-S les, 33.3% (n=5) of
teeth instrumented with hand K-les had optimal
lling [Figure 3] [Figure 4] . The results were not
statistically signicant (P=0.18).
Voids
Voids in the root canal after obturation
with metapex were present in all the three
experimental groups. In both Kedo-S square les
Figure 2 - Modified Wong-Baker pain rating scale.
Table I - Comparison of instrumentation time (in seconds) among
the groups
Treatment groups Sample size
Mean ± Standard
deviation (Seconds)
P value
K-file 15 121.4 ± 20.1
0.0001*Kedo-S file 15 82.7 ± 11.8
Kedo-S Square file 15 53.2 ± 9.6
*P<0.05, statistically highly significant (ANOVA test).
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Braz Dent Sci 2023 Apr/Jun;26 (2): e3497
Lakshmanan L et al.
Comparison of obturation quality, instrumentation time and post-operative pain using manual K-files and pediatric rotary files in primary molars – a double blinded randomised clinical trial
Lakshmanan L et al.
Comparison of obturation quality, instrumentation time and post-
operative pain using manual K-files and pediatric rotary files in
primary molars – a double blinded randomised clinical trial
and K-les, voids (20%; 3 of 15 teeth) were noted
in the middle third of root canals. In Kedo-S les,
6% voids (1 of 15 teeth) were in the apical third
of root canals and 13% (2 of 15 teeth) were in
the middle third of root canals. The results were
not statistically signicant (P=0.58).
Post-operative pain
At 6-hour, the intensity of pain experienced
by participants in the hand K-file group was
significantly higher than those in the rotary
Kedo-S and Kedo-S Square group (P=0.02).
At 12 and 24-hour intervals, there was no
signicant difference in the post-operative pain
between the three groups (P>0.05). None of the
participants in all the groups experienced any
pain at 48, 72 hours and 1-week intervals. In all
the three groups, the highest post-operative pain
scores were recorded at a 6-hour interval and
decreased over time [Figure 5].
DISCUSSION
Pulpectomy is the recommended means of
treating symptomatic primary teeth, and it is
statistically more effective than extraction [18].
The quality of mechanical debridement and
obturation determines the effectiveness of an
endodontic treatment [19]. In the published
literature, both in-vitro and in-vivo studies
using Ni–Ti files designed for permanent
teeth had investigated the multiple facets of
instrumentation technique such as cleaning
effectiveness, instrumentation time, obturation
quality, and association with post-operative pain
in primary teeth [20,21].
The use of rotary files in paediatric
endodontics was heralded by the introduction of
rotary Kedo-S les. The rst explicitly developed
paediatric rotary les, Kedo-S, were implemented
to address the limitations of using permanent
teeth rotary les, as well as to provide faster and
more efcient outcomes in primary teeth. The 4th
generation Kedo-S Square le with single le
system for molars is one such development in the
paediatric endodontics.
Figure 3 - Assessment of quality of obturation.
Figure 5 - Comparison of post-operative pain experienced by the
participants at different time intervals.
Figure 4 - Comparison of quality of obturation with three different
instrumentations.
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Braz Dent Sci 2023 Apr/Jun;26 (2): e3497
Lakshmanan L et al.
Comparison of obturation quality, instrumentation time and post-operative pain using manual K-files and pediatric rotary files in primary molars – a double blinded randomised clinical trial
Lakshmanan L et al.
Comparison of obturation quality, instrumentation time and post-
operative pain using manual K-files and pediatric rotary files in
primary molars – a double blinded randomised clinical trial
In the present study, only primary mandibular
molars were included to maintain uniformity and
for convenience. Children aged between 4 and
8 years were included, and the study population
was evenly distributed among the three groups
with respect to age. In addition, there was an
equal distribution of the teeth and participants
with respect to gender, minimizing the risk of
selection bias. Children who took analgesics
12 hours before treatment were excluded from
the study due to the possibility of bias in the
assessment of post-operative pain.
Mandroli and Baruka found no statistically
signicant difference in clinical and radiographic
success rates between single and multi-visit
pulpectomy in primary teeth with apical
periodontitis after 6 months of follow-up [22].
Furthermore, the single visit pulpectomy technique
saves time, decreases treatment costs, and reduces
child anxiety by obviating the need for a second
visit with an added anesthetic injection, rubber
dam placement. Hence, single visit pulpectomy
was preferred in the present study.
All the pulpectomy procedures were
performed by a single operator, thereby
eliminating the operative bias in the study.
The rotary instruments were operated based on
manufacturer’s recommendation. In the Kedo-S
le group, mesial canals were instrumented with
D1 les and distal canals were instrumented with
D1 followed by E1 les in lateral brushing motion.
Whereas in the Kedo-S Square file group, the
single le was used in brushing motion in both
mesial and distal canals. In hand K-le group,
instrumentation was carried out till no.30 size le
as recommended by Kennedy et al. [23].
In paediatric dentistry, the length of
treatment plays an important role in assessing
the effectiveness of the procedure, as a shorter
treatment time reduces children’s anxiety, resulting
in more positive behavior. The probable reason
for the shorter instrumentation time with Kedo-S
Square rotary system in current study is that each
canal is prepared with only one le, while hand
instrumentation involves sequential preparation
with 15 to 30 size les in each canal, and Kedo-S
le uses two les for canal preparation. This is
consistent with the results from previous clinical
trials utilizing various rotary systems [24-26].
The radiographic evaluation of the obturation
is the most conservative of these approaches in
terms of in-vivo studies. This is accomplished using
both traditional and digital imaging techniques.
Despite their two-dimensional nature, radiographs
are reliable for voids smaller than 300µm [27].
Based on the present study, the increased efciency
of Kedo-S Square les in canal preparation over
its earlier predecessor Kedo-S can be attributed to
the additional titanium oxide coat that increases
the flexibility of the file to negotiate even the
narrowest canal in primary teeth allowing easier
ow of obturating material. Coll and Sadrian [18]
found that teeth lled up to the apex had a higher
success rate than teeth that were underlled or
overlled [18]. Whereas Bawazir and Salama [28]
found that canals that were optimally lled and
overlled performed better than canals that were
underfilled [28]. The present study findings
were similar to that of Govindaraju et al. [29],
and Ochoa-Romero et al. [20], where overling
was commonly encountered with Kedo-S les,
and underfilling were found in manual files
group [20,29]. In this study, voids were found in
all the three groups. This matches the ndings of
previous research [28,30]. The form, consistency,
and viscosity of the obturation material, the
technique used to deliver the material, and the
operator’s expertise and experience all play a role
in the position and size of voids [31,32].
Pain assessment is critical for assessing the
level of discomfort and reaction to any treatment.
Pain is a subjective phenomenon with numerous
mitigating variables that are difcult to monitor in
an in vivo condition. Modied Wong Baker FACES
pain scale was chosen for the analysis because it was
stated to be more sensitive and easier to understand
by participants than other pain scales [33,34].
The study results indicated that the signicant post-
operative pain occurred 6 hours after pulpectomy in
all the three groups, and that pain scores decreased
over time. Comparatively, the pain score was least
with the rotary groups than hand K-les. This is
consistent with previous research that focused
on the frequency and intensity of post-operative
pain at various time intervals [14,33]. It is well
recognized that apically extruded debris is one
factor that leads to postoperative pain and swelling
following pulpectomy. Using manual files and
three different rotary les, Topçuoğlu et al. [33],
determined the amount of debris extruded during
root canal preparation in primary molars and found
that manual les extruded more debris than rotary
les [33]. When compared to other preparation
techniques, the crown-down technique used with
NiTi rotary systems during canal preparation
8
Braz Dent Sci 2023 Apr/Jun;26 (2): e3497
Lakshmanan L et al.
Comparison of obturation quality, instrumentation time and post-operative pain using manual K-files and pediatric rotary files in primary molars – a double blinded randomised clinical trial
Lakshmanan L et al.
Comparison of obturation quality, instrumentation time and post-
operative pain using manual K-files and pediatric rotary files in
primary molars – a double blinded randomised clinical trial
has been shown to be associated with less debris
extrusion. As a result, it is conceivable that early
pre-aring is related to less debris extrusion and
postoperative pain [35,36]. Furthermore, K-les
are instrumented in ling motion that moves the
debris apically, and it has a taper of 0.02, which
provides less space for the debris to be ushed
coronally [37].
The limited sample size and use of a two-
dimensional imaging tool to assess obturation
quality cannot specify the precise size and number
of voids, which may be the possible drawbacks of
the current research. Further research evaluating
the shaping ability of each le system, as well as
long-term clinical and radiographic success should
be performed to establish denitive conclusions.
CONCLUSION
The results of the present study draw to the
following conclusions:
● Instrumentation time using Kedo-S Square
les was least compared to Kedo-S les and
manual K-les.
● Kedo-S Square les provided better quality of
obturation with a higher number of optimal
obturation.
● Root canal preparation with the rotary le
system resulted in less intense post-operative
pain when compared to the hand le system.
● The use of pediatric rotary instruments
for canal preparation during pulpectomy
will result in better quality of obturation in
reduced time with least post-operative pain.
Author’s Contributions
LL, MR, GJ: Conception. LL: Methodology.
LL: Data Acquisition and Interpretation. MR, GJ:
Design. LL: Writing – Original Draft Preparation.
LL, MR, GJ: Writing – Review.
Conict of Interest
No conicts of interest declared concerning
the publication of this article.
Funding
The authors declare that no nancial support
was received.
Regulatory Statement
This study was conducted in accordance with
all the provisions of the local human subjects
oversight committee guidelines and policies
of: Institutional Ethical Committee of Saveetha
Institute of Medical and Technical Sciences. The
approval code for this study is: (SRB/SDC/PEDO-
1803/20/04). Clinical Trial Registration No.:
CTRI/2021/02/031512; Clinical Trial Registry
- India (CTRI).
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Mahesh Ramakrishnan
(Corresponding address)
Saveetha Institute of Medical and Technical Science, Saveetha Dental College,
Department of Pediatric and Preventive Dentistry, Chennai, Tamil Nadu, India.
Email: maheshpedo@gmail.com
Date submitted: 2022 Apr 28
Accept submission: 2022 Nov 14
