Endodontics in primary teeth can be challenging and time consuming, specially during canal preparation which is considered as one of the most important steps in root canal therapy. Root canal instrumentation is performed with files, reamers, Sonic instruments or mechanical apparatus and more recently with Rotary instruments

1. Rotary endodontics in
Paediatric dentistry

2. Introduction
• Endodontics in primary teeth can be challenging and time consuming, specially during
canal preparation which is considered as one of the most important steps in root canal
therapy.
• Root canal instrumentation is performed with files, reamers, Sonic instruments or
mechanical apparatus and more recently with Rotary instruments

3. Rotary endodontics was introduced in pediatric
dentistry in the year 2000 by Barr.
Barr, E.S., Kleier, D.J., Barr, N.V., 2000. Use of nickel-
titanium rotary files for root canal preparation in
primary teeth. Pediatr. Dent.2000; 22: 77–78.

4. Evolution of Rotary files

5. Ideal requisites of pediatric rotary files
• It should be flexible to maintain the canal centricity.
• Effective debridement of the root canal without
weakening the tooth structure or endangering the
underlining permanent teeth.
• Optium length for preparation of canals.

6. Why Rotary in pediatric
dentistry?

7. • Better cleaning efficiency
• Preservation of original
canal anatomy
• Continuously tapering uniform
preparation
• Reduced apical transportation

8. Better cleaning efficiency
• Esentürk G, Akkas E, Cubukcu E, Nagas E, Uyanik O, Cehreli ZC. A micro-computed tomographic
assessment of root canal preparation with conventional and different rotary files in primary teeth and
young permanent teeth. Int J Paediatr Dent. 2020;30:202–208.

9. Preservation of
original canal anatomy
Musale PK, Jain KR, Kothare SS. Comparative assessment of dentin removal
following hand and rotary instrumentation in primary molars using cone-beam
computed tomography. J Indian Soc Pedod Prev Dent 2019;37:80-6

10. Continuously tapering uniform preparation
Musale PK, Mujawar SA. Evaluation of the efficacy of rotary vs. hand files in root canal
preparation of primary teeth in vitro using CBCT. Eur Arch Paediatr Dent. 2014

11. Reduced apical transportation
Ahmed HM. Anatomical challenges, electronic working length
determination and current developments in root canal preparation of
primary molar teeth. International endodontic journal. 2013

12. • Reduced working time
• Less operatory fatigue
• Better child Corporation
• parental satisfaction
• more productivity

13. Armamentarium for Rotary
endodontics

14. GENERATIONS OF MOTORS
a) First generation motor without torque control.
b) Second generation motor with torque limiter.
c) Third generation motor with simple torque control.
d) Forth generation motor with apex locator and torque control.

15. Rotary files
permanent teeth Rotary files 21 mm or 25 mm

16. Paediatric Rotary files 16 mm or 17 mm

17. Pro AF Baby Files
• 17mm files
• Heat treated
• 4% - 6% tapper

19. Kedo S / SG / SG Blue

20. GUIDELINES FOR USE:
• Establish straight-line access
• Use #10 hand files to assess the patency of the canal
• Use #15 hand files for initial enlargement before the use of
rotary files
• Use root canal lubricant during instrumentation
• Clean flutes frequently and inspect for signs of distortion
• Use instruments with recommended motion, RPM and Torque

22. Kedo Rotary files using tips
Use
Use the files only in torque controlled endodontic
motor with 300 RPM, 2-2.4 torque.
Irrigate
Always irrigate the canal before engaging a file and
use the files ‘in and out’ action (not brushing).
Withdraw
Withdraw the files once the working length is
reached.
Clean
Clean the files after each use and check for
distortion.
Avoid
Avoid forceful preparation during instrumentation
by applying excess pressure on the files.

23. PrimePedo Files
• Developed in 2016, avaliable in India since 2017
• 3 file system
• Starter – 16mm / 8% taper
• P1 – 18mm / 6% taper
• P2 – 18mm / 6% taper
• Precurvability inspite being NiTi
• Optimal file length for pediatric use
• Specifications
• Speed – 250 – 400 RPM
• Torque – 2.0 - 4.0

25. Pedoflex

28. Irrigation protocol
PRIMARY TEETH
• 1% NaOCl irrigant of choice drop by drop during
shaping
• CITRIC ACID 6% solution should be used for 1 minute
• Final rinse with 2% CHX

29. Failure in Rotary
Endodontics

30. File seperation
• File separation is rare in primary teeth due to
softer radicular dentin and wider canals
• inherently thinner radicular dental necessitates
use of noninvasive or minimally invasive
techniques for removal of instrument
• use of enhanced vision is mandatory

31. Golden rules to avoid separation
Assess case difficulty
Adequate coronal
access
correct glidepath
preparation
follow
manufacturer's
instructions
copious irrigation
never work in dry
canals
inspect Rotary files
each time before
inserting
do not reuse more
than three times

32. Management of separated
files
Options- obturate/ bypass/ retrieve/ extract

33. Factors influencing re treatment
Pulp vitality status Root canal anatomy
Position and type
separated instrument
The amount of damage
that would be caused
to the remaining tooth
structure during
retrieval
Always consider
retrieval with minimally
invasive techniques like
steiglitz forceps or
indirect ultrasonics

34. steiglitz forceps

35. Cleaning of rotary
instruments

36. The protocol comprises of
vigorous strokes in sponge soaked in 0.2%
Chlorhexidine solution. Around 30 minutes pre soak in
are enzymatic cleaning solution
15 minutes of ultrasonication in the same solution
around 20 seconds rinse in running tap water.

37. Advances in
Rotary endodontics

38. Reciprocating files: wave
one
• Single file system with sophisticated endo motor
• file rotates in clockwise and counterclockwise direction which
avoids locking of the instrument inside the root canal
• Clockwise: file cuts dental and advances in the canal
• Counterclockwise: file descended this from the dented
• Advantages: reduction in the working time, prevention of cross
contamination and improved safety of the shaping procedure

39. Reference