Clinical effectiveness of pediatric rotary instrumentation systems in pulpectomy of primary teeth: A systematic review

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Highlights

Pediatric rotary instrumentation may reduce chairside time and improve clinical efficiency during pulpectomy of primary teeth.

Rotary systems generally demonstrated favorable outcomes regarding postoperative pain, instrumentation time, and obturation quality.

Further well-designed multicenter studies are needed to establish evidence-based recommendations for pediatric rotary instrumentation.

Abstract

The aim of this systematic review was to compare the efficiency of pediatric rotary systems used in the pulpectomy of primary teeth. The research protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). An electronic search was conducted across four databases: PubMed via MEDLINE, the Cochrane Central Register of Controlled Trials, ScienceDirect, and the Wiley Online Library using search equations formulated through combinations of keywords and Boolean operators. Reference management was performed using Zotero. Of the 128 records initially identified, 30 studies met the inclusion criteria. An additional 21 studies were included through manual searching of the reference lists of the selected articles. Consequently, a total of 51 studies were included in the present systematic review. The quality assessment was performed using the RoB 2 tool, and the overall risk of bias was judged to be low. The latest generations of the Kedo-S pediatric rotary systems, namely Kedo-S Plus, Kedo-S Square, and Kedo-SG Blue, were the most frequently investigated systems and generally demonstrated favorable outcomes, including reduced postoperative pain and bacterial load, shorter chairside time, improved obturation quality, and higher clinical success rates. WaveOne Gold and XP-Endo Shaper systems also showed promising efficiency; however, evidence regarding their performance remains limited. Comparisons of rotary techniques suggested that reciprocating motion may be associated with reduced chairside time and enhanced obturation quality. Nevertheless, heterogeneity among studies, inconsistent evaluation methods, and the predominance of studies conducted in India may limit the generalizability of the findings. In addition, important in vitro pulpectomy parameters, such as canal trajectory preservation and debris extrusion, were not assessed. Therefore, further well-designed multicenter clinical and in vitro studies comparing multiple pediatric rotary systems are required to establish definitive clinical recommendations.

Keywords: Dental Pulp Cavity; Endodontics; Obturation; Pain, Postoperative; Pulpectomy; Root Canal Preparation; Tooth, Deciduous

Author Affiliations

  1. Department of Pediatric and Preventive Dentistry, Faculty of Dental Medicine of Monastir, Tunisia
    Laboratory of Biological Clinical and Dento-Facial Approach (ABCDF Laboratory LR12ES10), University of Monastir, Tunisia (Correspondence:fatenballoumikhedher@gmail.com)

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Article Info

Contemp Pediatr Dent 2026:7(1):37-77

Received: 26 August 2025

Accepted: 24 March 2026

Online First: 22 April 2026

DOI: 10.51463/cpd.2025.49

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					Faten Balloumi. Clinical effectiveness of pediatric rotary instrumentation systems in pulpectomy of primary teeth: A systematic review. Contemp Pediatr Dent 2026:7(1):37-77

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