Comparison of disinfection effectiveness through manual instrumentation, rotary system and photodynamic therapy in primary molars: An in vitro study

Cesar Augusto Perini Rosas1image, José Carlos Pettorossi Imparato2image, Kelly Maria Silva Moreira3image, Samuel Nogueira Lima4image, Irís Nogueira Bincelli Seckler5image, Jonathan Sousa Amorim6image, Victor Cavallaro Bottesini7image, Danilo Antônio Duarte8image 


This study would help the pediatric dentists in clinical decision-making regarding the type of instrumentation for treating the root canals of primary teeth.

This study showed a bacterial reduction in all studied groups compared to the control group.

The application of these protocols reveals the novelty of the research, reducing the knowledge gap on the subject.


Aim: Due to the particular anatomy of primary teeth, improvements in the materials and protocols used for disinfecting and modelling the root canal system are needed to develop a more objective and efficient approach. The aim of this in vitro experimental study was to compare the disinfection of the root canal system of primary teeth with manual, rotary and photodynamic therapy systems. Methods: Forty-eight canals of primary molar teeth were infected with a suspension of Enterococcus faecalis and divided into four groups (n = 12): group G1, composed of canals prepared with manual H-type files from the Angelus® system via the crown-down technique; group G2, treated with the Sequence of Baby Files™ rotary system by the pecking motion technique; group G3, using the G2 treatment + photodynamic therapy, with methylene blue as photosensitizer at a concentration of 0.005%, irradiated with a 660 nm diode laser for 100 seconds, 100 mW power, 10 J energy and 357 J/cm² fluence; and group G4 (negative control), which received no treatment. Samples of the canal contents were collected with sterile paper cones before and after instrumentation, diluted and seeded on BHI agar plates. The bacterial colonies formed were counted, and the results were log transformed and subjected to analysis of variance (ANOVA) and Dunnett’s test. Results: Showed a bacterial reduction in all studied groups compared to the control group. Conclusions: We concluded that the manual, rotary and photodynamic therapy systems all significantly reduced the E. faecalis count.

Keywords: Deciduous Teeth; Enterococcus faecalis; Root Canal Therapy

Author Affiliations

  1. DDS, MSc. São Leopoldo Mandic College, SLMANDIC. Campinas, SP, Brasil ( Correspondence : )
  2. DDS, MSc, PhD. São Leopoldo Mandic College, SLMANDIC. Campinas, SP, Brasil
  3. DDS, MSc, PhD. São Leopoldo Mandic College, SLMANDIC. Campinas, SP, Brasil
  4. DDS, MSc. São Leopoldo Mandic College, SLMANDIC. Campinas, SP, Brasil
  5. DDS, MSc. São Leopoldo Mandic College, SLMANDIC. Campinas, SP, Brasil
  6. DDS, MSc. São Leopoldo Mandic College, SLMANDIC. Campinas, SP, Brasil
  7. DDS, Master’s Student. São Paulo State University, Unesp. São José dos Campos, SP, Brasil
  8. DDS, MSc, PhD. São Leopoldo Mandic College, SLMANDIC. Campinas, SP, Brasil
  1. Pawar B, Pawar AM, Bhardwaj A, Wahjuningrum DA, Rahardjo AK, Luke AM, et al. Effect of Adaptive, Rotary, and Manual Root Canal Instrumentation in Primary Molars: A Triple-Armed, Randomized Controlled Clinical Trial Biology 2021;42:1-11
  2. Manchanda S, Sardana D, Yiu CKY. A systematic review and meta-analysis of randomized clinical trials comparing rotary canal instrumentation techniques with manual instrumentation techniques in primary teeth. Int Endod J 2020;53:333–353
  3. Shah HS, Patil VM, Kamath AP, Mathur AA. Comparative Evaluation of Instrumentation Time, Obturation Time, and Radiographic Quality of Obturation Using Two Rotary Systems and Manual Technique for Primary Molar Pulpectomies: In vivo Study. Contemp Clin Dent 2021;12: 55-62
  4. Boonchoo K, Leelataweewud P, Yanpiset K, Jirarattanasopha V. Simplify pulpectomy in primary molars with a single-file reciprocating system: a randomized controlled clinical trial. Clin Oral Investig 2020;24:2683-2689
  5. Barasuol JC, Massignan C, Bortoluzzi EA, Cardoso M, Bolan M. Influence of hand and rotary files for endodontic treatment of primary teeth on immediate outcomes: Secondary analysis of a randomized controlled trial. Int J Paediatr Dent 2021;31:143-151
  6. Natchiyar N, Asokan S, Priya PRG, Kumar TDY. Comparison of Clinical and Radiographic Success of Rotary with Manual Instrumentation Techniques in Primary Teeth: A Systematic Review. Int J Clin Pediatr Dent 2021; 14:8-13
  7. Rathi N, Jain S, Thosar N, Baliga S, Ahmed F, Metha J. Comparative Evaluation of Cleaning Efficiency and Apical Extrusion of Debris Using Two Pediatric Rotary Endodontic Files: An In Vitro Study. Int J Clin Pediatr Dent 2021;14:196-200
  8. Seema T, Ahammed H, Parul S, Cheranjeevi J. Comparative Evaluation of Dentin Removal and Taper of Root Canal Preparation of Hand K File, ProTaper Rotary File, and Kedo S Rotary File in Primary Molars Using Cone-beam Computed Tomography. Int J Clin Pediatr Dent 2020;13:332-336
  9. Tyagi R, Khatri A, Kalra N, Sabherwal P. Comparative Evaluation of Hand K-flex Files, Pediatric Rotary Files, and Reciprocating Files on Instrumentation Time, Postoperative Pain, and Child’s Behavior in 4–8-year old Children. Int J Clin Pediatr Dent 2021;14:201-206
  10. Maciel Martins CR, de Andrade MV, Carvalho AP, Afonso Pereira RM, Bresolin CR, Mello-Moura ACV, et al. Photodynamic therapy associated final irrigation in root canals of the primary teeth. Photodiagnosis  Photodyn Ther 2021;33:102182
  11. Fonseca LA, Cangussu RA, Oliveira AS, Pinheiro SL, Shitsuka C, Duarte AD. Comparison of endodontic disinfection of primary teeth root canals using rotary and reciprocating system: An in vitro study. Res Soc Dev 2020;9:e457985882
  12. Panchal V, Jeevanandan G, Erulappan SM. Comparison between the Effectiveness of Rotary and Manual Instrumentation in Primary Teeth: A Systematic Review. Int J Clin Pediatr Dent 2019;12:340–346
  13. Moraes R, Perez R, Silva A, Machado AS, Lopes RT, Pintor A, et al. Micro-CT evaluation of root canal preparation with rotary instrumentation on prototyped primary incisors. Braz Oral Res 2021;35:e132
  14. Öter B, Topçuog Lu N, Tank MK, Çehreli SB. Evaluation of Antibacterial Efficiency of Different Root Canal Disinfection Techniques in Primary Teeth. Photomed Laser Surg 2018;36:179–184
  15. Walia V, Goswami M, Mishra S, Walia N, Sahay D. Comparative Evaluation of the Efficacy of Chlorhexidine, Sodium Hypochlorite, the Diode Laser and Saline in Reducing the Microbial Count in Primary Teeth Root Canals – An In Vivo Study. J Lasers Med Sci 2019; 10: 268–274
  16. Pinheiro SL, da Silva JN, Gonçalves RO, Villalpando KT. Manual and Rotary Instrumentation Ability to Reduce Enterococcus faecalis Associated with Photodynamic Therapy in Deciduous Molars. Braz Dent J 2014;25:502-507
  17. Tewari RK, Ali S, Mishra SK, Kumar A, Andrabi SMUN, Zoya A, et al. Mechanical reduction of the intracanal Enterococcus faecalis population by Hyflex CM, K3XF, ProTaper Next, and two manual instrument systems: an in vitro comparative study. J Investig Clin Dent 2016;7:168–173
  18. Mohan D, Maruthingal S, Indira R, Divakar DD, Al Kheraif AA, Ramakrishnaiah R et al. Photoactivated disinfection (PAD) of dental root canal system – An ex-vivo study. Saudi journal of biological sciences 2016;23:122–127
  19. Plotino G, Grande NM, Mercade M. Photodynamic therapy in endodontics. Int End J 2019;52:760–774
  20. Garcez AS, Hamblin MR. Methylene blue and Hydrogen peroxide for photodynamic inactivation in root canal – a new protocol for use in Endodontics. Eur Endod J 2017;2:29-35
  21. Okamoto CB, Bussadori SK, Prates RA, da Mota ACC, Tempestini Horliana ACR, Fernandes KPS, et al. Photodynamic therapy for endodontic treatment of primary teeth: A randomized controlled clinical trial. Photodiagnosis Photodyn Ther 2020;30:101732
  22. Musale PK, Mujawar SA. Evaluation of the efficacy of rotary vs. hand files in root canal preparation of primary teeth in vitro using CBCT. European archives of paediatric dentistry: official journal of the Eur Acad Paediatr Dent 2014;15:113–120
  23. Jafarzadeh M, Saatchi M, Jafarnejadi P, Gooran M. Digital Radiographic Evaluation of the Quality of Different Root Canal Obturation Techniques in Deciduous Mandibular Molars after Preparation with Rotary Technique. J Dent 2019;20:152–158
  24. Subramaniam P, Raveendran N, Madhusudhan KS. Comparative evaluation of two pediatric rotary file systems in primary teeth: A scanning electron microscope study. Contemp Pediatr Dent 2022;3:8-14
  25. Dalzell O, Mohd Ariffin S, Patrick CJ. Hardiman R, Manton DJ, Parashos P et al. Root canal instrumentation efficacy of non-fused and fused primary molar roots: a micro-computed tomography study. Eur Arch Paediatr Dent 2021;22:911–927
  26. Babu KLG, Kavyashree GH. Evaluation of the clinical efficiency of rotary and manual files for root canal instrumentation in primary teeth pulpectomies: A comparative randomized clinical trial. Contemp Pediatr Dent 2021;2:21-34
  27. Chauhan A, Saini S, Dua P, Mangla R. Rotary Endodontics in Pediatric Dentistry: Embracing the New Alternative. Int J Clin Pediatr Dent 2019;12:460-463

Article Info

Contemp Pediatr Dent 2022:3(2):52-60

Received: 25 March 2022

Accepted: 04 August 2022

Online First: 15 August 2022


Full Text

File Downloads
pdf CPD.2022.112 1866

How to Cite

					Cesar Augusto Perini Rosas, José Carlos Pettorossi Imparato, Kelly Maria Silva Moreira, Samuel Nogueira Lima, Irís Nogueira Bincelli Seckler, Jonathan Sousa Amorim, Victor Cavallaro Bottesini, Danilo Antônio Duarte. Comparison of disinfection effectiveness through manual instrumentation, rotary system and photodynamic therapy in primary molars: An in vitro study. Contemp Pediatr Dent 2022:3(2):52-60.

Related Articles

Share Article

Under a Creative Commons license