TREATMENT OUTCOME OF MANUAL VERSUS ROTARY TECHNIQUES IN SINGLE-VISIT ENDODONTICS FOR PATIENTS IN A NIGERIAN TEACHING HOSPITAL: A RANDOMIZED CLINICAL TRIAL

ABSTRACT

Background: Adequate canal preparation is essential in achieving successful outcome sequel to root canal treatment. Nickel-Titanium (NiTi) rotary instruments has steadily gained grounds in endodontics for root canals preparation, however, it is yet to be widely practiced among dental practitioners in Nigeria.

Aim and Objectives: To compare the treatment outcomes of single visit root canal treatment when either rotary or manual step-back preparation technique is used in shaping the canal, employing clinical and radiographic criteria. Design of the study: A randomized controlled trial.

Setting: Conservation Unit of Restorative Dentistry Clinics, Lagos University Teaching Hospital (LUTH), Lagos, Nigeria.

Materials and Methods: 120 consecutive consenting subjects were included in the study. The inclusion criteria were: medically fit individuals with restorable anterior, premolar or first molar tooth diagnosed with irreversible pulpitis, pulp necrosis or apical periodontitis; they had no to moderate pain, with periodontally sound and not excessively curved tooth. Randomization was performed by balloting using sealed envelopes and subjects were assigned in equal numbers to one of two groups, rotary and manual. Subjects were monitored following treatment for clinical and radiographic parameters at 1 day, 1 week, 1 month, 3 months and 6 months. Data analysis was done using SPSS-version 20.0, and differences were considered significant if p < 0.05.

Results: Twenty-seven (45%) and 23(38.3%) teeth in manual and rotary group respectively had pain at 1-day review. Significant difference in occurrence of pain in relation to both gender (p=0.001) and tooth-type (p=0.026) was noted between the groups at 1-day review. By the final review, there was no reported post-operative pain. There was no significant difference between the two groups in relation to the other clinical parameters at the different review periods. Twenty-four (40%) and 16 (26.7%) teeth had pre-existing periapical radiolucency in manual and rotary groups respectively; by final review, periapical radiolucency had reduced to 16.9% and 3.4% respectively, with the rotary group having significantly less radiolucency. Favourable outcome at 6-month review was significantly higher in the rotary group (96.6%), compared to the manual group (83.1%) in (p=0.033); the difference in outcome was due to significantly better outcomes with the molar tooth category in the rotary group.

Conclusion: There was a significantly more favourable treatment outcome in the rotary compared to the step-back technique in canal preparation, employing clinical and radiographic criteria.

Key words: Rotary, Manual, Treatment-outcome, Single-visit, Endodontics, Instrumentation