Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018

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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : November | Volume : 17 | Issue : 11 | Page : ZC01 - ZC05 Full Version

Clinical Efficacy of Kedo S Square Files versus Manual K Files in Root Canal Preparation of Deciduous Molars: A Randomised Clinical Trial

Published: November 1, 2023 | DOI:
Bala Anusha Durairaj, Prathima Gajula Shivashankarappa, Kavitha Muthukrishnan, G Ezhumalai, Eswari Ramassamy

1. Postgraduate Student, Department of Paediatric and Preventive Dentistry, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth (SBV) Deemed to be University, Pillaiyarkuppam, Puducherry, India. 2. Professor and Head, Department of Paediatric and Preventive Dentistry, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth (SBV) Deemed to be University, Pillaiyarkuppam, Puducherry, India. 3. Assistant Professor, Department of Paediatric and Preventive Dentistry, Mahatma Gandhi Postgraduate Institute of Dental Sciences, Government of Puducherry Institution, Puducherry, India. 4. Senior Statistician and Research Consultant, Department of Consultant Statistician, Sri Balaji Vidyapeeth (SBV) Deemed to be University, Pillaiyarkuppam, Puducherry, India. 5. Senior Lecturer, Department of Paediatric and Preventive Dentistry, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth (SBV) Deemed to be University, Pillaiyarkuppam, Puducherry, India.

Correspondence Address :
Dr. Prathima Gajula Shivashankarappa,
Professor and Head, Department of Paediatric and Preventive Dentistry, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth (SBV) Deemed to be University, Pillaiyarkuppam, Puducherry-607402, India.


Introduction: The conventional approach to root canal preparation in primary molars involves hand instrumentation. However, the disadvantage of longer instrumentation time poses a challenge for dentists treating paediatric patients. As a solution, rotary file systems have been introduced to reduce chairside time and improve patient cooperation. Among the various rotary file systems available, the "Kedo S Square" rotary files are exclusive single files made of Nickel-titanium (NiTi), offering increased flexibility and variable taper to adapt to the curved canals of deciduous molars.

Aim: To assess and compare the instrumentation time and obturation quality of rotary “Kedo S Square” files with manual K files in deciduous molars.

Materials and Methods: This randomised clinical trial was conducted from July 2022 to February 2023 included 40 primary molars from four to six-year-old children requiring root canal therapy. The teeth were evenly allocated to two groups: Group 1 underwent instrumentation using “Kedo S Square” files, while Group 2 underwent instrumentation using manual K files. The instrumentation time was recorded, and post-treatment radiographs were taken to evaluate the quality of obturation by a single-blinded investigator. Statistical analysis included the Independent t-test, Levene’s Test for Equality of Variances, Chi-square test, and Fisher’s-exact test.

Results: The use of Kedo S Square files resulted in significantly less instrumentation time (p<0.001) with a mean time of 3.91±1.462 minutes. There was no statistically significant difference in obturation quality between the two groups, with a p-value of 0.427.

Conclusion: Kedo S “Square” files demonstrated comparable obturation quality with shorter instrumentation time compared to manual K files in root canals of primary molars.


Deciduous teeth, Obturation, Pulpectomy, Rotary file

The major concern in the field of Paediatric Dentistry is the premature loss of primary teeth despite various efforts to prevent dental caries in children. The main objective of Paediatric Dentistry is to preserve the primary teeth in the oral cavity until their physiological exfoliation in order to retain the integrity of the dental arch (1). Pulpectomy, a therapeutic option for primary molars with pulp involvement, offers several advantages over extraction (2). The pulpectomy procedure involves complete removal of the pulp, root canal preparation, and subsequent obturation with a suitable resorbable material (3). However, it presents challenges due to the continuous physiological resorption of deciduous teeth and the presence of complex and narrow roots with extensive pulpal tissues (4). Consequently, pulpectomy of posterior teeth poses a challenge for clinicians treating children (5). The success of pulpectomy largely depends on the instrumentation of root canals in primary teeth, which aims to eliminate infection (6).

The literature describes the conventional approach of using hand files for cleaning and shaping the canals of primary teeth. However, the difficulties in instrumentation, complex canal anatomy, lengthy preparation time, and challenges related to patient behaviour necessitate the development of advanced techniques (7). In recent years, rotary nickel-titanium instrumentation techniques have been developed to overcome these challenges (8). Following the report by Barr et al., which described the use of permanent rotary instruments with a Profile 0.04 taper for biomechanical preparation of primary teeth, this technique gained popularity. However, it has limitations such as over-instrumentation in primary roots due to their relatively thin canal walls and difficulties in fully instrumenting oval, flat, curved, and irregularly shaped canals (9),(10). Furthermore, the longer length of adult rotary files makes their use challenging in paediatric patients due to their smaller mouth opening. Kuo CI et al., suggested that a paediatric-specific rotary file with modified length, tip size, and taper would be more suitable for performing pulpectomy in primary teeth (11).

An advancement in paediatric endodontics was the introduction of the exclusive paediatric Kedo S rotary file system. This system consists of U1 for primary anterior teeth, D1 for mesiobuccal and mesiolingual canals, and E1 for distal and palatal canals of primary molars. These files are unique as they have a variable taper (4-8%) and a variable tip diameter (D1-0.25 mm) (12). The more recent generation of Kedo S ‘Square’ files includes P1 for molars and A1 for anterior teeth. These files offer advantages such as increased flexibility, reduced dentin removal, and higher resistance to cycle fatigue due to their TiO2 coating (13). Studies in the literature have demonstrated that nickel-titanium rotary devices are superior to manual instrumentation in terms of time efficiency and cleaning ability for root canal instrumentation in primary teeth (14),(15),(16),(17),(18),(19).

Currently, limited data are available on the performance of Kedo S ‘Square’ files in curved and narrow canals of deciduous teeth (20),(21),(22),(23). An in-vitro study using Kedo S ‘Square’ files showed varying cleaning efficiency for both Kedo S ‘Square’ and manual K files in different thirds of root canals in primary molars (23). Therefore, to further contribute to this research, the current study was conducted with the hypothesis: “Does the use of paediatric rotary Kedo S ‘Square’ files improve the quality of obturation and reduce instrumentation time compared to manual K files in primary molars?”.

The aim of the present research was to clinically evaluate and compare the time required for mechanical preparation and assess the quality of obturation using Kedo S ‘Square’ files and manual K files in root canal preparation of primary molars.

Material and Methods

Based on Consolidated Standards of Reporting Trials (CONSORT) clinical guidelines and in compliance with the Institutional Ethical Review Board (IGIDSIEC2022NRP01PGBAPPD) and the Helsinki Declaration, the present randomised clinical trial was conducted from July 2022 to February 2023. The present single-blinded randomised clinical trial was registered in the Clinical Trials Registry-India (CTRI/2022/04/041853).

Sample size calculation: The sample size calculation was based on the research by Jeevanandan G and Govindaraju L, using the following formula (24),(25):


n is the desired number of samples,
p_ is the desired proportion of the population=(P1+P2)/2
Z1-β is the power,
Z1-α/2 is the critical and standard values for the corresponding confidence level,
P1 is the proportion in cases
P2 is the proportion in controls

P1=76.7%, P2=40% and α=0.05, β=0.2

Calculated sample size=20 per each groups

Inclusion and Exclusion criteria: Based on the inclusion and exclusion criteria, 40 teeth (18 boys and 22 girls) with decayed primary molars indicated for single visit pulpectomy, who had at least two-thirds of the remaining root, sufficient crown architecture to sustain rubber dam placement, and Frankel’s behaviour rating of 3 and 4, were included in the study. Children and parents who refused to participate in the study, special needs children, children with severe tooth mobility, internal or external root resorption, perforation in the pulpal floor, and non restorable teeth were excluded from the study.

Study Procedure

Demographic details and a brief case history were recorded for all the children included in the present study. Random allocation for the sequence of children requiring pulpectomy in either of their primary molars was done by a single operator using computer-generated sequence employing the block randomisation technique (blocks 2 and 4). Slips of paper with either Kedo S ‘Square’ or manual K files printed on them were placed in sealed envelopes by another investigator not associated with the present study. The outside of the envelope was sequentially numbered, and each child accepted into the study was given an individual number for identification. The present prevented allocation bias, and the paediatric dentist conducting the outcome assessment was kept blinded about the group to which the child had been assigned.

The primary molars included for pulpectomy in the present study were grouped into two groups:

• Group 1- Rotary instrumentation using Kedo S ‘Square’ Files (n=20, Kedo Dental, India)
• Group 2- Manual instrumentation using K files (n=20, NeoEndo K file, M/s Orikam Healthcare India Pvt., Ltd.,)

The CONSORT guidelines for planning and reporting clinical trials were followed during different stages of the study (Table/Fig 1).

Treatment procedure: Single-visit pulpectomy was performed on all the teeth included in the present study by a single operator. Local anaesthesia (LOX* 2% Adrenaline, Neon Laboratories Limited, India) was administered, followed by rubber dam isolation (GDC Marketing, Hoshiarpur, Punjab, India). The roof of the access cavity was removed using a safe-ended diamond tapered fissure bur with an outward brushing action, after opening the access with a number 4 round carbide bur. Patency of canals and working length were determined using a number 10 K file and digital radiographs. In Group 1, initial canal preparation was done using a number 20 K file, followed by Kedo S ‘Square’ rotary files (P1) and an Endodontic motor (Woodpecker E-com plus Cordless Endomotor, India) at 300 rpm and 2.2 N/cm torque. In Group 2, instrumentation was carried out using manual K files up to number 35, using a quarter turn and pull motion. Saline irrigation was done to flush out debris between files for all the groups. The total instrumentation time was measured using a digital stopwatch, starting from the introduction of the first manual #10 K file until the final saline irrigation.

After complete instrumentation and irrigation, the canals were dried using no. 30 sterile paper points (Dentsply Maillefer, OK, USA) and obturated with Metapex (Meta Biomed Co. Ltd., Chungcheongbuk-do, Korea). The paste was gently pushed into the canals with cotton pellets and an endodontic plugger. Coronal sealing was achieved using type IX glass ionomer cement (GC, India), and final restoration was completed using stainless steel crowns (Kids crown SS Primary Molar, India). Postoperative radiographs were taken to evaluate the quality of obturation. Another investigator, who was blinded to the type of instrumentation protocol, assessed the quality of obturation in each tooth according to the Coll JA and Sadrian R criteria (1996) (26). The obturation was scored as follows:

Score 1: Short fill- All the canals were filled 1 mm or more short of the apex.
Score 2: Complete fill- One or more of the canals had obturating material ending at the radiographic apex.
Score 3: Long fill- Any molar canal showed obturating material outside the root (Table/Fig 2)a-d.
Voids: Presence or absence.

Statistical Analysis

The data obtained were entered into an excel sheet and subjected to statistical analysis using Statistical Package for Social Sciences (SPSS) software version 16.0 (Chicago, SPSS Inc). An independent t-test was performed to compare the instrumentation time between groups. Chi-square test and Fisher’s-exact test were used to analyse the quality of obturation and the presence of voids. A p-value less than 0.05 was considered statistically significant.


In the present study, 40 primary molars (20 in each group) were treated in four to six-year-old children, consisting of 18 boys and 22 girls. The mean age of the children was 5.018±0.564 years. Among the treated teeth, the majority were mandibular primary second molars (n=32), followed by maxillary primary second molars (n=8).

Instrumentation time: The mean instrumentation time was observed to be higher in the conventional K files group (10.01±2.055 minutes) compared to the Kedo S ‘Square’ rotary files group (3.91±1.462 minutes) (p<0.001) (Table/Fig 3).

Quality of obturation: In terms of the quality of obturation, the Kedo S ‘Square’ group (85%) showed a higher number of complete fill (Score 2) compared to the K file group (75%). The occurrence of long fill (Score 3) was observed in 25% of canals instrumented with manual K files, while it was 15% in the Kedo S ‘Square’ file group (Table/Fig 2). However, the Chi-square test showed no statistically significant difference in the quality of obturation between the two groups, with a p-value of 0.427 (Table/Fig 4).

Voids: When examining the radiographic quality of obturation after K file instrumentation (Group 2), 30% of canals showed voids. In contrast, the canals instrumented with Kedo S ‘Square’ files (Group 1) showed complete absence of voids, and this difference was statistically significant (p<0.002) (Table/Fig 5).


There has been a significant shift in the management of primary molars with deep caries, moving from extractions to pulpectomy (27). Adequate remaining dentin thickness is crucial for an endodontically treated tooth to resist lateral and occlusal stresses. Conventional hand files may not allow for the present, which is why rotary files were introduced [20,28]. NiTi rotary files, such as the Kedo S ‘Square’ rotary file, are designed to adapt to the curvature of primary root canals, reducing the chances of zipping, transportation, and creating smooth, funnel-shaped canals (29).

The Kedo S ‘Square’ rotary file is a fourth-generation, exclusively paediatric rotary file with a variable taper and a working length of 17 mm. It effectively scrapes the dentin, removes a small layer from the entire root canal circumference, and maintains the structural integrity of the dentin to facilitate three-dimensional obturation [20,21]. While several studies have evaluated the clinical efficacy of rotary files in achieving optimal obturation quality, there are fewer clinical studies specifically using the exclusive Kedo S ‘Square’ files in primary teeth (29),(30),(31). Therefore, the present study aimed to compare the quality of obturation and instrumentation time of the paediatric rotary Kedo S ‘Square’ file with manual K file systems in primary molars.

The participants in the present study were between four and six years of age, as primary molars complete the development of their roots by four years and root resorption typically begins at six years. The mean age of the children included in the present study was 5.018±0.564 years, which was lower compared to a study by Kumar D and Ravindran V where the age range was four to eight years (32).

Single-visit pulpectomy was performed in all the primary molars included in the present study, as the teeth were vital, the pulp was superficially infected, and the root canals were free of bacteria, allowing for aseptic conditions during intracanal procedures (32),(33).

The instrumentation time was significantly shorter in the Kedo S ‘Square’ file group compared to the conventional K files group, with a statistically significant difference between them. The mean instrumentation time observed in the rotary technique used in this study was 3.91±1.462 minutes. In contrast, Mohamed RH et al., reported a mean instrumentation time of 2.12±0.82 minutes, Lakshmanan L et al., reported 73.46±8.62 seconds, Kumar D and Ravindran V reported 72.6±9.8 seconds using Kedo S ‘Square’ files in primary molars, and Lakshmanan L et al., reported 53.23±9.60 seconds, respectively (20),(22),(32),(34).

Regarding the quality of obturation, no significant difference was observed between the two file systems used in the present study. However, Lakshmanan L et al., reported good obturation quality with Kedo S ‘Square’ files compared to manual files in primary molars (22). Similarly, Kumar D and Ravindran V et al., and Lakshmanan L et al., observed higher rates of optimal fill (76.7%, 67%, and 66.6%) with the Kedo S ‘Square’ file system in primary mandibular molars, which is consistent with the present study where 85% of canals showed optimal fill. Additionally, a higher occurrence of long fill (25%) was observed in primary molars instrumented with manual K files compared to Kedo S ‘Square’ files (15%) in the present study. This contrasts with the findings of Kumar D and Ravindran V et al., and Lakshmanan L et al., where more underfillings (33.3% and 54%) were observed with manual instrumentation using K files (32),(34). The rotary group had a higher rate of optimal fill and lower rate of underfill. This may be attributed to its elastic memory and radial land, which help keep the file in the centre of the root canal through wall support and create conical-shaped canals (16).

The presence or absence of voids is another important factor that affects the quality of obturation. Voids can create pathways for leakage and increase the likelihood of bacterial and toxin retention, leading to post-treatment failures (35). No voids were observed in primary molars instrumented with Kedo S ‘Square’ files compared to manual files. A statistically significant difference in the presence of voids in obturation was observed between the rotary and manual techniques used in the present study. Similarly, more voids were observed in primary mandibular molars instrumented with manual K files compared to rotary files, as reported by Shah HS et al., and Lakshmanan L et al., In Lakshmanan L et al.,’s study, voids were equally present in primary root canals instrumented with Kedo S ‘Square’ files and K files (20%). Procedural errors, the presence of moisture in the canals, and the consistency and viscosity of the obturating material used can contribute to the formation of voids and compromise the quality of obturation (28),(34).


The present study had certain limitations, including the use of a two-dimensional radiographic assessment method to determine the quality of obturation and the lack of follow-up to assess treatment outcomes. Therefore, further studies with larger sample sizes and long-term follow-up are needed to accurately evaluate the patients’ acceptance of exclusive Kedo S ‘Square’ rotary files and determine the clinical and radiographic success rates.


Within the limitations of the present study, it can be concluded that the use of Kedo S ‘Square’ rotary files in primary molars resulted in reduced instrumentation time, fewer voids, and a higher rate of optimal fill compared to manual K files. Therefore, incorporating an exclusive single-file rotary system like Kedo S ‘Square’ files into routine paediatric dental practice can lead to more effective, efficient, and safer dental treatments, ultimately reducing chair-side time.


Ranly DM, Garcia-Godoy F. Current and potential pulp therapies for primary and young permanent teeth. J Dent. 2000;28(3):153-61. [crossref][PubMed]
Ruddle CJ. Cleaning and shaping the root canal system. In: Cohen S, Burns RC, editors. Pathways of the pulp. 8th ed. St. Louis: Mosby Inc. 2002. Pp. 231-92.
Fuks AB, Papagiannoulis L. Pulpotomy in primary teeth: Review of the literature according to standardised criteria. Eur Arch Paediatr Dent. 2006;7(2):64-71;discussion 72. [crossref][PubMed]
Moghaddam KN, Mehran M, Zadeh HF. Root canal cleaning efficacy of rotary and hand files instrumentation in primary molars. Iran Endod J. 2009;4(2):53-57.
Ramazani N, Mohammadi A, Amirabadi F, Ramazani M, Ehsani F. In vitro investigation of the cleaning efficacy, shaping ability, preparation time and file deformation of continuous rotary, reciprocating rotary and manual instrumentations in primary molars. J Dent Res Dent Clin Dent Prospects. 2016 Winter;10(1):49-56. [crossref][PubMed]
Haapasalo M, Endal U, Zandi H, Coil JM. Eradication of endodontic infection by instrumentation and irrigation solutions. Endod Topics. 2005;10(1):77-102. [crossref]
Silva LA, Leonardo MR, Nelson-Filho P, Tanomaru JM. Comparison of rotary and manual instrumentation techniques on cleaning capacity and instrumentation time in deciduous molars. J Dent Child (Chic). 2004;71(1):45-47.
Weiger R, Bruckner M, ElAyouti A, Leost C. Preparation of curved root canals with rotary Flex Master instruments compared to light speed instruments and NiTi hand files. Int Endod J. 2003;36:483-90. [crossref][PubMed]
Peters OA, Schönenberger K, Laib A. Effects of four Ni-Ti preparation techniques on root canal geometry assessed by micro computed tomography. Int Endod J. 2001;34(3):221-30. [crossref][PubMed]
Jindal L, Bhat N, Mehta S, Bansal S, Sharma S, Kumar A. Rotary endodontics in pediatric dentistry: Literature review. Int J Biol Health Sci. 2020;3(2):09-13.
Kuo CI, Wang YL, Chang HH, Huang GF, Lin CP, Guo MK, et al. Application of Ni-Ti rotary files for pulpectomy in primary molars. J Dent Sci. 2006;1:10-15.
Jeevanandan G. Kedo S paediatric rotary files for root canal preparation in primary teeth-case report. J Clin Diagn Res. 2017;11(3):ZR03-ZR05. [crossref][PubMed]
Pitchiah PA, Shivashankarappa PG. Rotary files in pediatric dentistry: From then till now. J Sci Dent. 2020;10(2):55-57. [crossref]
Elheeny AA, Khattab NM, Fouda TA. Comparative study of two rotary systems for endodontic treatment of infected primary molars: In vivo and in vitro study. Egypt Dent J. 2015;61:4293-300.
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;15(2):113-20. [crossref][PubMed]
Romero TO, Gonzalez VM. Comparison between rotary and manual techniques on duration of instrumentation and obturation times in primary teeth. J Clin Pediatr Dent. 2011;35(4):359-63. [crossref][PubMed]
Makarem A, Ravandeh N, Ebrahimi M. Radiographic assessment and chair time of rotary instruments in the pulpectomy of primary second molar teeth: A randomized controlled clinical trial. J Dent Res Dent Clin Dent Prospects. 2014;8(2):84-89.
Natchiyar N, Asokan S, Geetha Priya PR, Yogesh Kumar TD. 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(1):08-13. [crossref][PubMed]
Katge F, Ghadge S, Poojari M, Jain K, Patil D. Comparative evaluation of cleaning efficacy of prime Pedo™ and DXL-Pro™ Pedo rotary files with conventional H files in root canals of primary teeth: An in vitro study. J Clin Diag Res. 2019;13(7):ZC06-ZC09. [crossref]
Mohamed RH, Abdelrahman AM, Sharaf AA. Evaluation of rotary file system (Kedo-S-Square) in root canal preparation of primary anterior teeth using cone beam computed tomography (CBCT)- in vitro study. BMC Oral Health. 2022;22(1):13. [crossref][PubMed]
Lakshmanan L, Jeevanandan G, Maganur PC, Vishwanathaiah S. Fracture incidence of kedo-s square pediatric rotary files: A prospective clinical study. Eur J Dent. 2022;16(3):594-98. [crossref][PubMed]
Lakshmanan L, Jeevanandan G. Evaluation of quality of obturation and instrumentation time using Kedo-S square file, H file and K file in primary molars- a randomized controlled trial. Int J Pharm Res. 2021;1:3507-14.
Pragadeesh AP, Prathima GS, Nandakumar S. Comparative evaluation of Kedo- ‘S’ square files with manual instrumentation in primary molars: An in vitro study. Int J Life Sci Pharma Res. 2023;13(4):81-86. [crossref]
Jeevanandan G, Govindaraju L. Clinical comparison of Kedo-S paediatric rotary files vs manual instrumentation for root canal preparation in primary molars: A double blinded randomised clinical trial. European Archives of Paediatric Dentistry. 2018;19(4):273-78. [crossref][PubMed]
Sharma SK, Mudgal SK, Thakur K, Gaur R. How to calculate sample size for observational and experimental nursing research studies. Natl J Physiol Pharm Pharmacol. 2020;10(1):01-08. [crossref]
Coll JA, Sandrian R. Predicting pulpectomy success and its relationship to exfoliation and its succedaneous dentition. Pediatr Dent. 1996;18(1):57-63.
Sruthi S, Jeevanandan G, Govindaraju L, Subramanian E. Assessing quality of obturation and instrumentation time using Kedo SG blue, Kedo SH, and reciprocating hand K files in primary mandibular molars: A double blinded randomized controlled trial. Dent Res J. 2021;18:76. [crossref][PubMed]
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(1):55-62. [crossref][PubMed]
Panchal V, Jeevanandan G, Subramanian EM. Comparison of instrumentation time and obturation quality between hand K file, H files, and rotary Kedo S in root canal treatment of primary teeth: A randomized controlled trial. J Indian Soc Pedod Prev Dent. 2019;37(1):75-79. [crossref][PubMed]
Priyadarshini P, Jeevanandan G, Govindaraju L, Subramanian EMG. Clinical evaluation of instrumentation time and quality of obturation using paediatric hand and rotary file systems with conventional hand K-files for pulpectomy in primary mandibular molars: A double-blinded randomized controlled trial. Eur Arch Paediatr Dent. 2020;21(6):693-701. [crossref][PubMed]
Divya S, Jeevanandan G, Sujatha S, Subramanian EMG, Ravindran V. Comparison of quality of obturation and post-operative pain using manual vs rotary files in primary teeth-A randomised clinical trial. Indian J Dent Res. 2019;30(6):904-08.[crossref][PubMed]
Kumar D, Ravindran V. Comparison of quality of obturation and instrumentation time using manual hand-K files and rotary Kedo-S square files for pulpectomy in primary molars: a double blinded randomised controlled trial. J Popul Ther Clin Pharmacol. 2023;30(10):e46-e53. [crossref]
Singla R, Marwah N, Dutta S. Single visit versus multiple visit root canal therapy. Int J Clin Pediatr Dent. 2008;1(1):17-24. [crossref]
Lakshmanan L, Ramakrishnan M, Jeevanandan G. 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. Braz Dent Sci. 2023;26(2):e3497. [crossref]
Khubchandani M, Baliga MS, Rawlani SS, Rawlani SM, Khubchandani KM, Thosar N. Comparative evaluation of different obturation techniques in primary molars: An in vivo study. Eur J Gen Dent. 2017;6(1):42-47.[crossref]

DOI and Others

DOI: 10.7860/JCDR/2023/65065.18656

Date of Submission: Apr 27, 2023
Date of Peer Review: Aug 04, 2023
Date of Acceptance: Sep 19, 2023
Date of Publishing: Nov 01, 2023

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

• Plagiarism X-checker: Apr 29, 2023
• Manual Googling: Aug 25, 2023
• iThenticate Software: Sep 16, 2023 (16%)

ETYMOLOGY: Author Origin


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