Paediatric Rotary Files and Dentinal Crack Formation in Primary Teeth: A Systematic Review

Nickel-titanium (NiTi) rotary files are widely used in endodontics due to their flexibility, durability, and efficiency in shaping root canals. However, concerns have been raised regarding their potential to cause dentinal cracks, particularly in primary teeth with their unique structural vulnerabilities. This systematic review aims to evaluate the prevalence, characteristics, and implications of dentinal cracks associated with the use of NiTi rotary files in primary teeth. A comprehensive literature search across multiple databases yielded 5,147 articles, with five studies ultimately meeting the inclusion criteria. These studies primarily investigated various NiTi file systems, such as ProTaper, WaveOne Gold, Reciproc, and Kedo-S, examining their impact on crack formation. Findings indicated that systems with larger tapers and aggressive cutting actions, such as ProTaper, exhibited a higher incidence of dentinal cracks compared to paediatric-specific or more conservative designs like Kedo-S. The clinical implications of these findings underscore the importance of selecting appropriate instrumentation to minimise structural damage in primary teeth. The review advocates for standardised methodologies in future studies to enhance comparability and calls for innovations in paediatric-specific rotary file systems to improve treatment outcomes.