Comparing the use of pediatric files and conventional files in primary teeth: a systematic review

Pulp damage challenges pediatric dentists, mainly due to variations in the root canal system of primary teeth.

To compare the use of pediatric and conventional manual and mechanized files in primary teeth as to filling quality, instrumentation time, and postoperative pain.

This systematic review aligned with PRISMA was registered in PROSPERO. Clinical studies comparing pediatric and conventional files were included. The search was conducted until May 05, 2025, in five electronic databases (MEDLINE/EMBASE/Google Scholar/Cochrane), gray literature, and reference lists. Methodological quality (Rob-2), meta-analyses, and assessment of evidence certainty (GRADE) were performed. Of 3,643 studies, 10 were qualified for meta-analysis.

There was better filling quality (OR = 4.57 [1.78-11.74] and lower chance of sub-filling [OR = 6.40 [1.53-26.67] in root canals treated with manual pediatric files. There was no difference between pediatric and conventional mechanized files regarding the filling quality. The instrumentation time was shorter with manual (MD = - 38.21[- 73.17 to 3.24], I² = 94%) and pediatric mechanized (MD = - 49.81, [- 78.39 to - 21.24], I2 = 99%) files when compared to conventional files. No significant differences in postoperative pain were observed at 6, 24, and 48 h; however, at 12 h, conventional files resulted in significantly less pain (OR = 4.62 [1.76-12.11, I² = 14%]; OR = 2.95 [1.20-7.28, I² = 0%]). The evidence certainty was considered low for all outcomes.

Instrumentation with pediatric hand files may provide better obturation quality, and pediatric hand or mechanized files require less instrumentation time and may result in less postoperative pain.