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Published on: October 11, 2024
Influence of Engine-Driven NiTi Files on the Effectiveness and Technical Quality of Endodontic Treatment Performed by
Monique Corrêa Rocha Ferrari Barbosa1, Elidiane Elias Ribeiro1, Karem Paula Pinto1
1PROCLIN Department, School of Dentistry, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.
Background:
In recent years, many universities have incorporated engine-driven nickel-titanium (NiTi) instruments into their undergraduate endodontic programs, aiming to enhance the efficiency and precision of root canal treatments. While these techniques might offer advantages, concerns remain regarding their implementation, particularly in ensuring adequate training and supervision to prevent potential procedural errors that could compromise treatment outcomes.
Objectives:
This systematic review and meta-analysis aimed to evaluate the quality of clinical root canal treatments performed by undergraduate students, comparing outcomes between the use of engine-driven NiTi files and stainless-steel hand files.
Methods:
The search was conducted across four electronic databases up to April 2025. The selection process adhered to the Population, Intervention, Comparison, Outcomes and Study (PICOS) criteria, including clinical studies evaluating the quality of root canal treatments performed by undergraduate students using engine-driven NiTi files versus stainless-steel hand files. Study quality was assessed using the Risk of Bias 2 (RoB-2) tool for randomised clinical studies and Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) for nonrandomized studies. Meta-analyses were performed to compare the prevalence of adequate root canal treatment quality, root canal filling quality, and procedural errors between the two techniques, using RevMan 5.3 software. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool was applied to determine the overall certainty of evidence.
Results:
Ten studies were included, with most demonstrating a high risk of bias. Meta-analyses revealed that engine-driven NiTi root canal preparation with both rotary and reciprocating instruments resulted in significantly higher quality of root canal treatment, improving root canal filling quality, and reducing the incidence of ledge formation compared to stainless-steel hand files. However, no significant differences were found between the techniques regarding overfilling, perforations, apical transportation, or instrument separation. The certainty of evidence was rated as low.
Conclusions:
Engine-driven NiTi instruments improve the quality of root canal treatments performed by undergraduate students, particularly by enhancing filling quality and reducing ledge formation without increasing other iatrogenic risks. Nevertheless, these conclusions are based on evidence of low certainty.
Trial Registration:
This systematic review was registered in the PROSPERO database (CRD42024600660).
