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Effectiveness of hand and rotary instrumentations during biomechanical preparation in primary teeth: an umbrella review with evidence stratification

Evidence-Based Dentistry volume 26, page 71 (2025)Cite this article

Subjects

Abstract

Aims/objectives

Biomechanical preparation (BMP) of primary teeth often involves using hand and rotary instruments. This study aimed to assess the effectiveness of hand and rotary instruments during BMP in primary teeth.

Methods

A thorough search for relevant systematic reviews and meta-analyses (SRMAs) was conducted in four databases, including MEDLINE, EMBASE, Google Scholar, and the Cochrane Library. The primary outcome assessed was the instrumentation time (IT) for BMP, and the identified SRMAs were qualitatively analysed using the ROBIS tool. Furthermore, quantitative analysis, evidence stratification, and GRADE analysis of eligible SRMAs were performed using the browser-based R package metaumbrella software.

Results

Six SRMAs addressing the research question were included, with five being evaluated as having a high risk of bias (ROB). The findings indicated that the IT required for BMP in primary teeth was 3.2 min less (95% CI = 1.52 to 4.93; I2 = 96%; P = < 0.001) using rotary instruments compared to hand instruments, with a ‘class IV’ evidence stratification and ‘very low’ class of evidence.

Conclusions

Based on the existing evidence, it can be inferred that there is insufficient quality data to recommend the use of rotary instruments over hand instruments in primary teeth.

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Fig. 5: Quantitative analysis of the instrumentation time, obturation quality and obturation time outcomes.

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Data availability

The data supporting this article can be made available by the corresponding author upon request.

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Funding

The author(s) received no specific funding for this work.

Author information

Authors and Affiliations

  1. Department of Dentistry, All India Institute of Medical Sciences, Rajkot, India

    Arun Kumar Patnana & Satya Narain

  2. Department of Community and Family Medicine, All India Institute of Medical Sciences, Rajkot, India

    Krupal Joshi

  3. Department of Pedodontics and Preventive Dentistry, Government Dental College and Hospital, Ahmedabad, India

    Shantanu Choudhari

  4. Department of Microbiology, All India Institute of Medical Sciences, Rajkot, India

    Ashwini Agarwal

  5. Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, India

    Pravin Kumar

Authors
  1. Arun Kumar Patnana
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  2. Krupal Joshi
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  4. Shantanu Choudhari
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  5. Ashwini Agarwal
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Contributions

AP contributed to conceptualisation, preparation of methodology, conducting the data curation, investigation, project administration, writing of the original draft, review and editing, Software management, Validation, Formal analysis, Visualisation and Final approval. KJ contributed to conceptualisation, preparation of methodology, conducting the data curation, investigation, validation, formal analysis, review and editing and final approval of the manuscript. SN contributed to conceptualisation, project administration, review and editing and final approval of the manuscript. SC contributed to conceptualisation, preparation of methodology, project administration, review and editing and final approval of the manuscript. AA contributed to conceptualisation, preparation of methodology, project administration, review and editing and final approval of the manuscript. PK contributed to conceptualisation, preparation of methodology, conducting the data curation, investigation, project administration, review and editing, validation, formal analysis, visualisation and final approval of the manuscript.

Corresponding author

Correspondence to Arun Kumar Patnana.

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Competing interests

The authors declare no conflicts of interest. The review was approved by the Institutional Ethics Committee with the reference code AIIMS.Rajkot/IEC/41/2024.

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Patnana, A.K., Joshi, K., Narain, S. et al. Effectiveness of hand and rotary instrumentations during biomechanical preparation in primary teeth: an umbrella review with evidence stratification. Evid Based Dent 26, 71 (2025). https://doi.org/10.1038/s41432-024-01080-w

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  • DOI: https://doi.org/10.1038/s41432-024-01080-w

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