Erdogan Elvis Șachir, Cristina Gabriela Pușcașu, Gheorghe Raftu, Cristina Bartok-Nicolae, Claudia Elena Sin, Steliana Gabriela Buștiuc, Aureliana Caraiane
ABSTRACT
Aim of the study To evaluate whether manual instrumentation outperforms rotary instrumentation in maintaining apical patency and preserving canal anatomy in severely curved root canals. Materials and methods Forty extracted human teeth with Schneider curvature >25° were allocated to manual (n=20) or rotary (n=20) instrumentation groups. After manual glide-path establishment, the manual group used a step-back hand-file technique, while the rotary group employed a heat-treated NiTi crown-down sequence. Patency checks with a size #10 K-file and periapical radiographs were performed after each step. Outcomes included patency success rate, time to initial patency, frequency of re-negotiation events, operator difficulty rating (0–10), and radiographic transportation score (0 = none, 1 = minimal, 2 = moderate). Statistical significance was set at α = 0.05. Results Manual instrumentation maintained apical patency in 100% of cases versus 80% for rotary (p = 0.02). Time to initial patency was similar, but rotary cases required additional time for re-negotiation when patency was lost. Operator difficulty was lower for manual (mean ≈3.2) than rotary (≈5.5; p < 0.001). Radiographic transportation was minimal in manual (mean ≈0.1) versus higher in rotary (≈0.8; p < 0.01). No procedural errors occurred in the manual group; rotary exhibited moderate transportation in some cases. Conclusions For severely curved canals, manual instrumentation ensures more reliable patency maintenance, lower perceived difficulty, and better curvature preservation than rotary techniques. Clinicians should emphasize manual glide-path shaping in complex anatomies and, if rotary files are used, apply them cautiously with frequent patency checks.
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