• Arshad Hasan Dow Dental College, Dow University of Health Sciences, Karachi http://orcid.org/0000-0003-4432-0308
  • Javeria Ali Khan Dow Dental College Dow University of Health Sciences. Karachi
  • Syed Abrar Ali Hamdard College of Medicine and Dentistry, Hamdard University
  • Farhan Raza Khan Aga Khan University Hospital
  • Farah Naz Dow International Dental College, Dow University of Health Sciences. Karachi


Background: Preparation of root canal according to its desired anatomy and complete disinfection is a laborious task. Several factors influence the endodontic treatment including operator’s skill and knowledge, anatomy of the tooth, the instruments and equipment used. In the past stainless-steel instruments were used to prepare the root canal but it causes many iatrogenic errors. Nickel titanium instruments evolved to overcome the iatrogenic damages caused by stainless steel instruments. Keeping this in mind a comparative study was conducted on the clinical work of dental intern using stainless steel files and progressively taper nickel titanium instruments. The objective of this study was to compare the performance of interns using either stainless Steel or progressively tapered hand operated NiTi instruments. Methods: This retrospective study included post-treatment radiographs of root canal treatments performed by interns by using either stainless steel files or NiTi Protaper files, in the endodontic department of Hamdard University Dental Hospital, Karachi, Pakistan. It was a 10-year audit, from 2008 to 2018, of endodontic performance. A total of 1219 post treatment radiographs of good quality and showing at least 2mm periapical area beyond the root apex were included. In SS group, preparation were performed by step back method, while in NiTi group the Protaper instruments for hand were used. Scoring criteria was used to evaluate technical quality. The data was analysed using SPSS for windows version 17.0. Chi-square test was used to determine difference in proportions between the outcomes in SS and NiTi groups at p£0.05. Results: A total of 1219 radiographs were included out of which 584 (47.9%) belonged to SS and 635 (52.1%) to NiTi group. Overall satisfactory performance was in 553 (45.4%) teeth. Treatment done with NiTi was only marginally better than that achieved with SS files (NiTi n=298 (46.9%), SS n=255 (43.7%)). In the SS group, there were more overfills and internal and external transportation (p<0.001). NiTi reported more cases of inadequate lateral seal and separated instruments (p<0.05). Conclusion:  Endodontic performance of interns was not improved with progressive taper NiTi manual instruments.

Author Biographies

Arshad Hasan, Dow Dental College, Dow University of Health Sciences, Karachi

Princiapl Dow Dental College, Head, Department of Operative Dentistry

Javeria Ali Khan, Dow Dental College Dow University of Health Sciences. Karachi

Assistant Professor, Department of Operative Dentistry

Syed Abrar Ali, Hamdard College of Medicine and Dentistry, Hamdard University

Professor and HOD Operative Dentisrry

Farhan Raza Khan, Aga Khan University Hospital

Associate Professor, Dental Section.

Farah Naz, Dow International Dental College, Dow University of Health Sciences. Karachi

Professor and HOD Operative Dentistry


Burke FM, Lynch CD, Ní RíOrdáIn R, Hannigan A. Technical quality of root canal fillings performed in a dental school and the associated retention of root-filled teeth: a clinical follow-up study over a 5-year period. J Oral Rehabil 2009;36(7):508–15.

Schafer E, Schulzbongert U, Tulus G. Comparison of Hand Stainless Steel and Nickel Titanium Rotary Instrumentation: A Clinical Study. J Endod 2004;30(6):432–5.

Rafeek RN, Smith WA, Mankee MS, Coldero LG. Radiographic evaluation of the technical quality of root canal fillings performed by dental students. Aust Endod J 2012;38(2):64–9.

Vadhera N, Makkar S, Kumar R, Aggarwal A, Pasricha S. Practice profile among endodontists in India: A nationwide questionnaire survey. Ind J Oral Sci 2012;3(2):90.

Gupta R, Rai R. The adoption of new endodontic technology by Indian dental practitioners: a questionnaire survey. J Clin Diagn Res 2013;7(11):2610–4.

Hasan A, Ali SA, Syed S. Quality of Endodontic Treatment Performed by House Officers. In Lahore: International Association for Dental Research; [Internet]. 2011 [cited 2018 Sep 20]. Available from: https://iadr.abstractarchives.com/abstract/pakistan11-151828/quality-of-endodontic-treatment-performed-by-house-officers

Hayes SJ, Gibson M, Hammond M, Bryant ST, Dummer PM. An audit of root canal treatment performed by undergraduate students. Int Endod J 2001;34(7):501–5.

Er O, Sagsen B, Maden M, Cinar S, Kahraman Y. Radiographic technical quality of root fillings performed by dental students in Turkey. Int Endod J 2006;39(11):867–72.

Pettigrew LK, Jauhar S, Lynch CD, Savarrio L, Carrotte P, Hannigan A. An audit of the quality of root canal treatments performed by undergraduate dental students on single-rooted teeth in Glasgow dental hospital and School. Eur J Prosthodont Restor Dent 2007;15(2):72–6.

Ilgüy D, Ilgüy M, Fisekçioglu E, Ersan N, Tanalp J, Dölekoglu S. Assessment of root canal treatment outcomes performed by Turkish dental students: results after two years. J Dent Educ 2013;77(4):502–9.

Cheung GSP, Liu CSY. A Retrospective Study of Endodontic Treatment Outcome between Nickel-Titanium Rotary and Stainless Steel Hand Filing Techniques. J Endod 2009;35(7):938–43.

Abu-Tahun I, Al-Rabab’ah MA, Hammad M, Khraisat A. Technical quality of root canal treatment of posterior teeth after rotary or hand preparation by fifth year undergraduate students, The University of Jordan. Aust Endod J 2014;40(3):123–30.

Alrahabi M. Comparative study of root-canal shaping with stainless steel and rotary NiTi files performed by preclinical dental students. Technol Health Care 2015;23(3):257–65.

Jungnickel L, Kruse C, Vaeth M, Kirkevang LL. Quality aspects of ex vivo root canal treatments done by undergraduate dental students using four different endodontic treatment systems. Acta Odontol Scand 2018;76(3):169–74.

Gluskin AH, Brown DC, Buchanan LS. A reconstructed computerized tomographic comparison of Ni-Ti rotary GT files versus traditional instruments in canals shaped by novice operators. Int Endod J 2001;34(6):476–84.

Cohen S, Burns RC, editors. Pathways of the pulp. 8th ed. St. Louis: Mosby, 2002; p.1031.

Cohen S. Cohen’s pathways of the pulp. Eleventh edition. Hargreaves KM, Berman LH, Rotstein I, editors. St. Louis, Missouri: Elsevier, 2016; p.907.

Kirkevang LL, Ørstavik D, Hörsted-Bindslev P, Wenzel A. Periapical status and quality of root fillings and coronal restorations in a Danish population. Int Endod J 2000;33(6):509–15.

Eleftheriadis GI, Lambrianidis TP. Technical quality of root canal treatment and detection of iatrogenic errors in an undergraduate dental clinic. Int Endod J 2005;38(10):725–34.

Khabbaz MG, Protogerou E, Douka E. Radiographic quality of root fillings performed by undergraduate students: Quality of root fillings. Int Endod J 2010;43(6):499–508.

Ribeiro DM, Réus JC, Felippe WT, Pacheco-Pereira C, Dutra KL, Santos JN, et al. Technical quality of root canal treatment performed by undergraduate students using hand instrumentation: a meta-analysis. Int Endod J 2018;51(3):269–83.

Haug SR, Solfjeld AF, Ranheim LE, Bårdsen A. Impact of Case Difficulty on Endodontic Mishaps in an Undergraduate Student Clinic. J Endod 2018;44(7):1088–95.

Kerekes K, Tronstad L. Long-term results of endodontic treatment performed with a standardized technique. J Endod 1979;5(3):83–90.

Benenati F, Khajotia S. A Radiographic Recall Evaluation of 894 Endodontic Cases Treated in a Dental School Setting. J Endod 2002;28(5):391–5.

Elsayed RO, Abu-bakr NH, Ibrahim YE. Quality of root canal treatment performed by undergraduate dental students at the University of Khartoum, Sudan: Root Canal Treatment Quality. Aust Endod J 2011;37(2):56–60.

Elemam RF, Abdul Majid ZS, Groesbeck M, Azevedo ÁF. Quality of Root Canals Performed by the Inaugural Class of Dental Students at Libyan International Medical University. Int J Dent 2015;2015:135120.

Sheikh A, Rashid S, Ali FM, Abdullah F. Radiographic Quality of Root Canal Filling Performed by House Officers at A Teaching Institute in Karachi, Pakistan. J Pak Dent Assoc 2019;28(02):56–62.

Hendi SS, Karkehabadi H, Eskandarloo A. Iatrogenic Errors during Root Canal Instrumentation Performed by Dental Students. Iran Endod J 2018;13(1):126–31.

Donnelly A, Coffey D, Duncan HF. A re-audit of the technical quality of undergraduate root canal treatment after the introduction of new technology and teaching practices. Int Endod J 2017;50(10):941–50.

Fong JYM, Tan VJH, Lee JR, Tong ZGM, Foong YK, Tan JME, et al. Clinical audit training improves undergraduates’ performance in root canal therapy. Eur J Dent Educ 2018;22(3):160–6.

Ali SA, Hussain M, Shahzad M, Nafees H. Frequency of Procedural Errors during Root Canal Treatment Performed by House Officers in Private Teaching Dental Hospital. J Liaquat Univ Med Health Sci 2019;18(01):55–9.

Gergi R, Rjeily JA, Sader J, Naaman A. Comparison of Canal Transportation and Centering Ability of Twisted Files, Pathfile-ProTaper System, and Stainless Steel Hand K-Files by Using Computed Tomography. J Endod 2010;36(5):904–7.

Abrar E, Baig QA, Afaq A, Anzar W. Efficacy of different endodontic procedure with post-operative pain and Quality of Life (QoL) using (OHIP-4). Prof Med J 2021;28(02):218–23.



Most read articles by the same author(s)

1 2 > >>