Abstract
Rotary instrumentation in primary teeth pulpectomy is gaining popularity due to its potential to improve procedural efficiency and clinical outcomes. While existing systematic reviews and meta-analyses (SRMAs) have explored rotary techniques, comparative evaluations of specific clinical endpoints, particularly cleaning effectiveness and postoperative pain, remain fragmented. This umbrella review synthesised evidence from SRMAs assessing rotary versus manual instrumentation in primary teeth, focusing on these two critical outcomes. A comprehensive literature search was conducted across six databases and grey literature until May 2025. Two eligible SRMAs were included: one addressed both cleaning effectiveness and postoperative pain, while the other focused solely on cleaning outcomes. Owing to clinical and statistical heterogeneity, meta-analysis was not feasible. Methodological quality appraisal using AMSTAR-2 rated one review as high confidence and the other as low confidence. According to the GRADE assessment, the certainty of evidence was low for cleaning effectiveness and moderate for postoperative pain, primarily due to inconsistency and imprecision. The findings suggest that rotary instrumentation may offer advantages in obturation quality and postoperative comfort in primary teeth. However, the limited number of high-confidence SRMAs and heterogeneity in outcome reporting underscore the need for standardised research protocols in pediatric endodontics.