Background: Pulpectomy is an important treatment modality for primary teeth with irreversible pulpitis or pulpal necrosis, with the objective of eliminating infection while retaining the tooth until its physiological exfoliation. Root canal instrumentation is a critical component of pulpectomy because effective cleaning and shaping facilitate disinfection and obturation. However, instrumentation of primary teeth is challenging because of their complex root canal anatomy, thin dentinal walls, pronounced root curvature and physiological root resorption.

Aim: This narrative review discusses the anatomical considerations influencing root canal instrumentation in primary teeth and critically reviews conventional hand instrumentation and contemporary nickel–titanium (NiTi) rotary and reciprocating systems, with emphasis on their clinical advantages, limitations and relevance to paediatric endodontic practice.

Main findings: Stainless-steel hand files remain useful because of their tactile feedback, controlled manipulation and ability to negotiate narrow and complex canals. However, conventional hand instrumentation is relatively time-consuming and may result in greater dentine removal in certain situations. NiTi rotary systems provide greater flexibility, improved shaping efficiency, reduced instrumentation time and more predictable tapered canal preparations. Several in vitro and ex vivo studies have reported comparable cleaning efficacy between hand and rotary techniques while demonstrating a significant reduction in instrumentation time with rotary systems. Nevertheless, rotary instrumentation has limitations, including cost, the need for specialised training, reduced tactile feedback and the possibility of leaving fins, isthmuses and other irregularities inadequately instrumented.