Single-Visit, Root Canal Re-treatment Using Advanced Technology

Roberto E. DiVito, DDS, on the GentleWave® G4 System by Sonendo

Despite the best efforts of dentists, seemingly well-completed root canal treatments still fail because all of the pulpal tissue was not fully removed. The complex anatomy of many root canal systems makes it very difficult if not impossible to completely clean them using traditional methods of instrumentation and disinfection. For patients who undergo root canal therapy that fails, re-treatment using traditional methods may still not result in completely clean canals and often requires the excessive removal of tooth structure, which can result in the need for extraction.

At my practice, we often see patients who present with root canal treatments that have failed. In the past, we experienced the challenges associated with the use of traditional methods, but since adopting the GentleWave^® G4 System by Sonendo, I am able to offer these patients minimally invasive re-treatment that achieves superior cleaning and disinfection with the GentleWave^® Procedure. The GentleWave System is the first and only FDA-cleared system for root canal therapy that addresses the limitations of conventional methods by combining procedure fluid optimization, advanced fluid dynamics, and broad-spectrum acoustic energy to debride and disinfect the deepest regions of complex root canal systems.

In the GentleWave Procedure, the procedure fluids undergo a proprietary degassing process to ensure their unobstructed flow into the tooth. Then, as they enter the procedure instrument, fluid dynamics and acoustic energy are induced to create a vortical flow that propels the fluids throughout the root canal system to provide tissue debridement and dissolution as well as disinfection. The effectiveness of this process is further enhanced through controlled cavitation and multisonic activation, which physically disrupt debris and also help to accelerate the chemistry of the procedure fluids. In addition, the vortical flow lifts debris up and out of the canal and allows the procedure fluids to be continuously refreshed.

In the case presented here, the GentleWave Procedure was used to successfully re-treat a tooth that had previously undergone traditional root canal treatment. During the radiographic examination, it was revealed that tooth No. 18 demonstrated a periapical radiolucency (Figure 1 and Figure 2). It was also noted that tooth No. 19 had a fractured root, so it was extracted prior to the re-treatment of tooth No. 18. To begin, the patient was administered an anesthetic, and a rubber dam was placed to achieve isolation. Next a conservative removal of the existing gutta-percha was accomplished with minimal instrumentation using rotary files (Figure 3). A SoundSeal^® platform was then constructed on the tooth (Figure 4). To accomplish this, a matrix that is designed to precisely interlock was used to center the platform material over the tooth access, enabling the connection of the Clean Flow Procedure Instrument (Figure 5). An industry first innovation, the Clean Flow Procedure Instrument cleans and disinfects root canal anatomy from the outside of the tooth. It has been optimized to improve procedure fluid replenishment, and its indications have been expanded to include anterior teeth. After 8 minutes and 15 seconds, the CleanFlow procedure instrument was removed and the canals were dried. The molar system was then filled to complete the re-treatment in a single visit (Figure 6). The postoperative 2D and 3D radiographs demonstrated outstanding results (Figure 7). At the 1-month follow-up appointment, the patient reported no postoperative pain. Additional radiographs were acquired both before and after the final crown was seated (Figure 8 and Figure 9).

With the GentleWave System, I can provide my patients who require root canal treatment with superior cleaning and disinfection with minimal instrumentation, whether they present for re-treatment or a first-time procedure. Beyond achieving excellent results, the efficacy of the system results in shorter procedure times, and patients report experiencing reduced or no postoperative pain as a result of the rapid healing. As a result, I have more open chair time to see additional patients. By providing a more effective and less invasive way to accomplish root canal treatments that benefits patients and practitioners alike, the GentleWave System represents the future of endodontics.

Key Takeaways

1. The first and only FDA-cleared system for root canal therapy that addresses the limitations of conventional methods by combining procedure fluid optimization, advanced fluid dynamics, and broad-spectrum acoustic energy to debride and disinfect the deepest regions of complex root canal systems.

2. Helps doctors preserve more tooth structure, leading to reduced postoperative pain and fast healing for patients.

3. The CleanFlow procedure instrument is optimized to improve procedure fluid replenishment and expands the GentleWave System's indications to include anterior teeth.

4. Increased efficiency enables single-visit treatment, improving patient satisfaction and practice profitability.

Roberto E. DiVito, DDS
Private Practice
Scottsdale, Arizona

Manufacturer Information
Sonendo, Inc. • gentlewave.com/doctor • 844-766-3636