The GentleWave® Difference isn’t just in the patient experience—it is proven in post-procedure radiographic examination. The far-reaching capabilities of the GentleWave Procedure can be visualized in the following case study gallery, evidencing its ability to locate and efficiently clean the deepest, most complex portions of the root canal system2,3 that are frequently left untouched by standard root canal therapy.4
4 Paqué F et al. (2010) J Endod. 36:703-7
Upon post-operative radiographic examination, multiple lateral canals within the apical third of the palatal and distobuccal canals as well as an isthmus between the mesiobuccal canals were visualized. Upon contact with the patient three days post-operative, the patient reported no discomfort.
In a single visit, three canals were prepared to an apical diameter of 20/04, followed by the GentleWave® Procedure to clean and disinfect the canals. Following obturation, an isthmus communication between the fused mesiobuccal and palatal roots was noted. The unusual PAX findings were evaluated by CBCT. An apical delta containing multiple exits was discovered in the palatal canal. The GentleWave Procedure cleaned a deep split isthmus between the mesiobuccal canal and palatal canal, which otherwise may have been left uncleaned and unfilled.
"Obturation revealed the GentleWave® Procedure debrided a mid-root and apical isthmus as well as multiple exits in the palatal canal, in the apical third of the mesiobuccal-palatal root formation and connections."
The patient reported no pain two days postoperatively (after reporting a preoperative pain level of 8 on an 11-point verbal pain scale). This case highlights the clinical significance of utilizing the GentleWave Procedure for cleaning complex apical anatomy during endodontic therapy.
In a single visit, the GentleWave® Procedure was able to effectively clean and disinfect this upper-right first molar. The tooth was diagnosed with pulp necrosis and symptomatic apical periodontitis. The mesiobuccal and distobuccal canals were shaped to a 20/.04. I was unable to reach the apical third of the palatal canal with files. Post GentleWave Procedure and obturation, this unreachable anatomy was revealed.
"In my experience, without the cleaning ability of the GentleWave® Procedure, standard RCT wouldn’t have allowed me to obtain the same result, particularly in the palatal canal."
A 61-year-old male was referred by his dentist for endodontic examination of tooth #4. The diagnosis was necrotic pulp and asymptomatic apical periodontitis. The tooth was accessed and instrumented to size 17/.06. The GentleWave® Procedure was used to clean and disinfect the root canal system and was followed by obturation with warm vertical condensation. Given the file’s inability to completely remove bacteria and biofilm, many clinicians feel that a two-visit approach to root canal therapy is prudent, especially in necrotic teeth. The GentleWave System’s ability to reach deep into dentinal tubules and other complex anatomy allows for the confidence to treat patients with a one-visit procedure.
A 40-year-old male presented with severe intermittent pain on the lower left side of the mouth for two months. His diagnosis was pulpal necrosis and symptomatic apical periodontitis. The old filling material and underlying carious lesion were removed and missing tooth structure was restored. The tooth was prepared with conservative straight-line access, and the canals were instrumented to size 20/.07. The GentleWave® Procedure was employed to clean and disinfect the root canal system, followed by obturation with warm vertical technique. Post-procedure, an isthmus was visualized between the two mesial canals, and a lateral canal and an apical delta were seen on the distal canal. Evaluation at 6, 9 and 18 months showed the tooth was asymptomatic. Significant bone regrowth with complete periradicular healing were evident at 18-month recall.
A tooth’s survivability is greatly reduced when there’s a crack at or near the level of its roots. In this case, tooth #31 was cracked with a diagnosis of pulpal necrosis and symptomatic apical periodontitis. Initial recommendation was tooth extraction, but the patient’s preference was to save the tooth. The GentleWave® Procedure was our best approach to preserve as much of the remaining structural integrity of the root. In a single visit and with minimal instrumentation, the GentleWave Procedure thoroughly cleaned and disinfected the root canal system to promote tooth healing.
"With minimal instrumentation, I was able to depend on the GentleWave® Procedure to thoroughly disinfect the root canal system. And for healing to occur in the presence of a crack is even more impressive."
At 6-month recall, the results are impressive. The patient is asymptomatic and showing excellent healing.