A History of Proven Efficacy

A 31-year-old female patient presented to our clinic with a chief complaint of pain in the lower right jaw. Tooth #30 was diagnosed with pulp necrosis/symptomatic apical periodontitis.

By the end of canal instrumentation, four canals had been located: two in the mesial and two in the distal roots. Following the GentleWave^® Procedure, two tiny orifices became noticeable between MB and ML canals; they turned out to be two mid-mesial canals. Pre-op CBCT had not hinted at the presence of mid-mesial canals.

The immediate post-op radiograph shows the filling of six canals with gutta-percha and BC Sealer™. The two mid-mesial canals join each other at the apical half, and all four canals in the mesial root join at the apical 3 mm level.

“Without the cleaning ability of the GentleWave Procedure, I would have missed the additional two middle canals, which could have resulted in a persistent infection.”

The patient presented with biting and palpation tenderness localized to tooth #19 with a draining sinus tract. Probing 12+ mm to the distal apex posed a prognosis challenge. The endo-perio lesion is a condition characterized by the association of periodontal and pulpal disease in the same dental element. Diagnosis, prognosis and treatment planning are complicated due to the influence of pulp pathology, which may cause periodontal involvement and vice versa.

Pulpal diagnosis was necrotic pulp with an apical diagnosis of chronic apical abscess. The GentleWave^® Procedure gave me the confidence to complete disinfection and finish treatment in a single visit. Re-evaluation in four weeks demonstrated resolution of the sinus tract and probing depths. At three months, this case demonstrated nearly complete osseous regeneration of previous low-density areas.

“The resolution of symptoms is one factor. However, the ‘early healing’ I am seeing in my practice with the GentleWave^® Procedure is extraordinary.”

In a single visit, canals were prepared using two rotary files to a final apical diameter of #20, then followed by the Gentlewave^® Procedure. After obturation, radiographic examination revealed at least two uninstrumented inter-canal isthmi and a lateral canal. At the 6-month recall, radiographs revealed that the GentleWave^® Procedure resulted in complete healing of apical periodontitis.

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.

This patient’s first molar, diagnosed with necrotic pulp with symptomatic apical periodontitis, was cleaned and disinfected with the GentleWave® Procedure in a single visit. Post-GentleWave Procedure, intricate apical anatomy with at least eight visible portals of exit was revealed.

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.