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VOLUME 19 , ISSUE 3 ( March, 2018 ) > List of Articles


Utilizing the GentleWave® System for Debridement of Undetected Apical Anatomy

Michael W Ford

Citation Information : Ford MW. Utilizing the GentleWave® System for Debridement of Undetected Apical Anatomy. J Contemp Dent Pract 2018; 19 (3):345-351.

DOI: 10.5005/jp-journals-10024-2264

License: CC BY 3.0

Published Online: 01-01-2015

Copyright Statement:  Copyright © 2018; The Author(s).


Aim and background

Debriding and disinfecting complex anatomies within the root canal system pose a major challenge during root canal therapy. Even with current chemomechanical techniques, debris and bacterial remnants are commonly left behind, which are generally believed to increase the risk of endodontic failure. This case details the use of a new technique to debride complex apical anatomy in a maxillary molar.

Case report

A 48-year-old female presented to the clinic with a chief complaint of increasing pain in her tooth. Clinical examination of the right first maxillary molar (#3) revealed moderate sensitivity to percussion and mild sensitivity to palpation. A pulpal diagnosis of symptomatic irreversible pulpitis and a periapical diagnosis of symptomatic apical periodontitis were made. Mechanical instrumentation was performed using rotary file size #25/.04 for the mesiobuccal and distobuccal canals and size #25/.06 for the palatal canal to create a fluid path and enable obturation of the root canal system following the GentleWave® Procedure. The GentleWave Procedure was completed using Multisonic Ultracleaning™ for complete debridement and disinfection of the root canal system. The tooth was obturated using a warm vertical continuous wave obturation technique. Postoperative radiographs revealed complex anatomy within the apical third that was undetected both during pre-operative radiography and mechanical instrumentation. The palatal canal exhibited a complex apical delta with multiple points of exit, and the mesiobuccal canal revealed an undetected lateral canal within the apical third that had a separate and distinct egress.

Conclusion and clinical significance

It is important for the clinician to debride and disinfect complex anatomy within the root canal system to reduce the risk of endodontic failure. This case report highlights the clinical significance of utilizing the GentleWave Procedure for detecting complex apical anatomy during endodontic therapy.

How to cite this article

Ford MW. Utilizing the GentleWave® System for Debridement of Undetected Apical Anatomy. J Contemp Dent Pract 2018;19(3):345-351.

  1. Analysis of the cause of failure in nonsurgical endodontic treatment by microscopic inspection during endodontic microsurgery. J Endod 2011 Nov;37(11):1516-1519.
  2. Failure of endodontic treatment: the usual suspects. Eur J Dent 2016 Jan-Mar;10(1):144-147.
  3. Fate of the tissue in lateral canals and apical ramifications in response to pathologic conditions and treatment procedures. J Endod 2010 Jan;36(1):1-15.
  4. Endodontics: part 4. Morphology of the root canal system. Br Dent J 2004 Oct;197(7):379-383.
  5. Incidence of accessory canals in Japanese anterior maxillary teeth following root canal filling ex vivo. Int Endod J 2010 May;43(5):370-376.
  6. Frequency, location, and direction of the lateral, secondary, and accessory canals. J Endod 1975 Nov;1(11):361-366.
  7. The enigma of the lateral canal. Dent Clin North Am 1984 Oct;28(4):833-852.
  8. The clinical significance and management of apical accessory canals in maxillary central incisors. J Am Dent Assoc 2005 Mar;136(3):331-335.
  9. Clinical study of refractory apical periodontitis treated by apicectomy. Part 1. Root canal morphology of resected apex. Int Endod J 1998 Jan;31(1):53-56.
  10. Maxillary molars with two palatal roots: a retrospective clinical study. J Endod 1991 Feb;17(2):80-84.
  11. Apical surgery: endoscopic findings at the resection level of 168 consecutively treated roots. Int Endod J 2011 Apr;44(4):290-302.
  12. Root canal morphology and its relationship to endodontic procedures. Endod Topics 2005 Mar;10(1):3-29.
  13. Radiographic detection of accessory/lateral canals: use of radio visio graphy and hypaque. J Endod 1995 Apr;21(4):185-190.
  14. Feasibility of cone-beam computed tomography in detecting lateral canals before and after root canal treatment: an ex vivo study. J Endod 2017 Jun;43(6):1014-1017.
  15. Contemporary endodontic retreatments: an analysis based on clinical treatment findings. J Endod 2002 Dec;28(12):834-836.
  16. Tissue dissolution by a novel multisonic ultracleaning system and sodium hypochlorite. J Endod 2014 Aug;40(8):1178-1181.
  17. Apical pressure created during irrigation with the gentleWave™ system compared to conventional syringe irrigation. Clin Oral Investig 2016 Sep;20(7):1525-1534.
  18. Evaluation of root canal debridement of human molars using the GentleWave system. J Endod 2015 Oct;41(10):1701-1705.
  19. Six-month healing success rates after endodontic treatment using the novel GentleWave™ system: the pure prospective multi-center clinical study. J Clin Exp Dent 2016 Jul;8(3):e290-e298.
  20. 12-month healing rates after endodontic therapy using the novel GentleWave system: a prospective multicenter clinical study. J Endod 2016 Jul;42(7):1040-1048.
  21. Effects of four Ni-Ti preparation techniques on root canal geometry assessed by micro computed tomography. Int Endod J 2001 Apr;34(3):221-230.
  22. Eradication of endodontic infection by instrumentation and irrigation solutions. Endod Topics 2005 Mar;10(1):77-102.
  23. Advances in endodontics: potential applications in clinical practice. J Conserv Dent 2016 May;19(3):199-206.
  24. Hard-tissue debris accumulation analysis by high-resolution computed tomography scans. J Endod 2009 Jul;35(7):1044-1047.
  25. Accumulated hard tissue debris levels in mesial roots of mandibular molars after sequential irrigation steps. Int Endod J 2011 Feb;44(2):148-153.
  26. In vivo efficacy of three different endodontic irrigation systems for irrigant delivery to working length of mesial canals of mandibular molars. J Endod 2012 Apr;38(4):445-448.
  27. Comparison of the effect of two endodontic irrigation protocols on the elimination of bacteria from root canal system: a prospective, randomized clinical trial. J Endod 2012 Nov;38(11):1479-1483.
  28. Efficacy of needle, ultrasonic, and endoactivator irrigation and photon-induced photoacoustic streaming in removing calcium hydroxide from the main canal and isthmus: an in vitro micro-computed tomography and scanning electron microscopy study. Photomed Laser Surg 2015 Jun;33(6):330-337.
  29. Effect of vapor lock on root canal debridement by using a side-vented needle for positive-pressure irrigant delivery. J Endod 2010 Apr;36(4):745-750.
  30. Evaluation of 4 different irrigating systems for apical extrusion of sodium hypochlorite. J Endod 2015 Sep;41(9):1530-1534.
  31. Comparison of the antimicrobial efficacy of the endovac system and conventional needle irrigation in primary molar root canals. J Clin Pediatr Dent 2017 Sep;41(4):284-288.
  32. Supplemental steps for removing hard tissue debris from isthmus-containing canal systems. J Endod 2016 Nov;42(11):1677-1682.
  33. Outcome of primary root canal treatment: systematic review of the literature–part 1. Effects of study characteristics on probability of success. Int Endod J 2007 Dec;40(12):921-939.
  34. Effect of different apical preparation sizes on outcome of primary endodontic treatment: a randomized controlled trial. J Endod 2012 Oct;38(10):1309-1315.
  35. Healing of periapical radiolucencies after nonsurgical endodontic therapy. Oral Surg Oral Med Oral Pathol 1991 May;71(5):620-624.
  36. Evaluating penetration depth of treatment fluids into dentinal tubules using the GentleWave® system. Dentistry 2016 Mar;6:366.
  37. Evaluation of root canal dentin erosion after different irrigation methods using energy-dispersive X-ray spectroscopy. J Endod 2016 Dec;42(12):1834-1839.
  38. In vitro study of calcium hydroxide removal from mandibular molar root canals. J Endod 2015 Apr;41(4):553-558.
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