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| Title |
GentleWave Results in Superior Debridement as Compared to Traditional Canal Debridement Techniques |
| Clinical Question |
In teeth that are endodontically treated, does GentleWave result in superior debridement as compared to traditional canal debridement techniques? |
| Clinical Bottom Line |
In teeth that are endodontically treated, GentleWave results in superior debridement of pulpal tissue and bacterial toxins as compared to traditional irrigation techniques. This is confirmed by multiple in vitro studies in which GentleWave outperformed passive ultrasonic irrigation (PUI) and needle irrigation in removal of debris. However, more data concerning the removal of bacteria, toxins, and organic tissue in vitro and in vivo is required to solidify these findings as these combined studies have a relatively small sample size. Furthermore, GentleWave is expensive to both the practitioner and the patient, which decreases its availability and practicality to many doctor/patient groups. |
| Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| #1) 26275599 | Molina / 2015 | 45 Extracted Molars | In Vitro Study | | Key results | GW (GentleWave) resulted in significantly better debridement in the middle and apical thirds of the teeth, particularly in the mesial roots of mandibular molars and MB roots of maxillary molars (97.2% complete debridement as compared to 67.8% using traditional irrigation techniques). | | #2) 31731396 | Choi / 2019 | 47 Extracted Molars | In Vitro Study | | Key results | GentleWave demonstrated significantly greater reduction in biofilm within the main canal-especially the apical region-and isthmuses of mesial roots of mandibular molars and mesiobuccal roots of maxillary molars when compared to conventional rotary and passive ultrasonic irrigation (p< 0.001). In the main canals, the GentleWave group showed a median biofilm score of 0 (no biofilm), while passive ultrasonic irrigation (PUI) had a median score of 2 (presence of well-defined biofilm) (P=0.003). | | #3) 35247369 | Velardi / 2022 | 60 Extracted maxillary 1st Premolars with 2 roots | In Vitro Study | | Key results | There were two GW groups: one that was shaped up to a 15/.04 and another shaped up to 35/.04. There were two PUI groups: one that was shaped to 15/.04 and another shaped to 35/.04. “GW + MIT and GW + CIT were the most effective protocols against E. faecalis lipoteichoic acid (LTA), with no difference between them (P > 0.05). PUI + CIT was more effective than PUI + MIT (P < 0.05) but less effective than GW + MIT and GW + CIT (P < 0.05). E. faecalis LTA was recovered from 100% of the root canals after PUI + MIT and PUI + CIT. In contrast, no E. faecalis LTA was detected in 42% of the root canals after GW + MIT and GW + CIT.” | |
| Evidence Search |
Gentlewave[All Fields] AND (("biofilm"[All Fields] AND "removal"[All fields]) OR "faecalis"[All Fields] OR ("root"[All Fields] AND "canal"[All Fields] AND "debridement"[All Fields])) |
Comments on
The Evidence |
After completing a comprehensive review of the current evidence we selected 3 studies as the best current evidence. An in vitro study from Molina showed that GentleWave had a 30% better debridement of mesial roots in mandibular molars and mesial buccal roots of maxillary molars compared to traditional irrigation (p<0.005). In another in vitro study by Choi in 2019, both GentleWave and passive ultrasonic irrigation with conventional instrumentation was compared in the removal of E. Faecalis. In this study, SEM showed there was better debridement in both the apical and middle regions of mesial roots on maxillary and mandibular molars (p=0.003). Another study by Velardi compared passive ultrasonic irrigation of canals instrumented to different sizes including 15/.04 and 35/.04 in comparison to a GentleWave group also instrumented to these sizes. The results showed that both GentleWave groups were more effective at the removal of E. Faecalis when compared to both passive ultrasonic irrigation groups (P<0.05). When sampled for E. Faecalis LTA, 100% of the PUI groups had LTA detected, while LTA was only detected in 42% of GW groups. These data are clinically relevant, because we know that a more complete debridement of organic and bacterial material results in higher success rates. While all of these studies show promising results for GentleWave efficiency, there are limitations. All are well designed in vitro studies but are considered a lower level of evidence compared to clinical trials. However, all of these in vitro studies have good P-values, indicating significance to their data. Linking the effects of these results to clinical practice would require in vivo studies that investigate the clinical benefits of using GentleWave systems. Furthermore, two of these studies measured biofilm removal for GentleWave in comparison to passive ultrasonic irrigation and not conventional irrigation. While many endodontists use passive ultrasonic irrigation clinically, there is still a vast amount of endodontics performed through the conventional approach so without a comparison to both treatment modalities we cannot make an accurate conclusion. One final discussion point is that for the Molina study, there are two authors on this article that work for Sonedo (GentleWave developer), and Sonedo also gave the equipment that contributed to the Velardi study. The studies are high quality, but further investigation is warranted due to possible conflict of interests and the lack of current evidence. |
| Applicability |
These studies provide limited evidence to the superior action of GentleWave in debriding root canal systems, specifically in cases of complex anatomy. While promising, more independent studies with no conflict of interest are needed to assess the capabilities of GentleWave systems as compared to tried-and-true debridement and disinfection methods that are more cost-effective. In vivo studies are needed to show the clinical significance of the current evidence. These devices carry a significant financial burden to the provider and the patient, solidifying the need to demonstrate substantial advantages to their use over traditional methods. |
| Specialty/Discipline |
(Endodontics) |
| Keywords |
GentleWave, Gentle Wave, Canal debridement, biofilm removal
|
| ID# |
3569 |
| Date of submission: |
10/22/2024 |
| E-mail |
albarrak@livemail.uthscsa.edu |
| Author |
Marwan Al-Barrak |
| Co-author(s) |
David Durfee, Darian Shomali |
| Co-author(s) e-mail |
durfeed@livemail.uthscsa.edu , shomali@livemail.uthscsa.edu |
| Faculty mentor/Co-author |
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| Faculty mentor/Co-author e-mail |
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Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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