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| Title |
Is GentleWave a Viable Alternative to Two-Visit Calcium Hydroxide Treatment? |
| Clinical Question |
In primary nonsurgical root canal treatment of mature permanent teeth with pulp necrosis, does single-visit root canal treatment using GentleWave (GW) irrigation result in a comparable reduction of bacterial load in the root canal compared with two-visit root canal treatment using calcium hydroxide (Ca(OH)2) as an intracanal medicament? |
| Clinical Bottom Line |
While there is significant in-vitro evidence to support the improved reduction of bacterial load in the root canals of teeth treated with GW irrigation there is not enough in-vivo evidence to determine how effective GW is at reducing bacteria in a clinical setting. Clinical evidence does not show a significant effect of using Ca(OH)2. There are currently no studies that directly compare the reduction in bacterial load between using GW in a single visit or Ca(OH)2 in multiple visits. More research needs to be done to determine if GW can justifiably be used in a single visit fashion in lieu of using Ca(OH)2 as an intracanal medicament to reduce bacterial loads in necrotic teeth. |
| 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) 15448460 | Law, 2004 | 164 teeth | Systemic Review | | Key results | Initial cultures (S1) were positive in almost all canals (162 of 164). After instrumentation (S2), 101 canals (62%) registered a positive culture. The percentage of positive cultures at S2 ranged from 14% to 100% of test canals. After medication with Ca(OH)2 (S3), 45 (27%) canals of the overall test sample showed detectable bacterial growth. While the most effective treatment was instrumentation, Ca(OH)2 can reduce residual microbial flora further. GW was not included in this study. | | #2) 37983635 | Park, 2024 | 23 extracted mandibular molars with a history of pulp necrosis and periapical radiolucency | Ex-Vivo Study | | Key results | GW multisonic irrigation produced an estimated 2.6 log10 microbial reduction, which was significantly greater than the 1.6 log10 reduction achieved by ultrasonic irrigant activation using 6% NaOCl (p=0.048). It is not clear whether this is a clinically significant effect. Ca(OH)2 was not a treatment in this study. | | #3) 36681702 | Alquria, 2023 | 56 extracted single rooted mandibular premolars infected with 3 week old E. Faecalis and E.Coli biofilm | In-Vitro Study | | Key results | All tested protocols, (GW + MIT (minimally invasive technique), PUI (passive ultrasonic irrigation) + CIT (conventional instrumentation technique), and XP-EF (XP-endo Finisher) + CIT, significantly reduced bacteria, lipoteichoic acid (LTA) and lipopolysaccharide (LPS) (p<0.05). GW + MIT was significantly more effective than the other two protocols (p<0.05). GW reduced the mean bacteria count from 6.36 to 0.15 Log10, LTA from 595.3 to 113.8pg/mL, and LPS from 22.84 to 1.15EU/mL. This study did not look at the effects of Ca(OH)2. | |
| Evidence Search |
"Root Canal Irrigants"[Mesh] OR "GentleWave" OR "ultrasonic irrigation" OR "calcium hydroxide") AND ("Bacteria"[Mesh] OR "Biofilms"[Mesh] OR "lipopolysaccharide") AND "Endodontics"[Mesh] |
Comments on
The Evidence |
The Law 2004 study supported the use of Ca(OH)2 as an intracanal medicament to reduce the bacterial load in Root Canal Treatment. Neither the Park 2024 nor the Alquria 2023 were clinical studies, which limits their clinical relevance. Park used a PCR method to determine the number of bacteria and show dead bacterial products that may have been inactivated and not relevant to an in-vivo situation. Alquria used a culturing technique, but not all bacteria survived the culture and may not be represented by the CFUs. Despite that, there seems to be some evidence that GW may be a viable disinfection protocol that is as good as, if not better than, only using Ca(OH)2. However, in vitro and in vivo studies directly comparing the two are needed. |
| Applicability |
These findings directly translate to specialist endodontic practice treating complex root canal anatomies, necrotic pulps, and persistent apical periodontitis. While advanced multisonic systems offer superior debridement and permit minimally invasive instrumentation, adopting this technology introduces capital investment and workflow adaptation constraints compared to traditional Ca(OH)2 medication or standard passive ultrasonic irrigation. |
| Specialty/Discipline |
(Endodontics) |
| Keywords |
Endodontic Disinfection, GentleWave, Passive Ultrasonic Irrigation, Calcium Hydroxide, Biofilm, Apical Periodontitis
|
| ID# |
3773 |
| Date of submission: |
10/22/2026 |
| E-mail |
atherh@livemail.uthscsa.edu |
| Author |
Hunaiza Ather |
| Co-author(s) |
Riley Johnson |
| Co-author(s) e-mail |
Johnsonr15@livemail.uthealth.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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