Title Use of the GentleWave System for Endodontic Irrigation Does Not Increase Postoperative Pain When Compared to Other Irrigation Methods
Clinical Question In patients undergoing nonsurgical root canal treatment, does use of the GentleWave System for irrigation as compared to other irrigation methods cause an increase in post-operative pain?
Clinical Bottom Line For patients undergoing nonsurgical root canal treatment, use of the GentleWave System for irrigation does not cause an increase in postoperative pain when compared to other irrigation methods. This is based on one randomized controlled trial with 36 patients. While the results are favorable, this study is underpowered. Future studies with a larger sample size are required to determine whether there is a significant difference in the incidence and intensity of postoperative pain between the two groups.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
32553417Grigsby/202036 patients/teeth requiring molar or premolar RCT Randomized Controlled Trial
Key results36 patients with molars or premolars needing root canal treatment were selected for this study. 72% of standard irrigation patients reported postoperative pain compared to 83.3% of GentleWave System patients. The pain intensity was higher for the standard irrigation group, but the difference was not statistically significant. Post-op pain occurred most frequently 6 hours post-treatment for both groups (P>.433). The authors conclude that there was no significant difference found with the incidence or intensity of pain when comparing the two irrigation types.
Evidence Search "Gentlewave"[All Fields] AND ("irrigant"[All Fields] OR "irrigants"[All Fields] OR "irrigate"[All Fields] OR "irrigated"[All Fields] OR "irrigates"[All Fields] OR "irrigating"[All Fields] OR "irrigational"[All Fields] OR "irrigator"[All Fields] OR "irrigators"[All Fields] OR "therapeutic irrigation"[MeSH Terms] OR ("therapeutic"[All Fields] AND "irrigation"[All Fields]) OR "therapeutic irrigation"[All Fields] OR "irrigation"[All Fields] OR "irrigations"[All Fields]) AND ("pain"[MeSH Terms] OR "pain"[All Fields])
Comments on
The Evidence
Validity: A comprehensive PubMed search for evidence on this clinical question returned one randomized controlled trial as the best current evidence comparing postoperative pain in patients that had GentleWave irrigation vs other irrigation methods. The patients were randomized into the experimental or control group with 18 patients per group. All patients were accounted for at the conclusion of the study. Possible confounding variables such as age or pulpal diagnosis were accounted for and tested for statistical significance in regards to the results. However, there were significant differences between the groups. For example, 14/18 cases in the GentleWave System group were mandibular teeth. This means that they required block anesthesia, which tends to last longer than anesthesia done through infiltration. Only 4/18 in the control group were mandibular teeth. Also, the control group had more pre-operative pain than the GentleWave System group, which means that they are more likely to have post operative pain. Therefore, the study had questionable internal validity due to these factors. One of the main weaknesses of this study is the sample size, which affects the external validity. While a power of 80% was used to calculate the sample size, a larger sample size might have shown more statistically significant data between the two irrigation groups. The study showed that there is no statistically significant difference in patients’ postoperative pain level after use of the GentleWave System compared to other irrigation methods.
Applicability This study shows that the GentleWave system can be a useful adjunct for root canal treatment while expecting patients to have postoperative pain levels comparative to more traditional irrigation methods. The high cost and lack of high evidence studies may be a deterrent for clinicians considering purchasing a GentleWave unit to use in clinical practice. More studies are needed with larger sample sizes to verify these findings.
Specialty (Endodontics) (General Dentistry)
Keywords Postoperative Pain, GentleWave, Irrigation, Endodontics
ID# 3505
Date of submission 11/26/2022
E-mail Smithr13@livemail.uthscsa.edu
Author Dr. Renee Smith
Co-author(s) Dr. Eva Otgonbayar
Co-author(s) e-mail otgonbayar@uthscsa.edu
Faculty mentor Dr. Asma Khan
Faculty mentor e-mail KhanA2@uthscsa.edu
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?)
None available
Comments and Evidence-Based Updates on the CAT
None available