A transformative innovation that continues to make a difference

Dr. Josh Todd talks about the GentleWave System, and the many ways that benefits his practice and his patients.

A conversation with Dr. Josh Todd about how the GentleWave® System is helping him create a win-win-win for patients, referring dentists, and his practice

Why did you choose to enter the field of endodontics?

I gained a great education and valuable access to highly trained specialists during my years in dental school at the University of Louisville in Kentucky. I received a scholarship as well as a phenomenal dental school experience. After graduating, I worked with professionals in endodontics, oral surgery, periodontics, and pediatric dentistry while attending an advanced dental education residency at Fort Bragg, North Carolina. My endodontic mentor, COL Lindsay, encouraged me to seriously consider specializing. Because I really enjoyed general dentistry, at first, I was skeptical. But, after several years of practicing, my mentor’s words echoing in my ear, and conversations with my wife — who is also a general dentist — I decided to apply for an endodontic residency program at Fort Gordon, Georgia through the Army. I was accepted into the program, and in a full-circle and serendipitous moment, discovered that my endodontic mentor was the director of residency.

What inspired you to open your own practice?

I was in the Army for 12 years, and we were moving every 2-to-3 years to a different base. My wife and I wanted our children to grow up around family members living in Pensacola, Florida. As I was conducting research and sending out feelers to inquire about who was hiring in the area, I was surprised to learn that no one was. It became clear that this location was underserved by endodontists. My wife was the one who really encouraged me to open our own practice.

So, we started an endodontic practice in a town where we knew almost nobody in August 2020, shortly after the COVID-19 shutdown. Due to the restrictions placed on me by the Army during the pandemic, I was not allowed to travel outside of Tennessee. So, ahead of opening day, my wife and our office manager were able to visit the local general dentists’ offices, make connections, and market the practice. We’re so grateful to have had referrals from day one. It’s been a wild ride — but it’s been a great success.

What are some common challenges that clinicians face when performing traditional root canal treatment?

There is rarely a straightforward root canal, with every tooth having unique curves and delicate nuances within the anatomy. Working in Florida, I have grown accustomed to treating an older patient population. These cases are not often easy, with hidden canals, highly complex anatomies, and more.

Treating calcified root canals is one of the most common challenges I face. As a clinician, when I’m fighting a calcified canal, I sometimes feel like I am spending too much time, effort, and energy trying to get down to hard-to-reach places. When this happens, my biggest concern is my patients, who are sitting in the chair and feeling the amount of time I’m spending on them. This can be very stressful.

While files have significantly improved over the years, they still have physical limitations that prevent them from negotiating certain aspects of the root canal anatomy (lateral canals, accessory canals, isthmuses, etc.). It can also be challenging to get the appropriate amount of disinfecting solutions into those areas.

Long-time challenges like these are why it’s important for endodontists to consider new technology. At my practice, I use the GentleWave® System, which is redefining the standard of root canal treatment with a minimally invasive process that preserves tooth structure and promotes early healing. With it, I’m able to better disinfect those hard-to-reach places. And I have the confidence of knowing the additional anatomy that files can’t reach is cleaned and disinfected by the fluids in the GentleWave System.

Dr. Todd explaining how the GentleWave G4 system is a modern way to treat root canal infections and promote pain-free fast healing

Can you describe patient sentiment surrounding traditional root canal treatment?

Root canal treatment is what everyone compares to the most horrible things they can think of — “At least it’s not a root canal!” It’s no surprise that the overwhelming connotation behind root canals is negative. In my opinion, much of this stems from the history of root canal therapy, which was not always as effective or seamless as it is today.

My patients have told me time and time again that the GentleWave® Procedure is less painful and easier than traditional therapy. Patients who have received traditional treatment in the past can, hopefully, relax a bit more when undergoing a GentleWave Procedure and allow me to treat them without being overburdened with fear and anxiety. Some patients even like the noise that the machine makes, and several have compared it to a calming sound machine!

When and how did you learn about the GentleWave® Procedure?

In 2019, a friend of mine invited me to the TDO Software meeting (now known as EndoCon). I attended a continuing education (CE) event about the GentleWave Procedure while I was there. During the presentation I thought to myself, “I have never had a root canal look like that, ever.” In my head, I knew that was what I wanted to be able to offer my patients when I started my own practice because I recognized it was a higher level of cleaning and disinfection, and therefore, the best treatment available. I have used the GentleWave System since opening day.

When adopting new technology, clinicians will always have to unlearn some of their traditional instrumentation techniques. This was challenging — especially as I was opening a new practice and training staff all at the same time. To make this learning curve easier, I followed the advice of my GentleWave trainer and trusted the technology to do what it says it does. I adhered to necessary protocols and encouraged myself to forge ahead.

With this, it didn’t take more than a few short weeks to get fully up to speed on the GentleWave System. I was committed to it — and it more than paid off. I have also spent a lot of time discussing clinical protocols with other GentleWave providers who have been using the technology longer than I have and have gained wisdom from their techniques.

Another example of constant and never-ending learning is my colleague, Dr. Terry Webb, a fellow of the International College of Dentists, and Diplomate of the American Board of Endodontics. After completing his 30-year naval career in 2023, he joined us at Elite Endodontics, has embraced the GentleWave System, and includes it in most of his cases.

Case 1: Pre-op and diagnosis: A 68-year-old female presented with localized vestibular swelling buccal to tooth No. 30. No. 30 had been symptomatic for a few days, but the swelling started to alarm the patient and caused her to seek treatment. Upon evaluation, No. 30 was diagnosed as necrotic pulp with acute apical abscess. Two treatment options were discussed with the patient: 1) Tooth No. 30 non-surgical root canal therapy or 2) Tooth No. 30 extraction. The patient elected tooth No. 30 non-surgical root canal therapy (NSRCT). A pre-op Small FOV CBCT revealed a heavily calcified pulp chamber and calcified canals and a radix entomolaris. The CBCT revealed PARL’s at the apex of the mesial, distal, and radix entomolaris roots with the lesion extending coronally into the furcation. The patient was advised before treatment that this would be a very challenging case, and No. 30 NSRCT would be given a guarded prognosis, but she chose to proceed with No. 30 NSRCT. Treatment: No. 30 NSRCT, the patient was anesthetized with 68 mg Lidocaine with 0.034 mg EPI via IAN and 68 mg Septocaine with 0.017 mg EPI via buccal infiltration. Rubber dam isolation was utilized, and access was prepared through the PFM crown. 4 canals were located and then immediately after identification of the canal orifices, a platform was created with Soundseal, and the GentleWave Cleanflow handpiece was utilized to help break up the calcified tissue and negotiate each canal, alternating between a pathfile to slowly negotiate the coronal half of the canals and then running the GentleWave CleanFlow Procedure Instrument for 30-40 seconds to remove the accumulated debris. By alternating between files and the CleanFlow with GentleWave, all 4 canals were negotiated to length, and patency was achieved. The final working lengths were between 23 mm-24.5 mm for all 4 canals. All canals were instrumented to a Master Apical File of 20/.04 and obturated with high-flow BC Sealer. By utilizing the GentleWave and High-Flow BC Sealer, the apical delta of the distal root was cleaned, disinfected, and obturated in ways that would not have been possible with traditional endodontic therapy. Post-op: The patient was called 24 hours after treatment and reported she was pain-free, the swelling had reduced, and she was doing well.

How did the GentleWave® System help overcome some of the challenges you described earlier and others?

In addition to helping me navigate complex anatomies and calcified root canals, the GentleWave Procedure has limited the number of re-treat and multi-visit cases that I see. It does such a thorough job of cleaning, all without having to remove nearly as much tooth structure as with traditional therapy. By having the unique ability to find additional canals and reach complex areas, about 98% to 99% of my patients come in for one visit only. I love this, and so do my patients — their time is valuable.

Additionally, several of my referring dentists have noticed that the GentleWave System allows me to be as minimally invasive as possible — all while keeping tooth structure intact. The GentleWave Procedure gives restorative dentists more tooth structure to work with after treatment, which benefits the patient and offers a better long-term prognosis for that tooth. Using the GentleWave System not only helps endodontists and patients, but it also helps other industry professionals.

Case 2: Pre-op and diagnosis: A 52-year-old female presented with a chief complaint of pain to hot and cold. Pulpal sensitivity testing on tooth No. 31 revealed a lingering, aching response to thermal testing. A clinical exam revealed a small crack extending from the occlusal resin over the distal marginal ridge. Probing depths around No. 31 were all <3 mm. No. 31 was diagnosed symptomatic irreversible pulpitis with symptomatic apical periodontitis. A pre-op small FOV CBCT revealed No. 31 to have a C-shaped canal morphology. Two treatment options were discussed with the patient: 1) Tooth No. 31 non-surgical root canal therapy or 2) No. 31 extraction. The patient elected No. 31 non-surgical root canal therapy (NSRCT). Treatment: No. 31 NSRCT, the patient was anesthetized with 68 mg Lidocaine with 0.034 mg EPI via IAN and 68 mg Septocaine with 0.017 mg EPI via buccal Infiltration. Rubber dam isolation was utilized, and access was prepared. Due to the C-shaped canal morphology, only two canals could be identified. Prior to placement of the SoundSeal platform, a small amount of bonding agent was placed over the crack along the distal marginal ridge and distal portion of the pulp chamber. The SoundSeal platform was securely placed to create a vacuum seal. The two canals were negotiated to achieve patency by alternating rotary instrumentation and the GentleWave CleanFlow Procedure Instrument for 30-40 seconds to thoroughly debride the internal anatomy. The mesial canal was instrumented to a Master Apical File of 20/.04, while the distal canal to a 25/.04 Master Apical File. Due to the larger and more irregular canal morphology of the distal canal, various-sized gutta-percha cones were used to gauge the size to be used for obturation. The mesial canal was obturated with a Sealer-based obturation method with High Flow BC Sealer and a single 20/.04 master cone. The distal canal was obturated with High Flow BC Sealer and Warm Vertical Compaction. With the aid of the GentleWave and the CleanFlow Procedure Instrument, the C-Shaped canal anatomy was more deeply cleaned, pulp tissue more thoroughly removed, and this case was completed in a single visit which would have been much more difficult to accomplish with traditional endodontic therapy.

How has integrating the GentleWave System helped you as a business owner?

Nearly everyone is relatively tech-savvy today, and patients notice that we have updated equipment and the latest technology in our office. We differentiate our practice by using the GentleWave System, and we see patients coming in specifically because they know it’s what they want. More people are making informed choices about their healthcare and doing their own research about various procedures and techniques. When patients are looking for an endodontic practice in our area, they quickly realize that we’re the only one offering the GentleWave Procedure.

Sonendo, the developer of the GentleWave System, has made our marketing efforts as seamless and straightforward as possible. We have implemented Sonendo’s library of marketing materials, joined a community of GentleWave users, and more. The GentleWave Portal consists of various digital resources, including brochures, that are easy to customize with our practice name and logo, which makes marketing very easy.

Additionally, as practice owners, we have many pieces of equipment that must be maintained, serviced, or repaired on a regular basis, and the staff is tasked with keeping track of it all. The GentleWave System removes the administrative work, telling us when it’s ready for maintenance and outlining the necessary steps. It then sends this data to Sonendo, so our team doesn’t have to keep any records on hand. While having one less thing to worry about from a maintenance standpoint may seem small, it makes our lives as business owners much easier.

There is clear evidence showing that the GentleWave Procedure provides excellent clinical results. But, what’s exceptional about Sonendo is the amount of support it shows its customers. They have fostered a community of like-minded professionals who support one another. They are also always offering a wide variety of educational content to help us become better clinicians and business owners. The company is unparalleled in this way.

Dr. Todd leverages the latest technology, including the GentleWave G4 system, to differentiate his practice

In your opinion, why do some clinicians remain hesitant to adopt innovative technology like the GentleWave System? What is your advice?

It’s almost always uncomfortable to learn something new. We’re creatures of habit, and clinicians tend to develop their own treatment protocols. However, to fully embrace the future of endodontics, we must be willing to unlearn years worth of habits. I would advise endodontists to take a step back and give themselves room to change and grow. I recognize that adopting new technology can be a leap of faith, but it can be worth it.

The GentleWave System will benefit you and your practice long-term. In fact, I have recommended this technology to many of my colleagues, who have adopted it for their own practices and are very glad that they did.

From my experience, it will improve your life as a clinician and business owner. It will differentiate you and your practice in the market, helping to ensure that you are providing the best possible care for your patients. It will offer access to a community of like-minded and supportive endodontists, who can serve as mentors and friends. Together, these factors add up to make the GentleWave System completely worth the investment.

Read more about retreatment with the GentleWave System in Dr. Rick Schwartz’s article, “Retreatment with GentleWave® of teeth that did not respond to traditional multi-visit treatment: a case series of five patients,” here: https://endopracticeus.com/retreatment-with-gentlewave-of-teeth-that-did-not-respond-to-traditional-multi-visit-treatment-a-case-series-of-five-patients/

Josh Todd, DMD, is a dual board-certified general dentist and endodontist. He received his undergraduate degree from Auburn University and went on to earn his DMD at the University of Louisville School of Dentistry. From there, he took his commission as an officer in the Army, where he completed two advanced residency programs in general dentistry and endodontics. He practiced general dentistry for 7 years before returning to pursue his endodontic training. He served as the Chief Dental Officer from 2010 to 2013 in Hohenfels, Germany and was the lead endodontic mentor at the Advanced Dental Education program at Fort Campbell, Kentucky from 2017 to 2020. He opened Elite Endodontics in Pensacola, Florida in August 2020.


Disclosure: The author declares that there are no conflicts of interest in connection with this article.


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