Dr. Rich Mounce reviews the steps to using the GentleWave™ System
Current methods of endodontic cleaning and shaping are limited, as no current cleaning and shaping technique is able to predictably remove bacteria, biofilm, and tissue from canal systems. In addition, no current instrumentation system touches all canal walls. As a result, bacteria are commonly entombed in the dentinal tubules and isthmuses after endodontic treatment. Today’s “state of the art” is technique-sensitive, operator-sensitive, and greatly affected by anatomic complexity and patient cooperation.1,2
Sonendo® has provided an innovative and unrivaled method designed to create “ultraclean” canals in order to overcome current limitations and challenges. The GentleWave™ System is capable of removing all tissue, smear layer, biofilm, and bacteria from the tubules to a very deep level that is not typically seen in traditional endodontic treatment.3
The GentleWave™ System gives the clinician options. It can be used either as an adjunct to traditional treatment protocols or as the primary treatment method with “minimum shaping.” Regardless of shaping protocol, the obturation method is performed with the clinician’s preferred technique. Treatment can be simpler, faster, and performed with less iatrogenic potential as GentleWave™ instrumentation protocols can be greatly simplified relative to existing instrumentation concepts. Minimal shaping protocols remove less tooth structure, which could possibly reduce the chance of vertical root fracture while cleaning canals to a degree never before possible. Because it is less technique sensitive, the GentleWave™ System can contribute to a treatment that may be less stressful and less invasive for the patient.
Sonendo’s GentleWave™ technology is provided by a handpiece connected to a freestanding, ergonomic, mobile console containing a reservoir of sodium hypochlorite, EDTA, and distilled water. The device has a user-friendly interactive screen that guides the clinician through each step sequentially.
The GentleWave™ System automatically cycles the treatment fluids through the device and into the entire canal system in a closed loop environment. As the fluids move through the treatment tip and into the canals, multisonic energy is created. This sonic energy presents in the form of specific wide spectrum wavelengths using different frequencies, aiding greatly in tissue and debris dissolution and removal as well as disinfection of root canals system. Aside from a preoperative system leakage test, at present, the total treatment time is less than 10 minutes.
T
he GentleWave™ causes energized fluid to move first across the pulp chamber floor and circulate gently throughout the entire root canal system to the apex. The design goal of GentleWave™ is a neutral to negative apical pressure providing complete fluid control with simultaneous canal cleaning. The GentleWave™ is able to reach all the previously inaccessible areas of the root canal system, including isthmuses, fins, cul de sacs, anastomoses, and other complexities.
Step 1: Preparatory steps
The rubber dam is applied. All caries is removed. Endodontic access is made. All canals are located, orifices negotiated and patency established, and working length determined.
Step 2: Shaping technique
Effective GentleWave™ ultracleaning is compatible with a minimal shaping protocol. In essence, the clinician determines the smallest taper and apical diameter (minimal shaping) appropriate to the canal being ultracleaned and obturated. After ultracleaning, obturation is performed using the clinician’s preferred method.
Step 3: Creating a closed loop system
A closed loop system is prepared that connects the Sonendo handpiece to the tooth being cleaned. If 1 mm of coronal tooth structure is present above the CEJ, then no rebuilding of the coronal tooth structure is required. Less coronal tooth structure requires rebuilding the tooth to facilitate the connection between the handpiece and the tooth. Sonendo has proprietary aids and techniques available to rebuild the tooth and create a closed loop system.
Step 4: Application of the GentleWave™
The handpiece is placed into its holder on the Sonendo console. A self-guided menu takes the clinician through the steps needed to prepare the system prior to use. Once the system is calibrated, during the treatment, an on-screen display illustrates the progress of the treatment.
Sonendo has grown from a concept in 2006 to its limited commercial release today. The device is FDA cleared. Located in Laguna Hills, California, Sonendo currently employs more than 80 engineering, marketing, and research professionals. For more information, contact Sonendo at info@Sonendo.com.
References
1. Del Carpio-Perochena AE, Bramante CM, Duarte MA, Cavenago BC, Villas-Boas MH, Graeff MS, Bernardineli N, de Andrade FB, Ordinola-Zapata R. Biofilm dissolution and cleaning ability of different solutions on intraorally infected dentin. J Endod. 2011;37(8):1134-1138.
2. Paqué, F, Balmer M, Attin T, Peters OA. Preparation of oval-shaped root canals in mandibular molars using nickel-titanium rotary instruments: a micro-computed tomography study. J Endod. 2010;36(4):703–707.
3. Haapasalo, M, Wang Z, Shen Y, Curtis A, Patel P, Khakpour M. Tissue dissolution by a novel multisonic ultracleaning system and sodium hypochlorite. J Endod. 2014;40(8):1178-1181.
