Defining our terms. Refining endodontics

Sonendo^® discusses the mechanism behind its new standard of clean

Recent discussion about the efficacy of laser technology as an advancement beyond standard root canal treatment is encouraging. It suggests that endodontics is now truly at a crossroads, where methods that have been in place for decades are finally being questioned. This presents an opportunity for a larger conversation about new methods and new alternatives that can advance endodontics into an entirely new era.

As with any great turning point, though, there also needs to be a discussion about how terms are defined. Eventually, through a healthy dialogue between informed parties, a consensus can be reached that provides an optimal way forward. This is the situation that endodontics faces today — will the future of best practices be centered around laser technology, or is an entirely new alternative going to set the standard, one that is able to provide an even higher standard of clean?

Proponents of laser technology in root canal treatments point to its ability to target bacteria and tissue with greater accuracy than standard methods. Lasers represent a marked improvement over standard methods. By more precisely targeting infection, endodontists can reduce the need for retreatment in the long run. In a recent survey, more than 90% of patients placed a high value on keeping their natural tooth.¹

The ideal innovation is one that enables patients to keep their natural tooth
While laser technology such as an Er:YAG laser activating NaOCl does represent an improvement over non-activated NaOCl for tissue dissolution,² we still need to define our terms more accurately.

The idea of dentin preservation is clearly important, as patients strongly express a desire to avoid an implant if possible. Preserving dentin, though, is only valuable if that dentin has been fully disinfected. Leaving biofilm behind leads to reinfection within the canal space — and that can lead to retreatments over time. The need to preserve tooth structure must be balanced against the ability to offer thorough disinfection throughout the entire canal structure.

The ideal innovation is one that ensures maximal dentin preservation and maximal removal of biofilm
In other words, we need to define what constitutes true cleaning in endodontics. And in defining that term, we need to consider the realities of the root canal and all of its complexities. In a position paper, the American Association of Endodontists states the following:

The advantages of using the laser, however, are balanced by several significant disadvantages. Root canal spaces are rarely straight and more often are curved in at least two dimensions. Root canal instruments used to clean the space throughout its length can be curved to follow the curvatures in a tooth root. In contrast, laser light will travel on a straight path; laser probes should be fabricated in a way that the laser light emerges laterally, uniformly interacting with the root canal wall.³

Consider, too, that clinical efficacy has not been achieved via laser technology in recent studies.⁴ Evidence suggests laser technology simply cannot navigate the complexities of a root canal. Which means a significant portion of the tooth is not being cleaned or disinfected.

The ideal innovation is one that can navigate all the complexities and curvature of the human root canal system
As we define the concept of clean, we must consider what we can call “good enough.” Laser technology represents a different way of thinking, but does it represent a new standard of clean?

Achieving that higher standard of clean requires the ability to reach throughout complex anatomies, disinfecting and debriding from the crown into the apical third — and leaving no lateral canal or microscopic tubule behind. The GentleWave^® System from Sonendo^® accomplishes that goal using patented Multisonic Ultracleaning™ technology.

Multisonic Ultracleaning technology enables the GentleWave System to deliver a powerful vortex of degassed NaOCI, EDTA, and distilled water through the entire root canal. The optimized procedure fluids are able to reach into even the most complex anatomies, removing bacteria, biofilm, and smear layer in a way that other technologies simply cannot. By cleaning and disinfecting throughout isthmi, lateral canals, dentin tubules, and curved anatomy, the GentleWave System goes beyond lasers and enables a new standard of clean.

Just as importantly, the GentleWave System’s mechanism of action ensures that procedure fluids clean all the way into the apical third. In addition, because the GentleWave System’s fluid management system extracts gases and optimizes the treatment fluid, it prevents the bubbles that can lead to apical vapor lock and restrict the flow of fluids into dentin tubules and throughout the apical third. As the optimized procedure fluids make their way from the crown to the apex, you can achieve highly effective cleaning that’s minimally invasive and relies less on instrumentation.

Because there’s less instrumentation involved, GentleWave System users are better able to preserve canal structure and in the process save more teeth. Knowing what we know about patient preferences, that can be very meaningful to individuals weighing their various treatment options.

We need to define what constitutes true cleaning
in endodontics. And in defining that term,
we need to consider the realities of the root canal
and all of its complexities

While we at Sonendo are heartened to see that the status quo in endodontics is being challenged on a number of fronts, we believe that an ideal system is one that enables patients to keep their natural teeth, preserves tooth structure, and offers effective cleaning and disinfection into the apical third and throughout the complex anatomies that are a reality in root canals systems. We invite you to go in-depth and learn more about the GentleWave System and its breakthrough Multisonic Ultracleaning technology.

At sonendo.com, you can discover what makes the GentleWave System’s mechanism of action unique. You can also browse case reports, peer-reviewed clinical outcomes, in vitro research, webinars, and more. We offer innovations that are backed by research because we believe the future of endodontics belongs to Saving Teeth Through Sound Science^®, and that the ideal innovation — GentleWave technology — has already arrived.

This information was provided by Sonendo®