Dentaltown July 2020 - 44

snug fit of my gutta-percha. Tugback is gone.
In my cases, I typically use nonstandardized
fine gutta-percha cones, and sometimes
Size 20/.04 gutta-percha cones. I use Dentsply's Calamus Pack to apply heat and apical
pressure about 1-3mm into the canal space,
then I use standard pluggers to continue to
apply apical pressure. The hydraulic forces
in these steps allow the BC Sealer HiFlow
to get into the canal ramifications. And I
see this happen routinely in my GentleWave
cases. It's truly remarkable.
In the GentleWave re-treatment case in
Figs. 6a-e, the mesial canals were completely
calcified, as can be seen from the incomplete
obturation of the first root canal treatment
(Fig. 6a). I was able to achieve working
length in the mesiobuccal canal, but not the

mesiolingual canal. I ran the GentleWave
and obturated and, on the postoperative
radiograph (Figs. 6b and 6c), BC Sealer can
be seen in the mesiolingual canal to the apex
of the tooth. No instruments made it into
the apical third of the canal-none!-but
the GentleWave obviously cleaned and
debrided it well enough that the BC Sealer
could seal it and the tooth had healed at
the one-year follow-up (Fig. 6e).

Fig. 6a: Preoperative PA demonstrating complete
calcification of the mesial root canals.

Fig. 6b: Postoperative PA showing obturation of
all canals to working length.

Considerations for use
Not every tooth is a candidate for
GentleWave. It can be used on about 85%
of teeth and does have some limitations. It
becomes particularly difficult to gain an
airtight seal in heavily carious teeth, some
fractured teeth and teeth with open/deficient

Fig. 6d: Six-month recare demonstrates a
decrease in the size of the apical radiolucencies.

44

crown margins. In these teeth, if there is an
undetected leak, the system will still run
through its cycle, but minimal cleansing
and disinfection will happen.
Contrary to the sales and marketing
strategies I've seen employed by Sonendo,
GentleWave is not an "eight-minute root
canal." GentleWave isn't going to find canals
for you or make up for operator shortcomings. I've done more than 20,000 cases in
my career, and the most difficult parts of
the procedure are the parts leading up to the
rotary instrumentation: accessing a calcified
pulp chamber, locating and negotiating
calcified canals, removing gutta-percha in
re-treatments. All of these steps still require
a skilled operator to ready a tooth for with
this system.

Fig. 6c: Red arrows indicate the mesiolingual
canal, where mechanical instrumentation was
unsuccessful. After running the GentleWave, the
obturation was successful.

Fig. 6e: One-year recare demonstrates complete
resolution of pathology.

JULY 2020 // dentaltown.com

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Dentaltown July 2020

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