29 January 2020

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A new systematic for endodontic treatment in teeth with necrotic pulp

Massimo Gagliani

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Has the end of endodontic instruments arrived? It could be good news for "non-lovers" of root canal shaping. In the multicenter study conducted on 45 patients having dental elements with pulp affected by irreversible pathologies, concomitant with periapical lesions larger than 3 millimeters, the authors found a remarkable success rate.  

Materials and methods
The detail of the study: as said 45 dental elements with periapical lesion of endodontic origin evident on radiographic examination. The instrumentation procedure provided for normal access to the pulp chamber, no tools were used to enlarge the root canal entrances to preserve the dental structure. ISO 10 or 15 manual files were used to test the root canal patency up to the desired working length. At the same length, nickel titanium alloy files with apical ISO 20 diameter and taper greater than .06 were used.
At this point the Multisonic instrument for active irrigation (GentleWave Procedure, Sonendo, USA) was used to remove all the necrotic material and the bacterial component. The filling was performed with vertical condensing guttapercha and a resin cement (AH Plus, Dentsply Sirona, USA).  

Results
44 teeth were checked after one year and 97.7% of these had been considered functionally valid, presenting 36 out of 44 teeth a regression of the periapical pathology to make them considered healed and 7 a decrease in size. 

A dental element has been extracted.  

Conclusions
The GentleWave system, although in a small sample of patients, has shown very interesting results; the use of endodontic instruments to perform a first reaming of the root canal is always necessary but the cleansing capacity - evidenced by the high percentage of healings observed at 12 months - of the system seems very interesting, worthy of being evaluated in other clinical circumstances and with a greater number of cases observed for a more consistent time.    

For additional informations:  Healing of Periapical Lesions after Endodontic Treatment with the GentleWave Procedure: A Prospective Multicenter Clinical Study