Single-Visit, Minimal Instrumentation Retreatment of Molar Endodontics Using Advanced Technology

Roberto E. DiVito, DDS

Even a seemingly well-completed root canal treatment (RCT) can fail if all of the pulpal tissue is not fully removed. In this case, the GentleWave^® Procedure (Sonendo, Inc., gentlewave.com/doctor) was used to successfully retreat a failing traditional RCT. The GentleWave System is the first and only FDA-cleared system for RCT that addresses the limitations of conventional methods by combining procedure fluid optimization, broad-spectrum acoustic energy, and advanced fluid dynamics to debride and disinfect deep regions of the complex root canal system in a less-invasive procedure that preserves tooth structure. Tooth No. 19 was removed due to a fractured root prior to retreatment of tooth No. 18. The patient was administered anesthetic, and a rubber dam was placed for isolation. A conservative removal of the existing gutta-percha was accomplished using minimal rotary files. A SoundSeal^® platform was constructed onto the tooth and treated with a CleanFlow^™ procedure instrument (PI). The CleanFlow Technology cleans and disinfects without the PI entering the tooth. After 8 minutes and 15 seconds, the CleanFlow PI was removed and the canals dried. The molar system was filled to complete the retreatment in a single visit. Postoperative 2D and 3D radiographs demonstrated outstanding apical results. At the 1-month follow-up appointment, the patient reported no postoperative pain.

Key Takeaways

Use of the advanced root canal technology, the GentleWave System, allows clinicians to perform endodontic microsurgery with a repeatable and automatic protocol while conserving more tooth structure.

The GentleWave System with CleanFlow Technology improves the predictability of retreatment outcomes and allows for more reliable healing.

Only minimal re-preparation is now needed to complete one-visit retreatments. This is accomplished by utilizing proper magnification, knowledge of shaping, and better irrigation techniques to properly clean and sterilize a root canal system.

About the Author
Roberto E. DiVito, DDS
Private Practice, Scottsdale, Arizona

Figures and Images

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Figure 1

Fig 1. Preoperative panoramic radiograph showing apical radiolucency, tooth No. 18.

Figure 2

Fig 2. Preoperative radiograph showing apical radiolucency, tooth No. 18.

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Fig 3. Conservative removal of gutta-percha.

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Fig 4. SoundSeal platform on top of crown, which facilitates an airtight seal between the CleanFlow PI and the tooth.

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Fig 5. SoundSeal platform with the CleanFlow PI, enabling easy access and a favorable approach angle for posterior teeth.

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Fig 6. Cone fit image after completion of the CleanFlow protocol demonstrating minimally tapered re-preparation. With traditional retreats, clinicians tend to drastically enlarge already tapered canals to allow re-entry of irrigants to clean to the apex, which can lead to transportation and even stripping. The GentleWave System with CleanFlow Technology helps avoid this.

Figure 7

Fig 7. Final obturation and immediate coronal seal, postoperative.

Figure 8

Fig 8. One-month postoperative follow-up radiograph.

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Fig 9. One-month postoperative crown seat.