Abstract
Aim: The objectives of this scoping review are to map the evidence available in the literature on using the GentleWave System (GWS) in endodontic treatments and to identify knowledge gaps. Methods: Searches were conducted in PubMed, Scopus and Web of Science. We included randomized and non-randomized clinical trials, cohort studies, case series and cross-sectional studies that evaluated or reported using the GWS. In vitro studies assessing the GWS versus a control group were included. Studies were independently selected by two researchers based on eligibility criteria. Two reviewers each extracted data from half of the included studies. The following data were extracted: study design, purpose, number of study groups, sample size and sample type, analyzed outcome, outcome measurement and main results. A descriptive analysis of the data was performed. Results: Twenty-seven studies were included. In vitro studies were the most frequent study design (85.2%). Of these studies, 13 evaluated root canal disinfection. The general results demonstrated that the GWS produces results superior to the observed comparison groups. Only four studies were conducted in humans (13.8%): three prospective clinical studies and one randomized clinical trial. However, the results of these studies seem to demonstrate that the GWS is a promising treatment. Conclusion: Available evidence demonstrates that knowledge about GWS is still very limited. Although most of the studies in our review demonstrated that the GWS performed better than or similar to other observed systems, caution should be exercised regarding its clinical recommendation, as evidence of its superiority comes only from in vitro studies.
References
Dye BA. Global periodontal disease epidemiology. Periodontol 2000. 2012 Feb;58(1):10-25. doi: 10.1111/j.1600-0757.2011.00413.x.
Franciscatto GJ, Brennan DS, Gomes MS, Rossi-Fedele G. Association between pulp and periapical conditions and dental emergency visits involving pain relief: epidemiological profile and risk indicators in private practice in Australia. Int Endod J. 2020 Jul;53(7):887-94. doi: 10.1111/iej.13293.
Jin LJ, Lamster IB, Greenspan JS, Pitts NB, Scully C, Warnakulasuriya S. Global burden of oral diseases: emerging concepts, management and interplay with systemic health. Oral Dis. 2016 Oct;22(7):609-19. doi: 10.1111/odi.12428.
Kassebaum NJ, Smith AGC, Bernabé E, Fleming TD, Reynolds AE, Vos T, et al. Global, Regional, and National Prevalence, Incidence, and Disability-Adjusted Life Years for Oral Conditions for 195 Countries, 1990-2015: A Systematic Analysis for the Global Burden of Diseases, Injuries, and Risk Factors. J Dent Res. 2017 Apr;96(4):380-7. doi: 10.1177/0022034517693566.
Peters OA, Peters CI. Cleaning and shaping of the root canal system. In: Hargreaves KM, Berman LH. Cohen’s pathways of the pulp. 10th ed. Saint Louis: Mosby; 2010.
Schilder H. Cleaning and shaping the root canal. Dent Clin North Am. 1974;18(2):269-96.
Soares CJ, Rodrigues MP, Faria-E-Silva AL, Santos-Filho PCF, Veríssimo C, Kim HC, et al. How biomechanics can affect the endodontic treated teeth and their restorative procedures?. Braz Oral Res. 2018 Oct;32(suppl 1):e76. doi: 10.1590/1807-3107bor-2018.vol32.0076.
Crozeta BM, Chaves de Souza L, Correa Silva-Sousa YT, Sousa-Neto MD, Jaramillo DE, Silva RM. Evaluation of passive ultrasonic irrigation and gentlewave system as adjuvants in endodontic retreatment. J Endod. 2020 Sep;46(9):1279-85. doi: 10.1016/j.joen.2020.06.001.
Dotto L, Sarkis Onofre R, Bacchi A, Rocha Pereira GK. Effect of root canal irrigants on the mechanical properties of endodontically treated teeth: a scoping review. J Endod. 2020 May;46(5):596-604.e3. doi: 10.1016/j.joen.2020.01.017.
Molina B, Glickman G, Vandrangi P, Khakpour M. Evaluation of root canal debridement of human molars using the GentleWave system. J Endod. 2015 Oct;41(10):1701-5. doi: 10.1016/j.joen.2015.06.018.
Siddique R, Nivedhitha MS. Effectiveness of rotary and reciprocating systems on microbial reduction: a systematic review. J Conserv Dent. 2019 Mar-Apr;22(2):114-22. doi: 10.4103/JCD.JCD_523_18.
Siqueira Junior JF, Rôças IDN, Marceliano-Alves MF, Pérez AR, Ricucci D. Unprepared root canal surface areas: causes, clinical implications, and therapeutic strategies. Braz Oral Res. 2018 Oct;32(suppl 1):e65. doi: 10.1590/1807-3107bor-2018.vol32.0065.
Sigurdsson A, Garland RW, Le KT, Rassoulian SA. Healing of periapical lesions after endodontic treatment with the gentlewave procedure: a prospective multicenter clinical study. J Endod. 2018 Mar;44(3):510-7. doi: 10.1016/j.joen.2017.12.004.
Charara K, Friedman S, Sherman A, Kishen A, Malkhassian G, Khakpour M, et al. Assessment of apical extrusion during root canal irrigation with the novel gentlewave system in a simulated apical environment. J Endod. 2016 Jan;42(1):135-9. doi: 10.1016/j.joen.2015.04.009. Epub 2015 Nov 4.
Hargreaves KM, Berman, LH. Cohen’s pathways of the pulp. 12th ed. United States: Elsevier Health Sciences; 2022.
Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Scoping reviews. In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis. JBI; 2020. [cited 2023 July 18]. Available from: https://synthesismanual.jbi.global.
Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018 Oct;169(7):467-73. doi: 10.7326/M18-0850.
Choi HW, Park SY, Kang MK, Shon WJ. Comparative analysis of biofilm removal efficacy by multisonic ultracleaning system and passive ultrasonic activation. Materials (Basel). 2019 Oct;12(21):3492. doi: 10.3390/ma12213492.
Jaramillo DE, Arriola AR. Histological evaluation of multisonic technology for debridement of vital and necrotic pulp tissues from human molar teeth. An observational study. Appl Sci. 2021;11(22):11002. doi: 10.3390/app112211002.
Vandrangi P. Evaluating penetration depth of treatment fluids into dentinal tubules using the GentleWave® system. Dentistry. 2016;6:366. doi: 10.4172/2161-1122.1000366.
Velardi JP, Alquria TA, Alfirdous RA, Corazza BJM, Gomes APM, Silva EG, et al. Comparison of GentleWave system and passive ultrasonic irrigation with minimally invasive and conventional instrumentation against LPS in infected root canals. Sci Rep. 2022 Mar;12(1):4894. doi: 10.1038/s41598-022-08835-4.
Velardi JP, Alquria TA, Alfirdous RA, Griffin IL, Tordik PA, Martinho FC. Efficacy of GentleWave System and passive ultrasonic irrigation with minimally invasive and conventional instrumentation technique against enterococcus faecalis lipoteichoic acid in infected root canals. J Endod. 2022 Jun;48(6):768-74. doi: 10.1016/j.joen.2022.01.021.
Zhang D, Shen Y, de la Fuente-Núñez C, Haapasalo M. In vitro evaluation by quantitative real-time PCR and culturing of the effectiveness of disinfection of multispecies biofilms in root canals by two irrigation systems. Clin Oral Investig. 2019 Feb;23(2):913-20. doi:10.1007/s00784-018-2515-x.
Chan R, Versiani MA, Friedman S, Malkhassian G, Sousa-Neto MD, Leoni GB, et al. Efficacy of 3 supplementary irrigation protocols in the removal of hard tissue debris from the mesial root canal system of mandibular molars. J Endod. 2019 Jul;45(7):923-9. doi:10.1016/j.joen.2019.03.013.
Coaguila-Llerena H, Ordinola-Zapata R, Staley C, Dietz M, Chen R, Faria G. Multispecies biofilm removal by a multisonic irrigation system in mandibular molars. Int Endod J. 2022 Nov;55(11):1252-61. doi: 10.1111/iej.13813.
Dash S, Ismail PM, Singh J, Agwan MA, Ravikumar K, Annadurai T. Assessment of effectiveness of erbium:yttrium-aluminum-garnet laser, gentlewave irradiation, photodynamic therapy, and sodium hypochlorite in smear layer removal. J Contemp Dent Pract. 2020 Nov;21(11):1266-9.
Park SY, Kang MK, Choi HW, Shon WJ. Comparative analysis of root canal filling debris and smear layer removal efficacy using various root canal activation systems during endodontic retreatment. Medicina (Kaunas). 2020 Nov;56(11):615. doi: 10.3390/medicina56110615.
Ordinola-Zapata R, Mansour D, Saavedra F, Staley C, Chen R, Fok AS. In vitro efficacy of a non-instrumentation technique to remove intracanal multispecies biofilm. Int Endod J. 2022 May;55(5):495-504. doi: 10.1111/iej.13706.
Liu H, Shen Y, Wang Z, Haapasalo M. The ability of different irrigation methods to remove mixtures of calcium hydroxide and barium sulphate from isthmuses in 3D printed transparent root canal models. Odontology. 2022 Jan;110(1):27-34. doi: 10.1007/s10266-021-00628-x.
Ma J, Shen Y, Yang Y, Gao Y, Wan P, Gan Y, et al. In vitro study of calcium hydroxide removal from mandibular molar root canals. J Endod. 2015Apr;41(4):553-8. doi: 10.1016/j.joen.2014.11.023.
Wright CR, Glickman GN, Jalali P, Umorin M. Effectiveness of gutta-percha/sealer removal during retreatment of extracted human molars using the GentleWave System. J Endod. 2019;45(6):808-12. doi: 10.1016/j.joen.2019.02.009.
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 Aug;40(8):1178-81. doi: 10.1016/j.joen.2013.12.029.
Wang Z, Maezono H, Shen Y, Haapasalo M. Evaluation of root canal dentin erosion after different irrigation methods using energy-dispersive x-ray spectroscopy. J Endod. 2016 Dec;42(12):1834-9. doi: 10.1016/j.joen.2016.07.024.
Wang Z, Shen Y, Haapasalo M. Root canal wall dentin structure in uninstrumented but cleaned human premolars: a scanning electron microscopic study. J Endod. 2018 May;44(5):842-8. doi: 10.1016/j.joen.2018.01.014.
Ordinola-Zapata R, Crepps JT, Arias A, Lin F. In vitro apical pressure created by 2 irrigation needles and a multisonic system in mandibular molars. Restor Dent Endod. 2021 Feb;46(1):e14. doi: 10.5395/rde.2021.46.e14.
Chen B, Shen Y, Ma J, Haapasalo M. Effect of apical size on apical pressure during syringe-needle and multisonic negative pressure irrigation. Odontology. 2021 Jul;109(3):625-31. doi: 10.1007/s10266-020-00586-w.
Haapasalo M, Shen Y, Wang Z, Park E, Curtis A, Patel P, et al. Apical pressure created during irrigation with the GentleWave™ system compared to conventional syringe irrigation. Clin Oral Investig. 2016 Sep;20(7):1525-34. doi: 10.1007/s00784-015-1632-z
Sigurdsson A, Le KT, Woo SM, Rassoulian SA, McLachlan K, Abbassi F, et al. Six-month healing success rates after endodontic treatment using the novel GentleWave™ System: The pure prospective multi-center clinical study. J Clin Exp Dent. 2016 Jul;8(3):e290-8. doi: 10.4317/jced.52779.
Sigurdsson A, Garland RW, Le KT, Woo SM. 12-month healing rates after endodontic therapy using the novel GentleWave System: a prospective multicenter clinical study. J Endod. 2016 Jul;42(7):1040-8. doi: 10.1016/j.joen.2016.04.017.
Grigsby D Jr, Ordinola-Zapata R, McClanahan SB, Fok A. Postoperative pain after treatment using the gentlewave system: a randomized controlled trial. J Endod. 2020 Aug;46(8):1017-22. doi: 10.1016/j.joen.2020.04.004.
Freire MCM, Pattussi MP. [Types of studies]. In: Estrela C. [Scientific methodology. Science, teaching and research]. 2ª ed. São Paulo: Artes Ciência, Ensino e Pesquisa Médicas; 2005.
Pound P, Ebrahim S, Sandercock P, Bracken MB, Roberts I, Reviewing Animal Trials Systematically (RATS) Group. Where is the evidence that animal research benefits humans? BMJ. 2004 Feb;328(7438):514-7. doi: 10.1136/bmj.328.7438.514.
Friedman LM, Furberg CD, DeMets DL, Reboussin DM, Granger CB. Fundamentals of clinical trials. 5th ed. New York: Springer; 2015.
Coaguila-Llerena H, Gaeta E, Faria G. Outcomes of the GentleWave system on root canal treatment: a narrative review. Restor Dent Endod. 2022 Feb;47(1):e11. doi: 10.5395/rde.2022.47.e11.
Chalmers I, Altman D. Systematic reviews. BMJ Publishing Group; 1995.
Coelho TP, Rezende CP, Sousa MCVB, Pereira CEO, Mendonça SAM. [Comparison and analysis of the use of systematic review and scoping review in the area of patient care in pharmacy]. Res Soc Devel. 2021;10(12):e08101219915. Portuguese. doi: 10.33448/rsd-v10i12.19915.
Atlas Resell Management. Garden City, Idaho, USA; 2023. [cited 2023 Feb 28]. Available from: https://atlasresell.com/blogs/news/sonendo-gentlewave-the-new-wave-of-endodontics-technology-and-safety-1.

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