Abstract
The purpose of this study was to compare disinfection and the biofilm removal efficacy of the GentleWave System (Sonendo, Inc., Laguna Hills, CA, USA) with passive ultrasonic activation method. Forty-seven freshly extracted human molars were inoculated with Enterococcus faecalis and cultured for five weeks to establish biofilm. Eight molars were tested for confirmation of infection. Four of the eight teeth were not inoculated in order to provide a negative control. The remaining 39 inoculated molars were randomly separated into three treatment groups (n = 13 per group): Group 1—no treatment, Group 2—conventional rotary instrumentation and passive ultrasonic activation, and Group 3—minimal instrumentation and the GentleWave System treatment. Roots were subsequently prepared per standard histological tissue processing procedures. Modified Brown and Brenn stained sections and Hematoxylin and Eosin stained sections were visualized at 4× and 13.5× magnification using a stereomicroscope. The sections were scored and blindly analyzed by two independent evaluators, including a histopathologist, to evaluate the presence of biofilm on canal wall. A significant difference was found between Group 2 and Group 3 in both apical and middle regions (p = 0.001) of the mesial roots of mandibular molars and mesiobuccal roots of maxillary molars. Group 3 revealed significantly less biofilm than the controls (p = 0.003). The GentleWave System demonstrated significantly greater reduction in biofilm within the mesial roots of mandibular molars and mesiobuccal roots of maxillary molars than those treated with conventional rotary instrumentation and passive ultrasonic activation protocol.
Highlights
It has been well established that endodontic disease is a biofilm-mediated infection
System demonstrated significantly greater reduction in biofilm within the mesial roots of mandibular molars and mesiobuccal roots of maxillary molars than those treated with conventional rotary instrumentation and passive ultrasonic activation protocol
The most comprehensive explanation for endodontic failures is the prevalence of bacteria in the root canal space
Summary
It has been well established that endodontic disease is a biofilm-mediated infection. Multiple in vivo and in vitro studies have shown the presence of residual bacteria in more than 80% of all cases, in the apical region, when treated with the conventional methods [2,4,5,6]. Another more recent methodology used in the disinfection of endodontic biofilms is ultrasonic activation. The handpiece delivers a stream of irrigant fluid into the pulp chamber, and the built-in suction removes the outflowing fluid, creating negative pressure within the root canal system
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