A retrospective pragmatic clinical study of healing and predictors of success following gentlewave and conventional endodontic irrigation.

OBJECTIVE

This retrospective pragmatic study aimed to evaluate and compare the healing outcomes of the multisonic GentleWave irrigation system with conventional syringe-needle irrigation used for non-surgical endodontic treatment.

METHODS

The study included 46 teeth that underwent nonsurgical endodontic treatment using two different irrigation protocols: (1) GentleWave irrigation system, and (2) Conventional syringe-needle irrigation, with a minimum follow-up of 1 year. Preoperative and follow-up data from treatment records, including clinical signs and symptoms, periapical radiographs, and cone-beam computed tomography (CBCT) images when available, were collected. Two independent evaluators scored the radiographs and CBCT scans based on the 2D periapical index (PAI) and 3D CBCT-PAI index, respectively. Based on clinical data and radiographic evaluation, treatment outcomes were categorized as healed, healing, or diseased. The success rate was assessed using both strict and loose criteria. Statistical analyses included Fisher's exact tests, and Wilcoxon rank-sum tests, where appropriate. The significance level was set at 0.05.

RESULTS

Based on the periapical index and clinical evaluation, both the GentleWave and conventional groups exhibited comparable percentages of healed cases, corresponding to success rates of 69% and 70%, respectively (strict criteria). Using loose criteria, the success rate based on periapical imaging was 96% for conventional and 85% for GW groups. No statistically significant difference in healing outcomes/success rate was observed between the groups on both periapical radiograph and CBCT interpretation. Male sex, negative pulp vitality, presence of pre-operative periapical radiolucency (PARL), and absence of pre-operative symptoms were associated with reduced healing in the Conventional group. Pre-operative PARL and non-surgical root canal retreatment were associated with reduced healing in the GW group.

CONCLUSION

There were no differences in success rates or healing outcomes of endodontic treatment between the GentleWave irrigation system and conventional syringe-needle irrigation at 12-month follow-up. The presence of pre-operative PARL was significantly correlated with reduced success in both groups.

CLINICAL RELEVANCE: This study highlights similar success rates and healing outcomes for endodontic treatment with the GentleWave irrigation system compared to conventional syringe-needle irrigation at 12 months follow-up.