Efficacy of GentleWave System and Passive Ultrasonic Irrigation with Minimally Invasive and Conventional Instrumentation Technique against Enterococcus faecalis Lipoteichoic Acid in Infected Root Canals

Abstract

Introduction: This study evaluated the effectiveness of the GentleWave System (GWS; Sonendo, Laguna Hills, CA) and passive ultrasonic irrigation (PUI) in removing Enterococcus faecalis lipoteichoic acid (LTA) from infected root canals with a minimally invasive technique (MIT) and the conventional instrumentation technique (CIT).

Methods: Sixty extracted human maxillary first premolars were included. All teeth were dentin pretreated and inoculated with LTA prepared from E. faecalis. First, 12 teeth were cryogenically ground to investigate the viability of recovering intraradicular E. faecalis LTA. Afterward, 48 teeth were randomly divided into the following groups: GWS + MIT, GWS + CIT, PUI + MIT, and GWS + CIT (all n = 12). Teeth were instrumented with a Vortex Blue (Dentsply Sirona, Ballaigues, Switzerland) rotary file size 15/.04 for MIT and 35/.04 for CIT. Samples were collected before and after a root canal procedure with sterile/apyrogenic paper points and after cryogenically ground for intraradicular LTA analysis. LTA was quantified with an LTA enzyme-linked immunosorbent assay kit.

Results: E. faecalis LTA was recovered from 100% of the samples (48/48) before the root canal procedure. GWS + MIT and GWS + CIT were the most effective protocols against E. faecalis LTA, with no difference between them (P > .05). PUI + CIT was more effective than PUI + MIT (P < .05) but less effective than GWS + MIT and GWS + CIT (P < .05). The GWS groups showed more root canals with undetected E. faecalis LTA after treatment than all groups tested.

Conclusions: GWS + MIT and GWS + CIT were the most effective protocols against E. faecalis LTA in infected root canals.

Keywords: Disinfection; Enterococcus faecalis; GentleWave System; lipoteichoic acid; root canal.