Complex Apical Anatomy Revealed Following Endodontic Treatment of a Maxillary Molar Using the GentleWave System: A Case Report

Introduction: Primary root canal treatment success depends on a number of variables, including debridement and disinfection of the root canal system to remove all bacteria and diseased pulpal and dentinal tissues. Complex root canal anatomy, such as concealed isthmuses, apical deltas and lateral canals, hinder this objective, making instrumentation of these regions nearly impossible. Recent advancements within the endodontic space have focused on improved cleaning and disinfection techniques that will enhance cleaning and debridement, even in difficult to navigate anatomy within the apical third. Background: This case study explores the effectiveness of the GentleWave® Procedure in treating a maxillary second molar diagnosed with irreversible pulpitis and symptomatic apical periodontitis that also featured complex apical root canal anatomy that was undetected until obturation was completed. Methods: A minimally invasive endodontic protocol was utilized to maximize preservation of tooth structure. The tooth was conservatively accessed followed by minimal instrumentation to a size 25/04 for creation of a fluid path and to facilitate future placement of root canal obturation material. Multisonic UltracleaningTM and debridement were accomplished with the GentleWave Procedure. After obturation with gutta-percha and sealer, a final radiograph revealed a clinically significant obturation with previously unseen lateral canals and an isthmus within the apical third. Results: The previously diagnosed symptomatic apical periodontitis had fully resolved by the three-week followup visit. This case report demonstrates a viable minimally invasive endodontic treatment for uncovering root canal systems with complex apical anatomy utilizing the GentleWave Procedure.