International Journal of Scientific Research in Dental and Medical Sciences

International Journal of Scientific Research in Dental and Medical Sciences

Healing of Apical Periodontitis after Gentle Wave System Versus Ultrasonic Activation with Negative Pressure Irrigation: A Systematic Review and Meta-analysis

Document Type : Review Article

Authors
Samin Sedghi 1
Negar Karamzadeh 2
Sara Karami Amidabadi 3
Maryam Afrasiabi 4
Yeganeh Azimi 5
1 Dental and Periodontal Research Center, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
2 Endodontist, Private Research Center, Bushehr, Iran
3 School of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran
4 Independent Researcher, Tehran, Iran
5 School of Dentistry, Pirogov Russian National Research Medical University, Moscow, Russia
10.30485/ijsrdms.2025.550551.1681
Abstract
Background and aim: The use of modern methods for root canal disinfection and the improvement of apical periodontitis are of great importance. Therefore, the present Systematic Review and Meta-Analysis was conducted to investigate the Healing of Apical Periodontitis after the Gentle Wave System versus Ultrasonic Activation with Negative Pressure Irrigation.
Material and methods: The international databases PubMed/Scopus, MEDLINE (Ovid), Cochrane Library, and Embase were searched using keywords aligned with the study objective, up to August 2025. Two blinded, independent authors reviewed all articles. STATA/MP.v17 (College Station, Texas, USA) was used to perform the analyses.
Results: Based on the findings of 12 included studies, healing rates for Gentle Wave System was 97% (ES: 97% 95% CI= 95%, 99%; p=0.51; I2=0); the healing rates for Ultrasonic Activation was 77% (ES: 77% 95% CI=75%, 79%; p=0.01; I2=62.88); the healing rates for Negative Pressure Irrigation. was 82% (ES: 82% 95% CI=79%, 85%; p=0.05; I2=60.79). There was a statistically significant difference in healing rates among the groups, with the Gentle Wave System performing significantly better than both Negative Pressure Irrigation and Ultrasonic Activation (p < 0.001).

Conclusions: Based on the present meta-analysis, the Gentle Wave System was found to be more effective than Negative Pressure Irrigation and Ultrasonic Activation in improving apical periodontitis.
Keywords
Infections
Periapical Periodontitis
Root Canal Therapy
Treatment Outcome

Subjects

[1] Wigsten E. Root Canal Treatment in a Swedish Public Dental Service-Studies of indications and results. 2021.
[2] Shah A, Peacock R, Eliyas S. Pulp therapy and root canal treatment techniques in immature permanent teeth: an update. British Dental Journal. 2022;232(8):524-30. https://doi.org/10.1038/s41415-022-4139-4.
[3] Fabrizio G, Sivori F, Cavallo I, Truglio M, Toma L, Sperati F, et al. Efficacy of sodium hypochlorite in overcoming antimicrobial resistance and eradicating biofilms in clinical pathogens from pressure ulcers. Frontiers in Microbiology. 2024;15:1432883. https://doi.org/10.3389/fmicb.2024.1432883.
[4] Park E, Shen YA, Haapasalo M. Irrigation of the apical root canal. Endodontic Topics. 2012;27(1):54-73. https://doi.org/10.1111/etp.12028.
[5] Chalub LO, Nunes GP, Strazzi-Sahyon HB, Ferrisse TM, Dos Santos PH, Gomes-Filho JE, et al. Antimicrobial effectiveness of ultrasonic irrigation in root canal treatment: a systematic review of randomized clinical trials and meta-analysis. Clinical Oral Investigations. 2023;27(4):1343-61. https://doi.org/10.1007/s00784-023-04897-4.
[6] Ali A, Bhosale A, Pawar S, Kakti A, Bichpuriya A, Agwan MA, Agwan MA. Current trends in root canal irrigation. Cureus. 2022;14(5). https://doi.org/10.7759/cureus.24833.
[7] Çiftçioğlu E, Yücel Ö, Işık V, Keleş A, Kayahan MB. Irrigant flow characteristics in the root canal with internal root resorption: a computational fluid dynamics evaluation. Odontology. 2022;110(4):769-76. https://doi.org/10.1007/s10266-022-00698-5.
[8] Montaser OK, Fayyad DM, Abdelsalam N. Efficacy of different irrigant activation techniques for cleaning root canal anastomosis. BMC Oral Health. 2023;23(1):142. https://doi.org/10.1186/s12903-023-02835-0.
[9] Wiese LB. Different Irrigation Activation Methods Effect Treating Asymptomatic Apical Periodontitis: Lithuanian University of Health Sciences (Lithuania); 2023.
[10] Tashkandi N, Alghamdi F. Effect of chemical debridement and irrigant activation on endodontic treatment outcomes: An updated overview. Cureus. 2022;14(1). https://doi.org/10.7759/cureus.21525.
[11] Ivezić K, Toljić B, Beljić-Ivanović K, Jakovljević A, Miličić B, Krdžović-Lazić E, et al. Clinical efficacy of different irrigation protocols in teeth with chronic apical periodontitis: Randomized clinical trial-a pilot study. Srpski arhiv za celokupno lekarstvo. 2025;153(7-8):336-342. https://doi.org/10.2298/SARH250622054I.
[12] Retsas A, Dijkstra RJ, van der Sluis L, Boutsioukis C. The effect of the ultrasonic irrigant activation protocol on the removal of a dual-species biofilm from artificial lateral canals. Journal of endodontics. 2022;48(6):775-80. https://doi.org/10.1016/j.joen.2022.03.005.
[13] 박성연. Root canal cleansing efficacy of various irrigant activation systems during non-surgical retreatment (Doctoral dissertation). 2021.
[14] Judd BR. Comparison of Postoperative Pain and Analgesic Intake for Patients Undergoing Molar Root Canal Treatment Using the GentleWave vs. EndoActivator: Prospective Randomized Clinical Trial. 2021.
[15] 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. Journal of Endodontics. 2022;48(6):768-74. https://doi.org/10.1016/j.joen.2022.01.021.
[16] Tugwell P, Tovey D. PRISMA 2020. Journal of Clinical Epidemiology. 2021;134:A5-6. https://doi.org/10.1016/j.jclinepi.2021.04.008.
[17] Luchini C, Stubbs B, Solmi M, Veronese N. Assessing the quality of studies in meta-analyses: Advantages and limitations of the Newcastle Ottawa Scale. World Journal of Meta-Analysis. 2017;5(4):80-4. http://dx.doi.org/10.13105/wjma.v5.i4.80.
[18] Higgins JP, Savović J, Page MJ, Elbers RG, Sterne JA. Assessing risk of bias in a randomized trial. Cochrane handbook for systematic reviews of interventions. 2019:205-28. https://doi.org/10.1002/9781119536604.ch8.
[19] Montero LQ, Basrani B, Ellis DA, Cohenca N. Healing outcomes following the treatment of molars using different root canal disinfection methods: a prospective cohort study. Journal of Endodontics. 2025. https://doi.org/10.1016/j.joen.2025.04.006.
[20] Kwon SK, Seog M, Kim D, Jung IY. Impact of minimally invasive root canal treatment on healing outcomes in a randomized clinical trial. Scientific Reports. 2025;15(1):23260. https://doi.org/10.1038/s41598-025-02905-z.
[21] Talpoș-Niculescu R, Veja I, Neagu CS, Rusu LC, Talpoș-Niculescu Ș, Popa M, Nica LM. Nonsurgical Endodontics and Decompression-Based Management of Extensive Periapical Cystic-Like Lesions: A Comparative and Radiological Study with A Two-Year Follow-Up. Journal of Clinical Medicine. 2025;14(17):6127. https://doi.org/10.3390/jcm14176127/.
[22] Ling D, Chen Y, Chen G, Zhang Y, Wang Y, Wang Y, et al. Outcome of nonsurgical management of large cyst-like periapical lesions using a modified apical negative pressure irrigation system: a case series study. BMC Oral Health. 2024;24(1):336. https://doi.org/10.1186/s12903-024-04110-2.
[23] Doğan MU, Arıcıoğlu B, Köse TE, Çıkman AŞ, Öksüzer MÇ. Association between the irrigation-agitation techniques and Periapical Healing of large periapical lesions: a Randomized Controlled Trial. Clinical Oral Investigations. 2024;28(7):376. https://doi.org/10.1007/s00784-024-05758-4.
[24] Arikan NS, Hepsenoglu YE, Ersahan S, Ozcelik F. Periradicular repair after single-visit root canal treatment using sonic irrigant activation of teeth with apical periodontitis. Clinical Oral Investigations. 2024;28(12):656. https://doi.org/10.1007/s00784-024-06059-6.
[25] Alaa A, Negm M, Elbaz A, Abdullatif S. A comparative study of the effect of the negative pressure irrigation system (Endovac) and ultrasonic-activated irrigation with sodium hypochlorite on intra-root canal enterococcus faecalis (an in vitro study). Advanced Dental Journal. 2023;5(4):803-14. https://doi.org/10.21608/adjc.2023.208099.1297.
[26] Verma A, Yadav RK, Tikku AP, Chandra A, Verma P, Bharti R, et al. A randomized controlled trial of endodontic treatment using ultrasonic irrigation and laser activated irrigation to evaluate healing in chronic apical periodontitis. Journal of clinical and experimental dentistry. 2020;12(9):e821-9. https://doi.org/10.4317/jced.56368.
[27] Sigurdsson A, Garland RW, Le KT, Rassoulian SA. Healing of periapical lesions after endodontic treatment with the GentleWave procedure: a prospective multicenter clinical study. Journal of endodontics. 2018;44(3):510-7. https://doi.org/10.1016/j.joen.2017.12.004.
[28] 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. Journal of clinical and experimental dentistry. 2016;8(3):e290-8. https://doi.org/10.4317/jced.52779.
[29] 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. Journal of endodontics. 2016;42(7):1040-8. https://doi.org/10.1016/j.joen.2016.04.017.
[30] Liang YH, Jiang LM, Jiang L, Chen XB, Liu YY, Tian FC, et al. Radiographic healing after a root canal treatment performed in single-rooted teeth with and without ultrasonic activation of the irrigant: a randomized controlled trial. Journal of endodontics. 2013;39(10):1218-25. https://doi.org/10.1016/j.joen.2013.06.024.
[31] Căpută PE, Retsas A, Kuijk L, de Paz LE, Boutsioukis C. Ultrasonic irrigant activation during root canal treatment: a systematic review. Journal of endodontics. 2019;45(1):31-44. https://doi.org/10.1016/j.joen.2018.09.010.
[32] Sabeti MA, Ihsan MS, Aminoshariae A. The effect of master apical preparation size on healing outcomes in endodontic treatment: a systematic review and meta-analysis. Journal of Endodontics. 2024;50(3):292-8. https://doi.org/10.1016/j.joen.2023.11.007.
International Journal of Scientific Research in Dental and Medical Sciences
Volume 7, Issue 3
Summer 2025
Pages 120-127

  • Receive Date 15 June 2025
  • Revise Date 21 July 2025
  • Accept Date 29 August 2025
  • Publish Date 01 September 2025