NCT07469150

Efficacy of Different Disinfection Technologies in Molar Non-Surgical Retreatment

Efficacy of a Multisonic System vs. Conventional Therapy in the Disinfection of Molar Retreatment Cases: A Randomized Clinical Trial

• Status: Not Yet Recruiting
• Phase: N/A
• Study type: Interventional
• Enrollment: 60 (estimated)
• Sponsor: University of Alabama at Birmingham · Academic / Other
• Sex: All
• Age: 16 Years
• Healthy volunteers: Not accepted

Summary

Post-treatment apical periodontitis is commonly associated with persistent intracanal infection following root canal treatment. Effective disinfection of the complex root canal system during nonsurgical retreatment remains challenging due to anatomical complexities that may harbor microbial biofilms. Conventional retreatment protocols typically involve nickel-titanium rotary instrumentation combined with irrigation using sodium hypochlorite and activation techniques such as Passive Ultrasonic Irrigation (PUI). The GentleWave System (GWS) is a minimally invasive irrigation technology designed to enhance tissue dissolution and microbial removal through multisonic energy, advanced fluid dynamics, and negative pressure. Although preliminary studies suggest promising results in root canal disinfection and patient outcomes, high-level clinical evidence comparing GWS with conventional retreatment techniques remains limited, particularly in molar teeth with post-treatment apical periodontitis. This randomized clinical study aims to compare the disinfection efficacy of GWS with a conventional nickel-titanium rotary instrumentation protocol combined with PUI in nonsurgical retreatment of molars with post-treatment apical periodontitis. Intracanal bacterial load will be quantified using quantitative polymerase chain reaction (qPCR), and microbial composition will be analyzed using next-generation sequencing (NGS). Residual organic debris will be evaluated using the chairside diagnostic device Endocator and facultative bacterial culturing. Postoperative pain levels will also be recorded to assess short-term clinical outcomes. The results of this study will provide clinical evidence regarding the comparative effectiveness, safety, and potential advantages of advanced irrigation technology for root canal disinfection in complex retreatment cases.

Detailed description

Post-treatment apical periodontitis in root canal-treated teeth is caused by persistent, secondary, or recurrent intra-canal infection. The complex anatomy of the root canal system-including isthmuses, fins, and lateral canals-can limit the effectiveness of conventional instrumentation and irrigation, allowing microbial biofilms to persist. As a result, nonsurgical endodontic retreatment often presents a lower success rate compared with primary root canal treatment. Conventional retreatment protocols typically involve mechanical debridement using nickel-titanium rotary instrumentation combined with irrigation using sodium hypochlorite. Irrigation activation techniques such as passive ultrasonic irrigation (PUI) are commonly used to improve irrigant penetration and enhance removal of debris and bacteria from complex canal anatomy. However, these techniques may still be limited in their ability to completely eliminate microbial biofilms and may carry a risk of irrigant extrusion. The GentleWave System (GWS) is an advanced irrigation technology that uses multisonic energy, negative pressure, and optimized fluid dynamics to enhance tissue dissolution and microbial removal throughout the root canal system. This system allows effective disinfection while minimizing the need for extensive mechanical instrumentation, potentially supporting minimally invasive endodontic approaches. Although studies have demonstrated promising results, well-designed randomized clinical trials evaluating its effectiveness in retreatment cases remain limited. This randomized clinical trial will compare the disinfection efficacy of GWS with a conventional retreatment protocol consisting of nickel-titanium rotary instrumentation combined with PUI in molars diagnosed with post-treatment apical periodontitis. Microbiological samples will be collected before treatment and prior to obturation. Intracanal bacterial load will be quantified using quantitative real-time polymerase chain reaction (qPCR), and microbial community composition will be analyzed using next-generation sequencing (NGS). In addition, residual organic debris will be evaluated using the chairside device Endocator, which provides a rapid quantitative Endoscore to determine the degree of disinfection of each group. The primary outcomes of the study are reduction in intracanal bacterial load and changes in microbial composition following disinfection. Secondary outcomes include the efficacy of the chairside device Endocator in disinfection of the root canal, compared with PCR-based methods as well as facultative bacterial culturing, and short-term postoperative pain assessment. These findings from this study aim to provide high-quality clinical evidence regarding the comparative effectiveness of advanced irrigation technologies versus conventional disinfection protocols in endodontic retreatment.

Conditions

• Apical Periodontitis

Interventions

Type	Name	Description
PROCEDURE	GentleWave System	Minimally invasive root canal disinfection using the GentleWave multisonic irrigation system following minimal instrumentation. The system delivers multisonically activated sodium hypochlorite and EDTA solutions under negative pressure to enhance irrigation dynamics and debris removal within the root canal system during nonsurgical endodontic retreatment.
PROCEDURE	Conventional rotary instrumentation with passive ultrasonic irrigation	Conventional nonsurgical endodontic retreatment using nickel-titanium rotary instrumentation followed by passive ultrasonic irrigation (PUI). Irrigation is performed using sodium hypochlorite delivered via a side-vented needle and ultrasonically activated irrigation to enhance canal disinfection after mechanical preparation.

Timeline

• Start date: 2027-07-01
• Primary completion: 2030-06-01
• Completion: 2030-12-01
• First posted: 2026-03-13
• Last updated: 2026-04-08

Locations

1 site across 1 country: United States