The manufacturer claims that the high-tech irrigation process of the GWS allows fluid to penetrate and clean complex root canal anatomy, optimizing root canal disinfection. The GWS is a multi-sonic ultra cleaning technology that uses advanced fluid dynamics, acoustic energy, and tissue dissolution chemistry. This advancement in technology has been explored recently 16, 17, 18, 19, 20, 21, 22, 23, 24, 25. The innovative GentleWave System (GWS) (Sonendo, Inc, Laguna Hills, CA) is designed to promote optimal debridement, cleaning, and disinfection of the root canal systems with minimal instrumentation 16. However, there is still room for improvement in eradicating LPS from root canals. Given their limited effectiveness in eradicating LPS from root canals, supplemental treatments with passive ultrasonic irrigation (PUI) and photodynamic therapy (PDT) have been investigated 13, 14, 15. Previous in vitro and in vivo studies evaluated the ability of different instrumentation techniques using single file or multiple files systems and irrigation protocols to eliminate LPS 9, 10, 11, 12. Several disinfection protocols have been tested against LPS in root canal infections over the years 9, 10, 11, 12, 13. High LPS levels in root canal infection are associated with the development of symptoms of endodontic origin such as spontaneous pain, pain on palpation, tenderness to percussion 5, 6, 7 and severity of periapical bone destruction 7, 8. Lipopolysaccharides (LPS) are the main virulent factor present in the outer cell wall of gram-negative bacteria 4. Primary endodontic infection is a polymicrobial infection comprised of gram-negative bacteria species 1, 2, 3. GWS was the most effective protocol against LPS in infected root canals using MIT and CIT techniques. PUI + CIT was more effective than PUI + MIT (p < 0.05) but less effective than GWS + MIT and GWS + CIT. GWS + MIT and GWS + CIT were the most effective protocols against LPS, with no difference between them (p > 0.05). LPS were quantified with LAL assay (KQCL test). Samples were collected before (s1) and after a root canal procedure (s2) and after cryogenically ground the teeth (s3) for intraradicular LPS analysis. Teeth were instrumented with Vortex Blue rotary file size 15/0.04 for MIT and 35/0.04 for CIT. Forty-eight teeth were randomly divided into treatment groups: GWS + MIT, GWS + CIT, PUI + MIT, and PUI + CIT (all, n = 12). Of those, twelve were dentin pretreated, inoculated with fluorescent LPS conjugate, and submitted to confocal laser scanning microscopy (CLSM) to validate the LPS-infection model. Sixty first premolars with two roots were inoculated with fluorescent LPS conjugate (Alexa Fluor 594). This study compared the effectiveness of GentleWave system (GWS) and passive ultrasonic irrigation (PUI) in removing lipopolysaccharides (LPS) from infected root canals after minimally invasive (MIT) and conventional instrumentation (CIT) techniques.
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