Revolutionizing the Root Canal to Minimize Pain and Maximize Success 

By Bjarne Bergheim, CEO of Sonendo, Inc. 

For most people, tooth decay is a term associated with anxiety-inducing dental work, ranging from filling a cavity to undergoing root canal therapy. Even though treatment is designed to address decay and save the tooth, traditional treatment methods have a history of being painful and even terrifying for patients, especially when it comes to the dreaded root canal. 

While teeth may look solid on the surface, they are porous by nature. A tooth infection starts on the outside of the tooth and eventually spreads to the inside, where it reaches the nerve endings. This is when root canal treatment is needed. According to the American Association of Endodontists, more than 15 million root canal procedures are conducted each year. It’s an incredibly common procedure – and one in need of a widespread update. 

The Current Standard of Care

When a root canal is performed, the goal is to clear the infected tissue inside of the tooth and protect it from further microbial invasion. Under conventional treatment methods, this procedure is performed with a series of files, which are used to scrape the inside of the tooth. However, according to a study published in the International Endodontic Journal, this process is only successful in about 70–85% of procedures due to several contributing factors. First, the file can reach only about half of the interior surface of the tooth, which often means infected tissue and bacteria are not accessible. Additionally, coring out the tooth material can leave the tooth structure weaker, as this material will not grow back. This can lead to future cracks and fractures.

Even with a successful procedure, 30–70% of patients find themselves in pain days and even weeks after, according to a study published in the European Journal of Dentistry. In fact, many doctors report receiving phone calls from patients in the middle of the night and on weekends asking for additional pain medication.

Clinical Workflow, Practice Workflow and Patient Flow 

From the viewpoint of an endodontist, three things are needed to maintain a healthy practice: an efficient and effective clinical workflow, practice workflow and patient flow.

While the current standard of care causes various issues with clinical outcomes, such as the potential for failure and the risk of post-operative pain and discomfort for patients, it also creates a backlog in clinical workflow. It is a manual process with limited standardization, meaning the outcome and time that a traditional root canal procedure takes is unpredictable. While it typically lasts about 90 minutes, this is just a rough estimate. Additionally, it’s highly likely that each patient will need to come in for more than one visit. According to a survey of endodontists conducted by Sonendo, only about 57% of root canals performed under the current standard of care can be completed in one visit.

The time-consuming and variable nature of the traditional root canal procedure, combined with the likelihood of having to schedule multiple appointments for the same patient, has the potential to negatively impact practice workflow, taking a toll on efficiency.

Finally, the current standard of care hinders patient flow. Without the ability to conduct shorter, more standardized procedures and having to book multiple visits for each patient, doctors are limited in the number of patients they can see. In a post-COVID world, patients do not want to spend any longer than necessary in a dental office. Looking ahead, practices that differentiate themselves from others will be the ones that enable a better patient experience, including less time in the dental office and a more digital workflow.

Updating the Standard of Care

It’s clear that the standard of care for root canal treatment is ripe for an update – and technological innovation can deliver needed change in outcomes and overall experience for doctors and patients. 

There is a new technology that has been used in more than 800,000 procedures across the United States and Canada called the GentleWave® System. It delivers a better patient experience and increases the success rate of a root canal procedure from about 70–85% to 97%, as noted in a study in the Journal of Endodontics, 2018. Rather than using invasive files, the system leverages advanced fluid dynamics, broad-spectrum acoustic energy and accelerated chemistry to flush out the infection. 

With the GentleWave System, patients also experience significantly less pain overall, which leads to higher patient satisfaction and a decrease in extended prescriptions for pain killers. In an ongoing clinical study sponsored by Sonendo, 99.5% of patients had no pain during the GentleWave procedure. And since many endodontists grow their practices from referrals, any procedure that reduces pain will attract more patients. Additionally, according to a study published in the Journal of Endodontics, 2016, more than 90% of procedures done with the GentleWave System can be completed in a single visit.

In simple terms, this means that there is now an advancement in conventional root canal therapy – one that offers superior and more predictable cleaning and reduced pain. It puts digital technology at the center of the treatment workflow and heralds a new era in patient and doctor experience.

As more endodontists adopt the GentleWave System and more patients begin to ask for it by name, along with other advanced technological tools, the current standard of care will undoubtedly shift. 

The Road Ahead

The introduction of new technology is never without challenges. There is bound to be some hesitancy amongst doctors, many of whom have been providing traditional root canal treatments throughout their entire careers. 

Although it can seem intimidating, adopting new technology is essential to the advancement of endodontics.

New innovations and technological tools that are on the market today have the power to significantly enhance how doctors operate, while also improving tooth decay treatment and overall oral health for everyone.