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Ask the Endodontist: Understanding Your Root Canal Procedure

If you’re preparing for a root canal procedure, you may have questions about what to expect, including what the standard treatment process is. We did a Q&A session with Dr. Marcus Palermo of Santa Fe Endodontics to help answer these questions for you. Read on to learn more!

Root Canal Procedure Q&AAsk the Endodontist: Dr. Marcus Palermo

Question: What are the differences between a dentist and endodontist?

Answer: All endodontists are general dentists first, but an endodontist receives 2-3 years of further training in endodontics, which is treatment of the dental pulp and surrounding tissues. The biggest difference beyond the additional education is that an endodontist is a root canal specialist who will treat root canals all day, every day. Depending on the practice, a general dentist may only perform one to two root canals per week—but an endodontist will typically perform up to ten root canals every day.

Question: Are there advantages or disadvantages to choosing an endodontist over a dentist for a root canal procedure?

Answer: Seeing an endodontist can lead to more efficient treatments, and these root canal specialists also have multiple technologies that a general dentist might not. These include a range of advanced options like the GentleWave® Technology, which is the most effective and efficient way to clean root canals. This translates to higher success rates, faster healing and less post-operative sensitivity.

Question: Which of the root canal treatment options—dental implants, standard root canal treatment or the GentleWave® Procedure—would you consider more beneficial for patients in terms of long-term results?

Answer: In most cases, root canal therapy is the best option and offers the most benefits to the tooth. It allows for complete cleansing of the canals and restoring the tooth back to normal bite function. Even root canal retreatment is usually more desirable than a surgical approach, as it allows patients to retain all of their root structure.

In general, the GentleWave Procedure cleans the canals so well, it offers a better chance for success. I now even approach advanced infections very differently. Before the GentleWave Procedure, I would often recommend extraction if a tooth appeared to have an infection indicative of a root fracture. Now, though, I am more inclined to at least open a tooth and see what we find. If there is a fracture, then the tooth still has to be removed—but, if there is no evidence of fracture, we are now completing these cases in a single visit of about an hour and are noticing incredible healing.

Question: How does the process for standard root canal treatment differ from the GentleWave Procedure?

Standard RCT Compared to the GW Procedure

Answer: Historically, the problems with root canals have stemmed from having to clean the intricate anatomy, which is formed by blood vessels. There are often accessory or lateral canals and connections between the canals within roots that are simply impossible to touch and clean with endodontic instruments. This meant that the standard root canal process involved opening the canals wide enough to allow for disinfectants to reach the root tips, where most of the anatomy can be complex.

For me, it also meant multiple visits to allow enough time to hopefully remove all of the tissue and debris from the canals. In the most advanced infections, this sometimes meant working on a tooth three or four times over a period of up to six months. While I was able to achieve success with this, it wasn’t convenient for anyone involved, especially the patient who had to sit through multiple visits until we were confident of eventual healing and success.

With the GentleWave Procedure, though, the root canal process has changed. We can now keep the canals very small, and we only do conservative canal preparations, which retains precious dentin in the roots. This gives more structural stability for the tooth. Additionally, standard root canal procedures predispose teeth to root fracture more often, which can lead to tooth loss. The GentleWave Procedure is a much better approach in my opinion.

“I have seen remarkable and almost miraculous healing of even really advanced infections when performing the GentleWave Procedure.”

Question: How long does standard root canal treatment take compared to the GentleWave Procedure?

Answer: Standard root canal treatment takes significantly more time than the GentleWave Procedure. With standard root canal treatment, the canals must be shaped to an adequate size to allow disinfectants to reach the tooth apices, then the disinfectant needs to sit in the tooth for a minimum of 40-60 minutes before sealing the roots and completing the treatment. For me, this was often achieved over multiple visits to allow sufficient time between appointments with the medicaments in the canals to better disinfect the roots.

With the GentleWave Procedure, the treatment time is much less. Now, we simply create a space in the canals for the GentleWave Procedure to follow and clean in just 8 minutes. We are then able to fill the roots and achieve greater success. The average time to fully treat a root canal system infection with the GentleWave Procedure is about 40-70 minutes, and all of this is done in a single visit. No temporary fillings—and no need to return to have the area numbed again and worked on multiple times.

“The healing happens much faster than what I’ve seen in my 10 years of practice prior to incorporating the GentleWave Procedure, and patients are experiencing less post-operative pain.”

Question: What are the common symptoms after a root canal procedure that patients can expect? What level of pain after root canal treatment is normal, and how does it compare between treatment options?

Answer: Following a root canal, it’s normal to have some tenderness when biting and chewing. This usually improves in a few days, but it may take several weeks before the tooth feels “normal” again. Most pain after root canal treatment is low grade and can be managed with over-the-counter pain medications.

In general, though, the post-operative pain levels after the GentleWave Procedure are less than standard root canal treatment. Most patients experience very little or no pain, and the tooth feels better almost immediately. There are still cases that take more time to settle back to normal, but they are far fewer than treatment without the GentleWave Procedure.

“Most patients are now experiencing almost zero pain following the GentleWave Procedure, which has definitely improved from standard root canal procedures.”

Question: How can patients ensure long-term success of their tooth after treatment?

Answer: The most critical thing following root canal treatment is to have the tooth restored in a timely fashion. This means returning to your general dentist to change any temporary fillings left by the endodontist, or the tooth may also require a crown, which can be done by your general dentist. Failure to complete necessary restorative work, like a crown or filling, may result in re-infection of the root canals, fracture of the tooth and possible tooth loss.

If a crown is required, it is best to contact your dentist within 24 hours to schedule that. The crown may be done at any time, ideally within the first 30 days. Beyond that time, the filling may leak, which could lead to re-infection of your tooth.


Question: What is the biggest benefit of the GentleWave Procedure for your patients?

Answer: The biggest benefit of the GentleWave Procedure is that we are saving more teeth in less time with less removal of healthy dentin. This means that patients are back to themselves sooner and can move on with life without the nuisance of a toothache.

“I believe we will see better long-term success with the GentleWave Procedure.”

Ready to Discover the Beneficial GentleWave Procedure?

The GentleWave Procedure is an innovative root canal treatment option that offers patients the chance for fewer appointments,4 fast healing4 and the opportunity to save their natural tooth. Ready to experience this state-of-the-art treatment option? Schedule a consultation today by finding a nearby GentleWave Provider using our Provider Locator!

The GentleWave® Procedure is a medical procedure that is designed to prepare, clean and preserve the structure of teeth1,2,4 indicated for root canal therapy. Similar to other root canal treatment procedures, there is a potential risk of adverse effects. If you are considering the GentleWave Procedure, ask your clinician if you are a proper candidate. For additional information, visit

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