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Inside Dentistry
October 2022
Volume 18, Issue 10

Game-Changing Technology Generates Referrals

Sonendo’s GentleWave® Procedure improves the efficacy of root canal therapy

Francisco Nieves, DDS, MDS

The path that led Francisco Nieves, DDS, MDS, to the field of dentistry began in the water. As a teenager, Nieves was a standout swimmer who competed for Puerto Rico's national team, and  he eventually attended St. Bonaventure University in New York on a full athletic scholarship. When he was 16, an acquaintance in the swimming community—Steve Wood, DDS, a world champion in the 50-and-older age group for backstroke—invited Nieves to shadow him at his orthodontic practice during a school winter break. "I found that I was really interested in a career in dentistry—not necessarily the technical aspects at that point, but I loved that Wood owned his own business and was able to take care of his patients," Nieves says. "He had great relationships with his referring dentists, his staff, his patients, and their families, and he just seemed like he enjoyed going to work every day."

Nieves returned to his home state of Texas to attend dental school at the University of Texas Health Science Center at Houston, where he developed a passion for endodontics. "Clearing infections from teeth and helping patients' bodies heal and respond so that they were able to chew and function again was pretty incredible," he says. Nieves' mentors at the school helped guide him to Rutgers University for an endodontic residency, where he formed an immediate connection with Craig Hirschberg, DDS, the chair of the Department of Endodontics. After graduating, Nieves again returned to Texas and worked as an associate for a few years before opening his own practice this past March in Granbury, a rural lakeside town outside of Fort Worth. He was the first full-time endodontist in the area, and many were skeptical of whether or not he could thrive there. However, Nieves notes that his schedule quickly became busy. "I am happy with the trajectory," he says. "I have a unique, high-tech office that patients and referring dentists greatly appreciate."

While Nieves was a resident, he was intrigued by the GentleWave® System from Sonendo, which minimizes the use of manual instrumentation and instead utilizes a powerful vortex of procedure fluids and acoustic energy to clean the deepest, most complex portions of the root canal system. He arranged a visit to the school by Sonendo, and the residents were able to gain experience with the GentleWave System on extracted teeth. "It was incredible," he says. "I knew it would be a game-changer because my philosophy already involved utilizing smaller instruments that conserved tooth structure. I had seen so many teeth that were fractured by the use of heavy, large, tapered instruments."

At Nieves first job as an associate, he introduced the owner to the GentleWave System, and the owner purchased a unit. However, when Nieves eventually moved, he felt so strongly about the GentleWave®  Procedure that he purchased a system himself. "Even as an associate, I paid for the system and the consumables myself because I knew that I didn't want to practice without it," he says. "From the perspective of a single-visit model, I believed that it would be profitable and that, wherever I worked, people would be impressed and continue to refer to me." That belief turned out to be correct not only during Nieves's time as an associate but also when he opened his full-time practice, where he estimates that he uses the GentleWave Procedure in 98% of his cases. "A dentist whose practice is 45 minutes away told me, ‘I have other endodontists who I could refer to, but whenever you treat my patients, I just do not have any problems. I do not have problems putting the crown on, and I do not get complaints, so I do not need to think twice when I send a referral to you.' That meant a lot," Nieves says. "I can provide the peace of mind that the tooth is as clean as it can possibly be, and we are not destroying a lot of tooth structure to do so."

That minimal invasiveness, of course, subsequently increases patient comfort. According to Nieves, he has not prescribed an opioid analgesic since he opened the practice, and the only antibiotics that he has provided have been to alleviate swelling prior to treatments. "We are not pushing debris out of the apex and causing flare-ups," he says. "It really has changed how we perceive root canal treatments and how patients experience them." Several of Nieves' referring dentists have even told him that they perform fewer traditional root canal treatments in-house now that they know that a much better option is available for their patients, and several request the GentleWave Procedure by name. "They know it is something special when they get the case report back and see that there are five or six canals in the tooth," he says.

As effective as the procedure is, Sonendo has continued to refine it in recent years. For example, the CleanFlow instrument features an improved design that eliminates the need for sealing caps and depth gauges, which reduces the steps required for procedure setup, streamlining the workflow. "The GentleWave System is just so simple and easy to use," Nieves says. "With CleanFlow, preparing the tooth for the GentleWave Procedure is faster. Sonendo is constantly working to improve and innovate, and CleanFlow is evidence of that."  Sonendo's customer support is an asset to users as well. Nieves notes that for difficult questions or cases, they  often connect him with other users to find the best possible strategies and solutions.  "It is a very collaborative group that is great to work with," he says. "The support team really cares about the dentists and the brand. The first thing that any GentleWave user will tell you is that the support is incredible."

That level of innovation and support allows Nieves, in turn, to provide his patients with the top-notch care that they deserve. "I want patients to have an experience in which they realize, ‘Wow, I did not think root canal treatments could be like this,'" he says. "That is the way it should be."

Key Points

Uses advanced fluid dynamics, broad-spectrum acoustic energy, and accelerated chemistry to debride and disinfect the root canal system.

Reduces patient inconvenience, operatory turnover, and the risk of viral exposure in practices.

The proprietary degassing process removes gases from the procedure fluids for effective delivery throughout the root canal system.


Offers a choice of protocols with varying fluid concentrations and treatment times.

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