Root canal filling is one of the most important dental treatment processes in which pulp has been removed before. The degree of durability of the treatment result depends on the quality of the filling. In the hermetically sealed root canal, the process of development of microorganisms occurs, as a result of which there is inflammation of the bone around the tooth. In addition, the situation also adversely affects the entire body. We offer you to find out what is the root canal, filling (steps and methods), as well as what are the complications after the procedure.
The main types of filling
Root canal treatment is the process of treating the internal areas of the teeth, that is, the part in which the pulp is placed. The need for this procedure is due to diseases such as pulpitis and periodontitis. Treatment consists in cleaning the canals of damaged tissues and their subsequent closure. Filling is the filling of the formed cavities with a special material by a specific method.
This procedure is of two types:
- Temporary root canal filling is the filling of a cavity with a plastic, non-hardening material (paste), which has certain healing properties. This is necessary in cases when there is running pulpitis or periodontitis. Then, first, the tooth is cleansed of damaged tissues, temporary filling for a period of days to several months, and then additional treatment.
- Constant root canal filling occurs when signs of acute inflammatory processes are not observed. Such a procedure is done either immediately or after a temporary one.
In order to carry out high-quality root canal filling, preparation for this process is necessary.
Stages of preparation for canal filling
The main stages are as follows:
- The introduction of anesthesia.
- Removal of affected tissue.
- Pulp removal.
- Channel length measurement.
- Mechanical restoration.
An injection with local anesthesia is done around the place where the diseased root canal is located. Filling, as well as preparation for it, is a rather unpleasant, and in some places also a painful process. Therefore, without anesthesia, treatment is not carried out.
Removal of affected tissue occurs as follows: the dentist cleans the inflamed area with a drill, while partially removing some healthy tissue. The procedure is necessary to destroy the focus of infection and open access to the mouths of the canals. Pulp removal is not only the removal of internal tissue from the crown of the tooth. Root canals are also cleaned.
Measurement of the length of the channels is necessary for high-quality filling. This part of the tooth in each person has a different length and degree of curvature. If these parameters are incorrectly measured, the probability that the cavity remains not completely filled is greatly increased. The result will be a repeated inflammatory process and treatment again.
Machining is one of the main steps. When filling root canals, cavity sealing is very important. Therefore, the dentist passes through the channels with a special thin instrument, thereby once again cleaning them and expanding them to the desired size in order to more densely fill the cavity.
Mechanical treatments for root canal filling are of two types:
- When using hand tools.
- When a special tip is used to insert titanium parts called profiles. The tool rotates in the root canal and removes chips from its walls, thereby expanding the cavity.
After completing these steps, you can proceed directly to filling the canals using special materials.
What do fillings make
The material for temporary root canal filling is paste. It is different, but its composition usually includes:
- a pair of antibiotics with a wide range of antibacterial and antifungal effects;
- any drug that can reduce inflammatory processes and at the same time not affect the protective reactions of the periodontium;
- X-ray contrast filler, with which you can evaluate the quality of filling the cavity on an X-ray.
Dental material for root canal filling on an ongoing basis is solid fillers (fillers), which are represented by gutta-percha and pins, as well as fixing cements (sealers), which fill the cavity between the filler and the canal walls.
The pins are made of two materials:
- Gutta-percha is a material that, when heated, is very liquid, and when chilled, it acquires elasticity and hardness.
- Metal (silver).
It is also worth noting that silver pins have been used in dentistry since the twenties of the last century. Today they are rarely used. Although such pins are distinguished by good qualities (they are easily inserted and removed, they have radiopaque contrast), they can lead to inflammatory processes with prolonged contact with tissues. Therefore, they came to replace the pins of gutta-percha.
Filling materials for root canal filling meet the following requirements:
- Provide reliable sealing.
- Non toxic
- High biocompatibility.
- They have a low ability to shrink.
- Easy to sterilize.
- They have high X-ray contrast.
- Do not change the color of tooth enamel.
- Easy to remove if necessary.
How is filling
Note that today in dental clinics there are the following methods of root canal filling:
- Using a homogeneous paste, for which a special powder and liquid are mixed. In this case, root canal filling consists in filling the cavity with the resulting pasty material. Such a composition is used when there are strongly curved and narrow tooth canals.
- Single pin method.
- Side condensation method.
- Using the Thermophile system.
- Depophoresis method.
- Using hot gutta-percha.
- Using the E&Q Plus system.
All methods, except the first, involve the use of solid materials for filling and / or pins. The use of one or another method of treatment depends not so much on the financial capabilities of the patient as on the anatomical features of his teeth.
Filling methods differ not only in the method of filling the root canal cavity, but also in the speed of the procedure, the durability of the result, and also the cost. Let's consider each method separately.
Single pin method
Root canal filling with pins is a fairly common treatment. The process is as follows: not only a hardening paste is inserted into the root canal, but also a pin. Its function is to seal the filling material and evenly distribute it along the walls of the channel. This method is more reliable than treatment when only paste is used.
To fill the root canals, a pin is introduced, which is made of gutta-percha. This is a product resulting from the processing of latex from tropical plants. When heated, such material softens, and when cooled, it solidifies to a solid and elastic state.
Method of lateral (lateral) condensation
In this case, the dentist uses sealer (sealant) instead of paste. Let's look at the stages of filling during the lateral condensation method:
- The central pin is located.
- Using additional paper pins, the sealing area is dried, and then they are removed.
- Enter sealer.
- Install the main pin and push it against the wall.
- Additional pins are introduced, which are also pre-treated with sealer.
- The remaining cavity is filled with sealer until complete tightness.
- Excess material is removed, giving the surface of the tooth a natural shape.
- Gutta percha is condensed at the mouth of the canal.
- The dentist conducts final therapeutic measures in the oral cavity.
As a result of such treatment, not only a sufficiently reliable closure of the apical opening is achieved, but also a full filling of the entire cavity of the root canal.
A method involving the use of the Thermophile system
Thermophile is a carrier made of plastic coated with gutta-percha. During this method, the following actions are performed:
- The prepared root canal is filled with a small amount of sealer.
- The carrier is heated in a special furnace and placed in a cavity.
- The remainder of the rod is cut off.
Thus, preheated gutta-percha has high fluidity and gradually fills the entire space of the root canal. The main advantage of this method is that filling occurs not only in the main root canal, but also in the lateral tubules. It is also a fairly quick process with reliable results.
The disadvantage of the method using the Thermophile system is that the filling material quite often goes beyond the canals.
The main advantages of this method are the following:
- high level of sealing integrity;
- the risk of re-inflammation is reduced;
- minimal toxicity;
- after the filling procedure, there is no pain;
- the treatment process is pretty fast.
Depophoresis filling method
It is used in cases of hard-to-reach and curved channels, as well as those that have already been treated before. The essence of the method is that with the help of the same tool, drugs are introduced into the entire root canal system. In fact, his goal is complete sterilization.
In difficult cases, the procedure of filling with depophoresis is performed several times with an interval of one to two weeks. The advantages of this method are that the result of treatment is much higher than all existing ones, the hardness of the tooth is preserved, and for many years, tooth tissue with a pulp removed has not been destroyed. But most importantly - thanks to the sterilization performed, the risk of reinfection is reduced to zero. The disadvantage of the procedure is its high cost.
Hot gutta-percha method
There are four methods to use hot gutta-percha:
- Injectable gutta-percha.
- Vertical condensation.
- Continuous wave.
- Using a syringe.
Gutta-percha injection for root canal filling implies the use of material heated to 200 degrees to fill the cavity. It spreads throughout the cavity, thereby carefully filling it.
The method of vertical condensation is quite complex and lengthy. It consists of the following steps:
- In the prepared cavity, material is heated to the desired temperature for root canal filling.
- Then it is directed towards the apical foramen and lateral tubules.
- After complete sealing, a softened gutta-percha pin is inserted into the central part .
- Excess material is removed.
Thanks to this method, the space is filled three-dimensionally, while gutta-percha is used to the maximum, and sealer is minimized.
The continuous wave method is a variation of the previous method of filling. It consists of two stages:
- A central pin is placed in the root canal, which is preheated to two hundred degrees, and cut off in the middle third.
- Still pins of the same size are introduced in sequence, but they are already warmed up to one hundred degrees.
The distinguishing feature that makes this method better than the previous one is that the process is simpler and the sealing is equally complete.
The method of introducing gutta-percha using a syringe is convenient and quick. But the filling of the lateral tubules in this case does not occur. And sometimes, the filling material does not reach the upper part of the root canal. As a result of this, work often has to be redone
Method using the E&Q Plus system
The E&Q Plus system is a special injection gun with a tip and various nozzles. Thanks to it, gutta-percha can be heated to the desired temperature in the root canal itself. Thus, a gradual constant compaction of the material occurs. As a result, the filling is three-dimensional.
You can also complete the process using a gun, or by resorting to the method of vertical condensation. The method of filling using the E&Q Plus system is recognized by dentists as one of the best today. Therefore, it is used most often.
Possible inflammatory processes and treatment of complications after filling
Quite often, after the procedure for filling the root canal, patients complain of pain in the cured tooth. This does not mean that something is wrong. Initially, you do not feel anything due to anesthesia. Then, when its action passes, natural processes appear. After all, filling is a third-party intervention.
Pain in the tooth can be of varying degrees. As a rule, the dentist warns about this and prescribes several medications or folk remedies to choose from, which should be taken in case of severe pain. Usually this condition is observed from a day to two.
If pain, whatever it may be, does not go away, it is worth re-making an appointment with your doctor. There is a likelihood of complications. A visit to the dentist is also worthwhile if the tooth just aches for a long period of time or hurts only when biting, and also if the gum is swollen.
At the second visit, the doctor should do the following:
- Conduct a visual examination of the sore spot.
- Make an X-ray diagnosis, with which you can assess the situation in the root lumen.
If there is perforation, the patient will experience severe pain, and blood will also flow and the instrument will fall through. In this case, re-filling of the cavity should occur.
Rarely enough, but there are cases when the tool broke off during the first treatment. Remaining in the root canal, it triggers inflammatory processes, which are also accompanied by pain. You can see the remains of the instrument on an x-ray. You can get rid of the problem only after tooth extraction.
In other cases, poorly performed fillings take place. There could be gaps that remained unfilled. Then the material is extracted, the root canal is cleaned and resealed. It is worth noting that over time it will be necessary to replace the tooth with an implant or bridge. The average lifespan of teeth with cured root canals is about fifteen years.