Earlier, in domestic dentistry, filling of tooth canals with a special paste was practiced. The method was very standardized and fairly cheap. However, not every paste has the necessary fluidity to completely block all the smallest channel openings. In addition, pastes contribute to the formation of voids, are subject to strong shrinkage and resorption, which causes the opening of channels and the development of the inflammatory process.
Also, substances can cause an allergic reaction. Due to all the negative properties, such a method has not been practiced for a long time. In place of innovative methods with a high level of efficiency.
Features of filling
Timely filling of the tooth canals at a professional level while eliminating periodontitis and pulpitis is the key to the absence of complications in the future. The main requirement at this stage of therapy is a high degree of sealing reliability, eliminating the possibility of the penetration of pathogens and combining the canal with the dental cavity and periodontium.
Since the root canals are narrow, an important step in preparing for filling is their expansion, as well as an improvement in the patency throughout.
It is difficult for a person who does not understand all the nuances of the dental profession to make a choice. Doctors do not always have enough time to tell the patient about all the advantages and disadvantages of a particular method. Therefore, the patient chooses the most suitable option for the duration and price, the use of which is not always advisable.
The article will talk about the methods of filling existing in modern dental practice, the materials used, as well as the pros and cons of all methods.
Filling Materials
Filling the root canals of the teeth is filling a scrubbed cavity with special material. Since the root canals go deep into the gums, the filling material is in constant contact with the periodontium. Thus, canal filling is an operation to replace damaged tissues with artificial contents.
Materials for filling the root canals of the teeth must meet a number of requirements:
- They must have absolute tightness, protect the channel from infection.
- An important component is the absence of an allergic reaction, dissolution and decomposition in contact with periodontal and tissue fluid.
- Substances must have an X-ray contrast. In the picture, they should be displayed explicitly. Otherwise, it will be very difficult for the dentist to understand how well the filling procedure was performed.
- If the manipulation is unsuccessful, the seal should be easily removed from the root canal. In addition, when solidified, the substance should shrink, while cavities filled with air should not form inside.
Over the years, dental root canal filling has undergone some changes. Many different methods have been tried. However, universal material that would meet all of the above criteria was never invented. That is why in modern dentistry it is customary to use combined formulations.
The main stages of preparation for the filling process
Filling the root canal involves a number of steps:
- All tissues affected by caries should be removed. The dentist can also remove unaffected parts of the tooth to allow free access to all channels.
- The tooth nerve is removed. And filling the channels after that is possible. The pulp from the root canals and crowns is also removed.
- The doctor determines the length of each channel.
- Using a special tool, the dentist walks along the entire length of the canals to the root apex, and also expands the diameter to the desired size.
- The direct filling process is carried out.
Determination of root canal length
High-quality filling of the tooth canals involves filling the canal with material to the apex of the root. If the treatment is carried out poorly, then an infection penetrates into the lumens. Over time, the inflammatory process can spread to the very top of the root.
Most often, the cause of poor-quality tooth filling is an incorrect measurement by the dentist of the length of the canal. As a result, the doctor does not process its entire length.
If this parameter was not determined correctly, periodontitis may develop or a cyst may appear. As a result, the tooth will have to be removed. If the sealing is done again, the patient may begin to complain that after filling the canals, the tooth hurts when pressed. The development of the inflammatory process is not excluded. Therefore, root canal measurement is an important component of treatment. The dentist carries out the procedure through special thin instruments. After the manipulation should take a picture. So the doctor can determine if the tip of the instrument has reached the root end.
Mechanical restoration
It involves the process of expanding the root canal. Channels that have not undergone such processing remain narrow. It is inconvenient to fill them with a filling substance.
Mechanical processing contributes to the expansion of the channel and the elimination of all irregularities and convolutions present in it. The channel expands to the desired size.
There are two types of processing: manual and mechanical. The latter method involves the use of a special tip. Titanium pro files are inserted into it. Using the tip, the pro-files are rotated in the channel, which helps to remove chips from its walls and expand. After such manipulation, the process of filling the canals is carried out.
Method of root canal filling with gutta-percha
How is dental canal filling performed? The materials, as noted, are different. One of them is gutta percha. She is firm and elastic.
The substance has inherent excellent characteristics:
- low toxicity;
- biocompatibility;
- the ability to completely fill the root canals in a heated state;
- ease of removal if necessary.
There are a number of methods for filling the canals with this material.
One Paste Method
In this case, the channel is closed with an elastic gutta-percha paste, which then hardens. This method in the vast majority of cases causes complications, so its use is impractical.
Single pin method
Methods of filling the canals of the teeth involve the use of a pin. After the root canal was filled with paste, a similar gutta-percha device is introduced into it. This method is also fraught with complications.
Side Condensation Method
This is the most commonly used method of filling, during which a sealer (sealant) is used. The effectiveness of this method is directly dependent on how well the surface for manipulation is cleaned.
Stages of lateral condensation
The main stages of the process are:
- Placement of the central pin. Before this process, its selection is carried out depending on how much the channel is expanded.
- The sealing area is thoroughly dried using paper pins.
- Next is the introduction of sealer.
- The introduction of the main pin.
- The pin is pushed to the wall of the tooth.
- Additional pins are introduced, which are pre-lubricated with sealer.
- The clearance is filled with material until complete sealing.
- Excess material is removed.
- Gutta-percha condensation occurs at the mouth of the canal.
- In the oral cavity, therapeutic procedures are performed.
Varieties of pastes for filling canals
- Pastes containing zinc and eugenol. They are used to close the channels of all types of teeth. Their minus is a quick wash out of the root. Also, such substances can cause irritation of the tooth tissue.
- Resorcinol. It has been used in dentistry for many years and has the property of changing the color of the tooth.
- Forfenan. During the polymerization period, it heats up in the channel, contributing to the release of a substance that penetrates into the tubules on the sides. Pulp turns into an insoluble formation.
- Endometasone - not resorbable and provokes irritation.
Key requirements for filling materials
For materials that are used in sealing, a number of requirements are put forward. Their presence ensures the reliability, durability and safety of the manipulations. Undoubtedly, it is difficult to envisage all the norms, but they should not be neglected when choosing a material for filling.
The main requirements include:
- sealing reliability
- lack of toxic substances;
- high level of biocompatibility;
- low shrinkage;
- a simple way to sterilize;
- optimal level of sensitivity to x-rays;
- easy removal;
- lack of effect on the color of tooth enamel.
Canal filling with hot gutta-percha
Methods of filling the canals of the teeth with gutta-percha are different:
- liquid gutta-percha injection;
- continuous wave method;
- vertical condensation;
- the introduction of gutta-percha through a syringe.
Thermophile filling method
The Thermophile system involves filling the tooth canals with hot gutta-percha. When the channel is filled, the material cools and becomes solid. This method has a high level of effectiveness, but requires the training of a doctor and considerable cash.
When heated, gutta-percha gains elasticity, which ensures tight closure of the dental canal system.
The tightness of the material reduces the likelihood of infection in the tooth. This system was invented after the emergence of tools through which it became possible to effectively process the channels.
Plastic pins along with hot gutta-percha are introduced slowly into the channel. Under pressure, the material fills all channels and branches. This method is called "volumetric filling", as the entire root canal system is sealed.
The main advantages of the Thermophile system are:
- high level of tightness;
- minimal risk of infection in the canal;
- low toxicity;
- lack of pain after filling;
- the speed of the therapeutic procedure.
The use of depophoresis
This method makes it possible to treat teeth that have curved and inaccessible canals, as well as to treat teeth that have already been filled. Also, the method makes it possible to seal a unit in the channel of which there is a fragment of a dental instrument.
After the manipulation, the patient usually does not experience any pain.
Silver pin application
Metals have been used to seal channels for many years. Widely used are gold, silver and lead, as these substances have elasticity.
In dentistry, silver pins have been used since 1920. Silver was chosen due to its antibacterial properties. In addition, it is quite soft metal, which makes it possible to install the pin directly into the curved channels.
To date, the antibacterial effect of silver has been scientifically proven. Pure silver is not toxic and does not cause irritation. However, with prolonged contact of the argentum with tissue fluids, as occurs when the pin is in the root canal, metal oxidation occurs. Corrosion releases silver sulfate, which is toxic. This can provoke the occurrence of an inflammatory process in nearby tissues. In this regard, pins made of silver in dentistry are practically not used.
As for the physical characteristics of the mentioned metal, the pins made of it are easily inserted into the root canal of the tooth and have a high level of contrast to the x-ray. However, the devices do not provide high-quality filling. They are recommended for use in conjunction with root sealants.
If secondary treatment is necessary, such pins are easily removed from the tooth canal. There are cases when the manipulation is fraught with a number of difficulties or is not subject to implementation at all.
What should I do if a toothache after filling?
Many are interested in: how much can a tooth hurt after filling the canals? If the tooth aches a little during 1-2 days, then this is considered the norm.
If the patient experiences intense pain, this may indicate complications:
- the presence of perforation of the root walls;
- insufficiently successful filling;
- finding a tool fragment in a channel;
- unsuccessful treatment with antiseptics;
- removal of material for filling at the top of the root.
Complicated Therapy
What to do if the tooth hurts after filling the canals? When perforations occur, treatment begins with a diagnosis through x-rays. This method makes it possible to visualize the state of the root lumen. If the perforation has occurred, then the tool begins to fall when pressing on the tooth, the gums bleed, and the patient complains of pain. In this case, therapy involves sealing the perforation with a filling material.
If the tooth hurts after filling the canals due to the remainder of the instrument, then in this case the tooth is subject to removal.
It happens that the filling was carried out poorly. Therapy involves re-cleaning and sealing.
If there are gaps in the root that do not contain material for filling, an inflammatory process may occur. In this case, you can not hesitate to contact a specialist.
When removing material to the apex of the root, treatment depends on the severity of the case.
Filling of milk canals
Filling of canals of temporary teeth (milk) in children differs from the manipulation performed with an adult patient due to the peculiarities of the structure of the child’s teeth.
When the temporary tooth should be replaced by a constant, its roots begin to dissolve, only the upper part remains. Therefore, root canals must be filled with a special paste, which is also subject to resorption. It is this method that makes teething of permanent teeth unobstructed.