Previously, in domestic dentistry, tooth filling was practiced by means of a special paste. The method was very unified and quite cheap. However, not every paste has the necessary fluidity to completely cover all minute channel holes. In addition, pastes contribute to the formation of voids, are subject to severe shrinkage and resorption, which causes the opening of channels and the development of the inflammatory process.
Also, substances can cause an allergic reaction. Because of all the negative properties of such a method has long been not practiced. In place of innovative methods, which have a high level of efficiency.
Features of filling
Timely filling of the tooth canals at a professional level with the elimination of 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, which excludes the possibility of penetration of pathogenic microorganisms and the integration of the canal with the dental cavity and periodontium.
Since the root canals differ in narrowness, an important step in the preparation for filling is their expansion, as well as an improvement in the rate of patency along the entire length.
A person who does not understand all the nuances of the dental profession, it is difficult to make a choice. Doctors do not always have enough time to tell the patient about all the advantages and disadvantages of this or that method. Therefore, the patient chooses the most suitable for the duration and price option, the use of which is not always appropriate.
The article will deal with the methods of filling, the materials used in modern dental practice, as well as the pros and cons of all methods.
Materials for sealing
Filling the root canals of teeth is filling the cleaned cavity with special material. Since the root canals go deep into the gum, 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 sealing root canals must meet a number of requirements:
- They must have absolute tightness, protect the channel from infection.
- An important component is the absence of allergic reaction, dissolution and decomposition when in contact with periodontium and tissue fluid.
- Substances should have contrast to the X-ray. In the image they should be displayed clearly. Otherwise, it will be very difficult for the dentist to understand how well the sealing procedure was performed.
- If the manipulation fails, the seal should be easily removed from the root canal. In addition, when hardening, the substance must shrink, and cavities filled with air should not form inside.
For a number of years the filling of the root canals has undergone some changes. Many different methods have been tested. However, the universal material, which would meet all of the above criteria, was never invented. That is why it is customary in modern dentistry to use combined formulations.
The main stages of preparation for the sealing process
Filling the root canal involves a number of steps:
- All tissues affected by caries should be removed. A dentist can also remove uninfected parts of the tooth to open access to all channels.
- The nerve of the tooth is removed. And the sealing of the channels is then possible. The pulp from the root and crown canals is also removed.
- The doctor determines the length of each channel.
- By means of a special tool, the dentist goes through the entire length of the canals to the root apex, and also extends the diameter to the required value.
- The immediate sealing process is carried out.
Determining the length of the root canals
Qualitative filling of the tooth canals involves filling the canal with material to the top of the root. If the treatment is performed poorly, then the infection gets into the lumens. Over time, the inflammatory process can spread to the very tip of the root.
The most common 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 the entire length.
If this parameter has been determined incorrectly, periodontitis may develop or a cyst may appear. As a result, the tooth will have to be removed. If the seal is reinserted, the patient may begin to complain that after filling the canals, the tooth hurts when pressed. The development of the inflammatory process is not ruled out. Therefore, measuring the root canal is an important part of the treatment. The dentist performs the procedure by means of special thin instruments. After the manipulation, take a picture. So the doctor will be able to determine if the tip of the root end instrument has reached.
It involves the process of extending the root canal. Channels that do not fall under such processing remain narrow. They are inconvenient to fill with a substance for sealing.
Machining helps to expand the channel and eliminate all the 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. It inserts pro-files from titanium. With the help of the tip, the pro-files in the channel rotate, which facilitates chip removal from its walls and expansion. After such manipulation, the process of filling the channels is carried out.
The method of root canal filling by means of gutta-percha
How is the canal filling done? Materials, as noted, are used differently. One of them is gutta-percha. It is firm and elastic.
The substance has excellent characteristics:
- low level of toxicity;
- biological compatibility;
- ability to completely fill the root canals in the warm state;
- easy removal if necessary.
There are a number of ways to seal channels with this material.
Method of one paste
In this case, the channel is closed by an elastic gutta-percha paste, which then hardens. This method in the vast majority of cases causes complications, so its use is inexpedient.
The method of one pin
Methods of filling the canals of teeth involve the use of a pin. After the root canal was filled with paste, a similar device from gutta-percha is introduced into it. This method is also fraught with complications.
Side condensation method
This is the most commonly practiced method of sealing, during which a sealer is used. The effectiveness of this method is directly dependent on how well the surface is cleaned for manipulation.
Stages of side condensation
The main stages of the process are:
- Placement of the central pin. Before this process, a selection is made, depending on how much the channel is expanded.
- The filling area undergoes thorough drying by means of pins made of paper.
- Further, the introduction of a silo is carried out.
- The main pin is inserted.
- The pin is pushed back to the tooth wall.
- Additional pins are introduced, which are pre-lubricated by the sealer.
- The lumen is filled with the material until it is completely sealed.
- The surplus material is removed.
- Condensation of gutta percha occurs at the mouth of the canal.
- In the oral cavity, therapeutic procedures are carried out.
Varieties of pastes for canal filling
- Pastes containing zinc and eugenol. They are used to close the channels of all kinds of teeth. Their downside is a rapid washout from the root. Also, such substances can cause irritation of the dental tissue.
- Resorcinol. It has been used in dentistry for many years and has the ability to change the color of the tooth.
- Forfenan. During the polymerization period, it heats up in the channel, contributing to the release of a substance penetrating into the tubules at the sides. The pulp turns into an insoluble formation.
- Endomethasone - is not subject to resorption and provokes irritation.
Key requirements for materials for sealing
To the materials that are used for sealing, a number of requirements are put forward. Their presence provides reliability, durability and safety of the conducted manipulations. Undoubtedly, it is difficult to envisage all the norms, but they should not be neglected when choosing a material for sealing.
The main requirements include:
- absence of toxic substances;
- high level of biological compatibility;
- low shrinkage;
- simple method of sterilization;
- optimal level of sensitivity to X-rays;
- easy removal;
- no effect on the color of tooth enamel.
Filling channels with hot gutta-percha
Methods of filling the canals with gutta percha are different:
- injection of gutta-percha in a liquid form;
- continuous wave method;
- vertical condensation;
- administration of gutta-percha by means of a syringe.
The method of filling with thermophil
The "Thermophile" system presupposes sealing of the tooth canals by means of hot gutta percha. When the channel is filled, the material cools and becomes hard. This method has a high level of efficiency, but requires professional training of the doctor and considerable money.
When heated, gutta-percha acquires elasticity, which ensures tight closure of the dental canal system.
The tightness of the material reduces the likelihood of penetration into the tooth infection. This system was invented after tools appeared, through which it became possible to effectively process the channels.
The plastic pins together with the hot gutta percha are introduced slowly into the channel. Under pressure, the material fills all channels and branches. This method was called "volumetric filling", as the whole system of root canals is hermetically sealed.
The main advantages of the "Thermophile" system include:
- high level of tightness;
- minimal risk of infection in the canal;
- low level of toxicity;
- absence 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 conduct therapy for teeth that have already been sealed. Also, the method makes it possible to seal the unit, in the channel of which there is a fragment of the dental instrument.
After the manipulation, the patient usually does not have any pain.
Using a silver pin
Metals have been used to seal channels for many years. Widespread use of gold, silver and lead, as these substances have elasticity.
In dentistry, silver pins have been used since the 1920s. Silver was chosen because of its antibacterial properties. In addition, it is a fairly soft metal, which makes it possible to install the pin directly into curved channels.
To date, the antibacterial effect of silver has been scientifically proven. Pure silver is not poisonous and does not cause irritation. However, with prolonged contact of the argentum with tissue fluids, as happens when the pin is in the root canal, oxidation of the metal takes place. In the event of corrosion, silver sulphate, which has a toxicity, is released. This can trigger the onset of an inflammatory process in nearby tissues. In this regard, the pins of silver in dentistry are practically not used.
With regard to the physical characteristics of the metal, the pins from it are easily inserted into the canal of the tooth root, have a high level of contrast to the X-ray. However, the devices do not provide quality sealing. They are recommended to be used in conjunction with root sealants.
If secondary treatment is necessary, these pins are extracted from the tooth canal with ease. There are cases when manipulation involves a number of difficulties or is not subject to implementation at all.
What if I have a toothache after the filling?
Many people are interested: how much can the tooth hurt after filling up the canals? If the tooth aches a bit for 1-2 days, then it is considered the norm.
If the patient experiences intense pain, this may indicate a complication:
- presence of perforation of the root walls;
- insufficiently successful filling;
- finding a tool fragment in the channel;
- unsuccessful treatment with antiseptics;
- removal of the material for sealing at the tip of the root.
Therapy in case of complication
What if the tooth hurts after filling the canals? When perforations occur, the treatment begins with X-ray diagnostics. This method makes it possible to visualize the state of the root lumen. If the perforation has occurred, the instrument, when pressed on the tooth, begins to fail, the gum bleeds, and the patient complains of pain. In this case, the therapy involves sealing the perforation with a filling material.
If the tooth hurts after filling the canals because of the presence of the remnant of the instrument in it, then the tooth will lie down to the removal.
It happens that the sealing was performed poorly. Therapy involves re-cleaning and sealing.
If there are lumens in the root that do not contain the material for sealing, an inflammatory process may occur. In this case, you can not hesitate to contact a specialist.
When removing material to the top of the root, the treatment depends on the severity of the case.
Sealing of canals of milk teeth
The filling of the canals of temporary teeth (dairy) in children differs from the manipulation performed with an adult patient due to the peculiarity of the structure of the child's teeth.
When the temporary tooth should change to a constant, its roots begin to resolve, only the upper part remains. Therefore, root canals are to be sealed with a special paste, which is also subject to resorption. It is this method that makes the eruption of permanent teeth unobstructed.