Root canal filling: materials and methods
The main types of sealing
Root canal treatment is the process of processing 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 from damaged tissues and their subsequent closure. Filling is the filling of the cavities formed with special material in a certain way.
This procedure is of two kinds:
- Temporary filling of the root canals is filling the cavity with a plastic non-hardening material( paste), which has certain healing properties. This is necessary in cases where there is a neglected pulpitis or periodontitis. Then, first, the tooth is cleaned of damaged tissues, temporary filling for a period of days to several months, and then additional treatment.
- Constant root canal filling occurs when there are no signs of acute inflammatory processes. This procedure is done either immediately or after a temporary one.
To make a qualitative root canal filling, it is necessary to prepare for this process.
Stages of preparation for sealing the channels of
The main stages are as follows:
- Introduction of anesthesia.
- Removal of affected tissues.
- Removal of pulp.
- Measuring the length of channels.
An injection with local anesthesia is done around the place where the diseased root canal is located. Sealing, as well as preparation for it, is rather unpleasant, and in some cases a painful process. Therefore, without anesthesia, treatment is not carried out.
Removal of affected tissues is as follows: the dentist cleans the inflamed area with a drill, and some healthy tissues are also partially removed. The procedure is necessary to destroy the focus of infection and to open access to the canal mouths. Removing the pulp is not only the removal of the inner tissue from the crown part of the tooth. Even the root canals are also cleaned.
Measurement of the length of the channels is necessary for quality sealing. This section of the tooth in each person has a different length and degree of curvature. If these parameters are not measured correctly, then the probability that the cavity remains not fully filled increases greatly. The result will be a second inflammatory process and treatment again.
Machining is one of the main stages. When sealing the root canals, it is very important to seal the cavity. Therefore, the dentist uses a special thin instrument to pass through the canals, thereby once again cleaning them and expanding to the desired size to fill the cavity more closely.
Mechanical treatments for sealing root canals are of two types:
- When hand tools are used.
- When a special tip is used, into which the titanium parts are inserted, called profiles. The tool rotates in the root canal and removes the chips from its walls, thereby expanding the cavity.
After these steps, you can proceed directly to filling channels using special materials.
What is made of seals
The material for sealing the root canals on a temporary basis is paste. It can be different, but it usually includes:
- a pair of antibiotics with a wide range of antibacterial and antifungal effects;
- any drug that can reduce inflammation and does not affect the protective reactions of periodontal disease;
- radiopaque filler, with which you can evaluate the quality of cavity filling on an X-ray.
Dental material for root canal filling on a permanent basis are solid fillers( fillers), which are represented by gutta-percha and pins, as well as fixing cements( sealers) that fill the cavity between the filler and the channel walls.
Pins are made of two materials:
- Gutta-percha is a material that is very liquid when heated up, and in the cooled state it becomes elastic and hard.
- 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 used quite rarely. Although these pins are distinguished by good qualities( easily inserted and removed, have radiopaque), 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:
- Securely seal.
- Have high biocompatibility.
- Have low shrinkage ability.
- Easy to sterilize.
- Have a high radiogenic contrast.
- Do not change the color of tooth enamel.
- Easily removable if necessary.
How is filling
Note that today in dental clinics there are the following methods of root canal filling:
- With a homogeneous paste, for which special powder and liquid are mixed. The filling of the root canals in this case consists in filling the cavity with the resulting paste-like material. This composition is used when there are strongly curved and narrow channels of the tooth.
- One-pin method.
- Side condensation method.
- Using the "Thermophile" system.
- Method of depophoresis.
- Using hot gutta percha.
- Using the E & Q Plus system.
All methods except the first involve the use of hard materials for sealing and / or pins. The use of this or that method of treatment depends not so much on the financial capabilities of the patient as on the anatomical features of his teeth.
The sealing methods differ not only in the way of filling the cavity of the root canals, but also in the speed of the procedure, the durability of the result, and the cost. Let's consider each method separately.
Sealing of the root canals with pins is a fairly common treatment. The process is as follows: not only hardening paste is introduced into the root canal, but also the pin. Its function is to compact the filling material and evenly distribute it along the walls of the canal. This method is more reliable than treatment, when only paste is used.
To seal the root canals, a pin is inserted, which is made of gutta-percha. It is a product created by the processing of latex from tropical plants. In a heated form, such a material softens, and in a cooled one it freezes to a firm and elastic state.
Side( lateral) condensation method
In this case, the dentist uses a sealer instead of a paste. Let's look at how the sealing steps look during the lateral condensation method:
- The central pin is located.
- With the help of additional paper pins the area of sealing is dried, after which they are removed.
- Enter the dealer.
- Install the main pin and push it to the wall.
- Additional pins are introduced, which are also pre-treated with a sealer.
- The remaining cavity is filled with a sealer until it is completely sealed.
- Excess material is removed, giving the tooth surface a natural shape.
- Guttaperchu condensed at the mouth of the canal.
- The dentist performs the final treatment in the oral cavity.
As a result of this 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 that involves the use of the Thermophile system
Thermophile is a carrier made of plastic with gutta-percha applied. During this method, the following actions are performed:
- The prepared root canal is filled with a small amount of a sealer.
- The carrier is heated in a special oven and placed in a cavity.
- The remainder of the rod is clipped.
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 the filling takes place not only the main root canal, but also the lateral tubules. It is also a fairly fast process with a reliable result.
The disadvantage of the method using the "Thermophile" system is only that the filling material quite often goes beyond the channels.
The main advantages of this method are the following:
- high sealing level;
- the risk of re-inflammation is reduced;
- minimum toxicity;
- after the procedure of sealing there are no painful sensations;
- the process of treatment proceeds fairly quickly.
The method of sealing with depophoresis
It is used in cases of hard-to-reach and curved channels, as well as those that have already been treated previously. The essence of the method is that with the help of the eponymous tool, drugs are introduced into the whole system of the root canal. In fact, his goal is complete sterilization.
In difficult cases, the procedure for sealing with depoφorus is performed several times at intervals of one to two weeks. Advantages of this method are that the result of treatment is much higher than all existing ones, the hardness of the tooth remains, for many years there is no destruction of the tooth tissues with the removed pulp. But most importantly - due to the sterilization carried out, the risk of re-infection is reduced to zero. The disadvantage of the procedure is its high cost.
Method using hot gutta percha
You can use hot gutta percha by four methods:
- Injection gutta percha.
- Vertical condensation.
- Continuous wave.
- Using a syringe.
Sealing of the root canal with gutta percha injectable means the use of a material heated to 200 degrees to fill the cavity. It spreads throughout the cavity, thereby carefully filling it.
The method of vertical condensation is rather complicated and prolonged. It consists of the following steps:
- The prepared cavity is placed the material heated up to the desired temperature for sealing the root canals.
- Then it is sent to the side of the apical opening and lateral tubules.
- After full sealing, a softened gutta-percha pin is inserted into the center piece.
- Surplus material is removed.
Due to this method, the space is filled three-dimensionally, with gutta-percha being used as much as possible, and the silo is minimal.
Continuous wave method is a variation of the previous sealing method. It consists of two stages:
- The central canal is placed in the root canal, which is preheated to two hundred degrees, and cut off in the middle third.
- Sequentially enter more pins of the same size, but they are heated up to a hundred degrees.
A distinctive feature that makes this method better than the previous one is that the process is simpler, and the sealing is as complete.
The method of introducing gutta-percha using a syringe is convenient and quick. But the lateral tubules are not filled in this case. And sometimes the filling material does not reach the upper part of the root canal. As a result, the work often needs to be reworked
Method using E & Q Plus
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, there is a gradual constant compaction of the material. As a result, the filling becomes three-dimensional.
The process can also be terminated with a gun, or by using the vertical condensation method. The method of sealing using the E & Q Plus system is recognized by dentists as one of the best for today. Therefore, it is used most often.
Possible inflammation and treatment of complications after filling
Quite often after the procedure for root canal filling, patients complain of pain in the cured tooth. This does not mean that something is wrong. Initially, you do not feel anything because of the injected anesthesia. Then, when its action passes, natural processes appear. After all, sealing 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 medicamental or folk remedies to choose from, which should be taken in case of severe pain. Usually this state is observed from a day to two.
If the pain, no matter what they are, do not go away, it is worth re-registering with the attending physician. There is a possibility of complications. Visit the dentist is also in the case if the tooth just aching for a long period of time or hurts only when nibbling, and if the gum is swollen.
On a second visit, the doctor should do the following:
- Perform a visual examination of the sore spot.
- Make X-ray diagnostics, with which you can assess the situation in the root gleam.
If there is a perforation, the patient will experience severe pain, and still there will be blood and a tool fall through. In this case, a repeated filling of the cavity should occur.
Rarely, but there are cases when the first treatment broke off the instrument. Remaining in the root canal, he starts inflammatory processes, which are also accompanied by painful sensations. You can see the remnants of the instrument on the X-ray. You can get rid of the problem only after tooth extraction.
In other cases, an inadequate sealing is performed. There could be gaps that remained unfilled. Then the material is extracted, the root canal is cleaned and re-sealed. It should be noted that over time it will be necessary to replace the tooth with an implant or bridge. The average life span of teeth with cured root canals is about fifteen years.