Filling root canals is one of the most important processes associated with the treatment of teeth in which pulps have previously been removed. The degree of long-term result of treatment depends on the quality of the filling. In an unsealed root canal, the process of development of microorganisms occurs, resulting in inflammation of the bone around the tooth. In addition, the situation also adversely affects the entire body. We offer you to find out what a root canal is, filling (stages and methods), as well as what are the complications after the procedure.
Main types of filling
Root canal treatment is the process of treating the inner areas of the teeth, that is, the part in which the pulp is located. The need for this procedure is due to diseases such as pulpitis and periodontitis. Treatment consists in cleaning the channels from damaged tissues and their subsequent closure. Filling is the filling of the formed cavities with a special material in a certain way.
This procedure is of two types:
- Temporary filling of root canals is the filling of a cavity with a plastic non-hardening material (paste), which has certain healing properties. This is necessary in cases where there is advanced pulpitis or periodontitis. Then, first, the tooth is cleaned of damaged tissues, temporary filling for a period from a day to several months, and then additional treatment.
- Permanent filling of the root canal occurs when there are no signs of acute inflammatory processes. Such a procedure is done either immediately or after a temporary one.
To carry out high-quality root canal filling, it is necessary to prepare for this process.
Steps of preparation for canal filling
The main steps are as follows:
- Administration of anesthesia.
- Removal of diseased tissues.
- Pulp removal.
- Measuring the length of channels.
- Machining.
An injection with local anesthesia is given around the site where the diseased root canal is located. Filling, as well as preparing for it, is a rather unpleasant, and in some places also painful process. Therefore, treatment is not carried out without anesthesia.
Removal of affected tissues occurs as follows: the dentist cleans the inflamed area with a drill, while some he althy tissues are also partially removed. The procedure is necessary to destroy the source of infection and openaccess to canal openings. Pulp removal is not only the removal of internal tissue from the crown of the tooth. The root canals are also cleaned.
Measuring the length of the canals is necessary for high-quality filling. This section of the tooth in each person has a different length and degree of curvature. If these parameters are measured incorrectly, then the likelihood that the cavity will remain incompletely filled increases greatly. The result of this will be a re-inflammatory process and a new treatment.
Machining is one of the main steps. When filling root canals, sealing the cavity is very important. Therefore, the dentist passes through the canals with a special thin instrument, thereby once again cleaning them and expanding them to the desired size in order to fill the cavity more tightly.
Mechanical treatments for filling root canals are of two types:
- When hand tools are used.
- When a special tip is used, into which titanium parts are inserted, 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 fillings are made of
The material for filling root canals on a temporary basis is a paste. It can be different, but it usually includes:
- a couple of antibiotics,with a wide range of antibacterial and antifungal activity;
- any drug that can reduce inflammation without affecting the protective reactions of periodontium;
- radio-opaque filler, which can be used to evaluate the quality of cavity filling on an x-ray.
Dental material for permanent root canal filling 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 from two materials:
- Gutta-percha is a material that is very liquid when heated, and becomes elastic and hard when cooled.
- Metal (silver).
It is also worth noting that silver posts have been used in dentistry since the twenties of the last century. Today they are rarely used. Although such pins are of good quality (easy to insert and remove, have radiopacity), they can lead to inflammatory processes during prolonged contact with tissues. Therefore, they were replaced with gutta-percha pins.
Filling materials for root canal filling meet the following requirements:
- Perform reliable sealing.
- Non-toxic.
- Highly biocompatible.
- Have low shrinkage.
- Easy to sterilize.
- High X-ray contrast.
- Does not change the color of tooth enamel.
- Easy to remove if needed.
How filling is done
Note that today in dental clinics there are the following methods of filling root canals:
- With the help of a homogeneous paste, which is obtained by mixing a special powder and liquid. Root canal filling in this case consists in filling the cavity with the resulting paste-like material. This composition is used when there are severely curved and narrow tooth canals.
- Single pin method.
- Side condensation method.
- Using the Thermofil system.
- Depophoresis method.
- Using hot gutta-percha.
- Using the E&Q Plus system.
All but the first methods involve the use of solid filling materials and/or pins. The use of this or that method of treatment depends not so much on the financial capabilities of the patient, but on the anatomical features of his teeth.
Filling 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 also in the cost. Let's consider each method separately.
Single pin method
Filling root canals with pins is a fairly common treatment. The process looks likeas follows: not only a hardening paste is introduced 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 canal. This method is more reliable than the treatment when only paste is used.
For filling root canals, a pin is inserted, which is made of gutta-percha. This is a product resulting from the processing of latex from tropical plants. When heated, such a material softens, and when cooled, it hardens to a solid and elastic state.
Lateral condensation method
In this case, the dentist uses a sealer (sealant) instead of paste. Let's take a look at what the filling steps look like during the lateral condensation method:
- The center pin is placed.
- The filling area is dried with additional paper points, after which they are removed.
- Inject the sealer.
- 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 sealer until it is completely tight.
- 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 performs the final treatment in the oral cavity.
As a result of such treatment,not only sufficiently reliable closure of the apical foramen, but also complete filling of the entire root canal cavity.
Method involving the use of the Thermofil system
Thermofil are carriers made of plastic on which gutta-percha is applied. 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 oven and placed in the cavity.
- The rest of the rod is cut off.
Thus, preheated gutta-percha has a 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 fast process with reliable results.
The only disadvantage of the method using the Thermofil system is that the filling material quite often goes beyond the canals.
The main advantages of this method are:
- high level of tight sealing;
- the risk of re-inflammation is reduced;
- minimum toxicity;
- no pain after the filling procedure;
- treatment process is quite fast.
Depophoresis filling method
It is used in cases of hard-to-reach and curved canals, as well as those that have already been treatedpreviously. The essence of the method lies in the fact that with the help of the instrument of the same name, drugs are introduced into the entire root canal system. In fact, its purpose is complete sterilization.
In difficult cases, the depophoresis filling procedure is carried out 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, for many years there is no destruction of tooth tissues with the pulp removed. But most importantly, thanks to the sterilization carried out, the risk of reinfection is reduced to zero. The disadvantage of the procedure is its high cost.
Hot gutta-percha method
There are four ways to use hot gutta-percha:
- Injection gutta-percha.
- Vertical condensation.
- Continuous wave.
- Using a syringe.
Filling the root canal with injectable gutta-percha involves the use of material heated to 200 degrees to fill the cavity. It spreads throughout the cavity, thereby filling it thoroughly.
The vertical condensation method is rather complicated and lengthy. It consists of the following steps:
- The material heated to the required temperature is placed in the prepared cavity for filling the root canals.
- Then it is directed towards the apical foramen and lateral tubules.
- After complete sealing in the central partinsert softened gutta-percha pin.
- Excess material is removed.
Through this method, the space is filled three-dimensionally, while the gutta-percha is used to the maximum, and the sealer is minimal.
Continuous wave method is a variation of the previous filling method. It consists of two stages:
- The central pin is placed in the root canal, which is preheated to two hundred degrees, and cut off in the middle third.
- Successively, more pins of the same size are inserted, but they are already warmed up to a hundred degrees.
The distinguishing feature that makes this method better than the previous one is that the process is simpler and the sealing is just as complete.
The method of introducing gutta-percha using a syringe is convenient and fast. But the filling of the lateral tubules in this case does not occur. And sometimes the filling material does not reach the top of the root canal. As a result, work often has to be redone
E&Q Plus method
The E&Q Plus System is a special injection gun with a tip and various attachments. Thanks to him, gutta-percha can be heated to the desired temperature in the root canal itself. Thus, there is a gradual permanent compaction of the material. As a result, the filling is three-dimensional.
You can also complete the process with a gun,or 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 a root canal filling procedure, patients complain of pain in the treated tooth. This does not mean at all that something is wrong. Initially, you do not feel anything due to the anesthesia administered. Then, when its action passes, natural processes appear. After all, filling is a third-party intervention.
Tooth pain 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 the pain, whatever it is, does not go away, it is worth re-scheduling an appointment with your doctor. There is a possibility of complications. It is also worth visiting a dentist if the tooth just aches for a long period of time or hurts only when biting, and also if the gums are swollen.
At a follow-up visit, the doctor should do the following:
- Conduct a visual inspection of the affected area.
- Make X-ray diagnostics, with which you can assess the situation in the root lumen.
If there is a perforation, the patient will experience severe pain, and will also bleed and fall throughtool. In this case, re-filling of the resulting cavity should occur.
Rarely enough, but there are cases when an instrument 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 tool on the x-ray. You can get rid of the problem only after the removal of the tooth.
In other cases, poor-quality filling takes place. There could be gaps left unfilled. Then the material is extracted, the root canal is cleaned and re-sealed. It is worth noting that over time it will be necessary to replace the tooth with an implant or bridge. The average life expectancy of teeth treated with root canals is about fifteen years.
