Filling dental canals: features of the procedure, treatment methods

Indications

The cavity located inside the tooth, where the nerve endings and blood vessels are located, is called the pulp. If the caries lesion is not treated in a timely manner, the pathology reaches the pulp, which leads to the occurrence of an inflammatory process called pulpitis. The process does not go away on its own; the pain that inevitably arises is removed by painkillers in the initial stages. Over time, they also stop working. In advanced cases, inflammation spreads to the bone, which leads to periodontitis and, as a consequence, osteomyelitis. The main indication for root canal filling is pulpitis caused by caries.

What factors affect the service life of a filling?

For a tooth to last for a long time, it is important to remember the following factors:

Tooth location. The chewing load is greater, so the fillings on them hold less well.
Bad habits. If the patient is accustomed to chewing nuts, seeds or candies, as well as opening bottles with his teeth, etc., then the service life of the restoration is rapidly decreasing.
Bruxism – contributes to tooth wear in general.
Poor quality treatment. An indicator of this may be how long it takes to place a filling, the lack of control images during the treatment of periodontitis, etc.

If the filling has already fallen out, how long can you walk without it? Dentists recommend not to delay, but to consult a doctor as soon as possible. Besides the fact that it is a source of infection in the mouth, the thin walls of an unfilled tooth can break when chewing or biting into hard foods. The next restoration will be more massive, or even require prosthetics with an inlay and a crown.

Filling methods

Until recently, the procedure was carried out using pastes, which are inexpensive and do not require complex technologies. Now professional dentists have abandoned them due to insufficient fluidity, which leads to the formation of cavities. Voids lead to depressurization and relapse of inflammation.

At the moment, doctors choose progressive methods:

Thermophile system. The filling is performed with hot gutta-percha, which hardens as it cools. It is characterized by high plasticity. There is no pain after treatment. The risk of complications is minimal;
depophoresis. It is used for filling difficult, curved canals, as well as for restoring elements from which it is difficult to remove old fillings and where fragments of ostomy instruments remain in the cavities. Efficiency - no less than 95%;
E&Q Plus. The latest generation method, which provides various methods of filling the roots of one tooth. The injection gun heats the gutta-percha directly inside the cavity. The doctor can control the temperature of the material using the information display.

Another common method is filling the canals with cold gutta-percha, which is used in several ways:

lateral condensation;
softening due to chemical action;
with one pin. To give the shape, a pin is installed in the canal. Sealing is ensured through the use of paste.

There are other technologies that are selected depending on the location of the channels, the condition of the tissues and the experience of the doctor.

Stages of canal filling

First of all, the doctor carries out an examination and the necessary diagnostic operations, which may include, for example, an X-ray examination of the oral cavity.

If suspicions about the need to fill the canal are confirmed, the dentist carries out preparatory manipulations. First of all, adequate anesthesia. After it has taken effect, the caries-affected tissue is removed using a burr. The dental nerve is then removed. Next, the doctor is engaged in mechanical processing of the endodont - a complex of dental tissues, including pulp and dentin.

Upon completion of the preparatory stage, the empty root canal is filled, then a permanent filling or crown is installed.

Reasons for the development of childhood caries

Main risk factors:

Excessive consumption of sweets. In this case, a harmful environment is formed in the child’s mouth, and the tooth enamel begins to suffer.
Transmission of infection from relatives. This can happen when sharing utensils, adults licking a baby's spoon, and sometimes even kissing.
Long contact with the bottle. This type of caries is called “bottle caries”. If a baby drinks a sweet liquid from a bottle and then falls asleep with it, then prolonged contact of the sweet with the teeth can lead to the rapid development of caries.
Deficiency of fluoride and calcium in food.
Lack of solid food. When chewing solid food, a lot of saliva is released, which naturally washes the oral cavity.
The use of medications that change the composition of saliva.
Chronic diseases.
Improper care of baby teeth. Infants need to wipe their teeth from the moment they erupt - you can use ordinary gauze wrapped around your finger. It is very important for parents to teach older children to brush their teeth and use a brush, constantly remind them of this and monitor compliance with the procedures. The example of parents is a strong motivating factor here.

Description of the procedure

Local snapshot. X-ray allows you to see the condition of all channels, their number, location. In difficult cases, a 3D image is taken.
Anesthesia.
Drilling of diseased tooth tissues.
Removal of nerve and blood vessels.
Determining the depth of the canal using an apexolator.
Widening the passage to place the drug and install the pin (if required).
Filling.
Control photo.

After treatment, it is not recommended to consume hot drinks and food for 1 – 2 hours.

Temporary filling

In some cases, medicine is introduced into the canals for a certain period of time. Manipulation is carried out for:

elimination of pathological microflora;
stopping the inflammatory process;
isolation of the canal, when it is impossible to carry out treatment in one visit.

Indications for temporary installation of a filling are injuries, perforation of walls, periodontitis in acute or chronic form.

The main active components of medicinal non-hardening pastes are antibiotics.

When is endodontic intervention indicated?

Endodontic treatment is carried out in the following cases:

Inflammation of the coronal and root pulp - pulpitis. Moreover, the form of the disease can be both acute and chronic.
Periodontitis.

Inflammation of blood vessels and nerve fibers is observed in complicated forms of caries, with a cracked tooth. Inflammation can also be a consequence of injury.

Are there any contraindications for this procedure?

Like any dental procedure, endodontics is contraindicated in a number of cases:

Vertical incisor fracture.
Too narrow, impassable dental canals.
Damage to periodontal tissue.

Cost of services

Consultation with an implant surgeon 0 rub.
1-canal tooth (canal filling with gutta-percha pins) 750 rub.

2-canal tooth (canal filling with gutta-percha pins) 980 rub.

3-canal tooth (canal filling with gutta-percha pins) RUB 1,300.

Placing a temporary filling costs 200 rubles.

Compomer filling for permanent teeth RUB 1,000.

Filling for permanent teeth made of gypsum resin, cotton RUB 1,200.

Filling for permanent teeth made of photocomposite RUB 1,800.

Placement of a light-curing filling for non-carious lesions RUB 2,000.

Placement of a light-curing filling for average caries RUB 2,500.

Placement of a light-curing filling for deep caries RUB 3,000.

Placement of a light polymerization filling for periodontitis (taking into account the formation of a cavity and the application of a lining) RUB 2,350.

Placement of a light polymerization filling for pulpitis (taking into account the formation of a cavity and the application of a gasket) RUB 2,370.

Restoration of the crown part of a tooth using light polymerization materials (caries) RUB 3,050.

Restoration (caries, pulpitis) RUB 4,650.

How to prepare a tooth for a crown: filling or inlay?

Should I use composite materials or should I use a metal-free inlay? Let's set the accents.

Dental filling

The main load falls on the fragile collapsing walls. A huge filling will not bear the load and will break along with the remains of the walls. Previously, the work was labor-intensive: if a large filling was installed on a pulpless tooth, then the use of a pin was required. Today, pin fillings have been replaced by Cerec modules, which combine both pin and filling capabilities, and such modules are manufactured within 15-20 minutes, which allows you to restore a tooth in one visit to the doctor.

Before prosthetics, filling with a pin was justified if the crown of the tooth had non-critical damage and its base was strong enough. The rod was installed in only one channel. If the pin broke, it damaged the root, and the patient had to undergo surgery to remove the remains of the tooth and then implant it.

As already explained, pins are becoming a thing of the past, and they are being replaced by modern Cerec dental inlays.

Dental inlays

A smart way to save a tooth

- This is an inlay made of ceramic or zirconium dioxide. Zirconium is phenomenally durable, but ceramics also show excellent results. Its strength is close to that of real enamel and under the crown the material will be a reliable support for the unit.

The inlay helps restore the occlusal surface and replace the chewing plane of the tooth as an independent method of restoration. The tab is installed in all channels and can withstand significant loads.

The natural unit is treated first, and then the prosthodontist begins preparations to place a crown on the tooth. In our clinic, a Cerec ceramic inlay will be made quickly and with filigree precision. The anatomical complexity does not matter - the module is performed taking into account all physiological characteristics and bite nuances.

If the patient’s tooth is significantly damaged, but there is a stable healthy root, then a technological solution would be:

installing an inlay under a crown or
complete restoration with one dental module “root + crown” using Cerec technology.

Possible complications after canal filling

In the absence of complications, the process can take about one to one and a half hours. But in severe and advanced cases, it may require several visits to the dentist.

The most common type of complications after filling a tooth canal is the neglect of the inflammatory process, accompanied by focal tissue destruction. In this situation, a temporary filling is installed from a non-hardening paste containing medications. The time of wearing it and the composition of medications is determined by the doctor during an individual consultation. This treatment shows high effectiveness for diagnoses of cystogranuloma and periodontitis.

Materials for canal filling

Unfortunately, situations are common in which pain continues to torment the patient even after all medical procedures have been completed, and after the period adequate for rehabilitation has expired. The reason for this reaction of the body may be an error in choosing the filling material. There is still no universal substance that would suit everyone. Consequently, dentists, based on their knowledge and the results of examining patients, each time make a choice in favor of one material or another.

Today the following substances are used for canal filling:

fillers. They are represented by gutta-percha, silver and titanium pins;
sealers. These are different types of cements, including polymer, natural, glass ionomer or containing calcium hydroxide, as well as polydimethylsiloxanes.

Gutta-percha can be called perhaps the most popular material due to the complex of its properties:

leaves the tooth color unchanged;
copes with absolute sealing;
not subject to dissolution;
not subject to deformation.

Tooth canal treatment methods

Along with canal filling, other techniques are common in modern dentistry that allow you to preserve both the appearance and functional load of teeth.

These include:

depophoresis method - designed to increase the efficiency of cleaning the canal from pulp tissue. It is based on the effect of copper-calcium hydroxide and a weak electric field on tissue.
The method of obturation with the Thermofil system allows you to introduce thermoplasticized gutta-percha into the prepared root canal with high precision.
Treatment with cold or heated gutta-percha allows you to achieve perfectly accurate filling of all tooth cavities after treatment.

It is important that the dentist strictly follows all ISO standards when selecting the instruments required for endodontic treatment. The caliber, diameter and even color of the instrument play an important role.

Medical errors in endodontic treatment

According to some data, Russian specialists achieve success with endodontic treatment in only 30% of cases.

The most common mistakes include:

incomplete obturation (when filling the prepared dental cavity with filling material, air bubbles remain; the material does not adhere tightly to the tooth tissue);
insufficiency, low quality of antiseptic treatment (threatens the occurrence of an inflammatory process);
deformation, breakage of the pin or tool.

Can an ordinary patient who does not have a medical education determine the degree of qualification of the endodontist he sees? Yes. The first, main sign of a low qualification of a doctor or insufficient technical equipment of the clinic is the lack of an X-ray examination at the beginning of therapy.

If inflammation occurs or if pain lasts for an inadequate duration after filling a tooth canal, you should immediately consult a doctor. Delay may result in tooth loss.

Expert of the article you are reading:

Lozinskaya Alla Nikolaevna

Pediatric dentist, general dentist.