Filling of teeth( cavities and root canals) - Causes, symptoms and treatment. MF.
If the caries has spread deeper than the surface layer of the enamel, especially when finding a defect in the natural grooves( fissures) or between the teeth, then this is an indication for tooth filling. With medium and deep caries, the filling of the defect is mandatory and is carried out using so-called insulating pads( to protect the deep layers of the dentin) and medical( containing calcium and promoting regeneration of dentin).
Consider how the filling of carious cavities occurs.
What are the types of seals today? What are their advantages and disadvantages?
"Light-curing" fillings
The most modern and very popular today are the so-called "light-cured" fillings. They are called so because they solidify under the influence of light of a certain frequency. These seals have many advantages over others: first, they are very aesthetic( imperceptible), which is especially important when sealing the front group of teeth, and secondly, they have good strength and small shrinkage. In addition, they are very convenient to use by a dentist, since they allow him to spend a sufficient amount of time to form an anatomical tooth shape.
For filling with such material, the doctor mechanically( with diamond and metal burs) removes all affected caries tissue.
With severe pain during anesthesia, anesthesia is possible. Then, after antiseptic treatment, the "lining" is mandatory, the purpose of which is to isolate the tooth tissues from the harmful effect of the filling material. After that, the entire cavity is treated with a special acid, after washing off, a "bonding"( glutinous) system is applied. It also causes such good adhesion( adhesion) of a seal.
The filling material is layer by layer, each layer is highlighted with a special lamp.
After mechanical surfacing of surplus material( when the doctor asks you to "bite", these surpluses become visible to him), polishing and polishing of the seal is performed. On a well polished filling, dental plaque is formed much more slowly, and this is the guarantee of a long service of the seal, in addition, a well-polished seal is virtually indistinguishable from the tooth tissue.
The whole process of setting such a seal, depending on the complexity, takes 40 - 90 minutes.
Fillings of chemical curing
No less popular are chemical sealings. Their solidification occurs under the influence of a chemical reaction between the constituent catalyst and paste, which are mixed immediately before use. The solidification of the material begins in a few minutes and lasts for a day. Otherwise, they have the same advantages as light materials - they also have a wide color palette, which makes it possible to pick them to the color of the tooth, are very strong, have a small shrinkage.
The setting of such seals also begins with anesthesia( if necessary) and the removal of infected tissues with a drill. Next, antiseptic treatment of the cavity and setting "lining", protecting the tooth tissue from the effects of chemical fillings, is carried out. The walls of the cavity are treated with acid( the same as when stamping the light-cured seal), the acid is washed off. Further, "bonding"( glutinous) composition is applied, the filling material is simultaneously introduced into the prepared cavity, formed under the anatomical shape of the tooth, polished and polished.
As in this case there is no time to exaggerate each layer of material, the duration of the procedure is reduced to 20-30 minutes.
The doctor's recommendation in this case is to refrain from using strong staining products( beets, carrots, carbonated drinks, juices, etc.), so they can distort the color of the seal.
Cements
The next type of seal is cement. To date, these fillings are the least popular, becausehave a number of disadvantages. They can not be matched to the color of the tooth, they are very demanding for the formation of a cavity for the doctor to fill and the method of preparation. They are the least durable and their service life is small. But at the same time they are very affordable, and they are used in some cases, especially in of pediatric dentistry when filling baby teeth .In this group there is a subgroup of glass ionomer cements, which should be told in more detail, since it has the widest application. These cements contain fluoride ions in their composition, which determines their ability to strengthen tooth tissues. In addition, they are resistant to moisture during the formulation, which is also very convenient in children's practice, when it is impossible to achieve absolute dryness.
For the cement seal insertion, the doctor also removes all tooth decayed caries( if necessary, under anesthesia), treats the cavity with an antiseptic, then the cavity is thoroughly dried and the necessary amount of cement is added to it. Then the surplus is removed using a drill, the surface of the filling is ground.
Polishing of cement fillings is impossible, which means that the surface of the filling remains rough, which is a favorable factor for the "sticking" of plaque to it.
Thus, the time spent on setting up a cement seal is only 10-20 minutes. After filling the seal, the doctor will recommend that you refrain from eating for 2 hours to avoid excessive loading on the seal and its final hardening.
Fillings of amalgam and plastics are used very rarely today due to high toxicity and unaesthetic.
Filling of the root canals of the tooth.
Sealing of the root canals of the tooth is necessary when the caries changes into pulpitis.
Sealing of the root canals of the tooth is to fill the root canals with as much filling material as possible, as this channel remains empty after removal of the nerve.
Modern methods of tooth canal filling and filling materials make it possible to carry out this process quite quickly and quite painlessly.
The root of the tooth is difficult to treat, as it is difficult to examine, and with this, there are also difficulties with the filling of the canal. It is very important to determine the length of the tooth canal, which is determined by X-ray. The correct moment is the correct filling of the tooth canal.
To fill the root canals in modern dental clinics, the following methods are used:
1. Method of filling the canal with one paste.
2. Method of one( central) pin.
3. Filling the canal with gutta-percha.
Side condensation method.
Method of filling with chemically softened gutta-percha.
Vertical seal of warm gutta percha.
Thermal mechanical seal of gutta-percha.
Obturation of the gutta-percha canal, injected with a syringe.
Method for the administration of gutta-percha on the carrier( -germafil)
4. Depophoresis with copper-calcium hydroxide.
Pastes for sealing the canals of teeth .
Pastes based on zinc oxide and eugenol. They are designed to seal all groups of teeth. True, they have a property to wash out from the root of the canal and have an irritating effect on the tooth tissue.
Resorcinol - formalin paste has found wide application in filling teeth for many decades. The material changes the color of the tooth.
Pasthenan paste. During the polymerization in the channel, it heats up and releases gaseous formaldehyde. It penetrates into the lateral tubules and turns pulp into an insoluble antiseptic formation. The paste is easily introduced into the channel and solidifies within 24 hours.
Pasta endamethosone. Has good characteristics. It does not dissolve in the canal of the tooth, does not cause irritation, remains in the channel in an unchanged form. The paste powder has two colors: pinkish-orange and ivory. The pinkish-orange changes the color of the tooth.
Disadvantages of pastes and cements when sealing :
When filling with one paste, despite the apparent simplicity, removing the material behind the top is the rule, not the exception. The distribution of material in the channel is often inhomogeneous, the possibility of an air layer appears. The drawback of the method is that the paste can be significantly reduced in volume, and some pastes - dissolve when in contact with the tissue fluid.
Unfortunately, in Russian clinics the most common root canal filling is with one paste.
Method of one( central) primary pin.
This method is called "standardized method" in some manuals. This method uses the principle of combining root canal filling with a paste with a single pin. It should be noted, however, that in this case it is necessary to prepare the root canal with the creation of an apical conical shape. Root canals are filled with paste.
After insertion into the paste canal, the fitted gutta-percha pin is immersed in the paste and slowly injected into the canal until it stops. As the slider moves slowly, the pin should not push the paste forward and push it past the tip, and evenly distribute it in the channel, pushing the excess into the tooth cavity. With proper use, this method guarantees reliable root canal filling.
Methods of filling gutta-percha canals should be preferred. However, at this stage, with significant financial difficulties, and also due to the great habit of sealing one paste, the method of one pin is quite accessible to a doctor of any level of the dental institution.
After filling the root canal, X-ray inspection is necessary, and only then a seal is applied.
Sealing of the root canals of gutta-percha
The sealing of the gutta-percha canal corresponds to the highest requirements for the filling material. But gutta-percha as a filling material has a serious drawback - the inability to block microorganisms.
Filling the gutta-percha channel - The method of lateral( lateral) condensation of cold gutta-percha. The lateral condensation of cold gutta-percha pins with a filler( sealant) is considered the most reliable method of sealing the root canals of .In addition, there are indications that the efficiency of lateral compaction is determined by the thoroughness of the root canal cleaning. It is noted that already 15 days after the filling, the inflammatory events subsided, and a year later the periodontal tissue was restored.
The following steps are envisaged for the lateral condensation method.
Fitting the central pin.
Drying the duct.
Sealant introduction.
Introduction to the main pin channel.
Push the pin back to the duct wall.
Introduction of an additional pin, pre-lubricated with a sealant, into the formed space.
Filling the channel with gutta-percha pins with repeating the indicated procedure.
Cutting excess gutta percha at the mouth of the canal.
Vertical condensation of gutta percha at the mouth of the canal.
Sealing of the cavity.
Thermophile
Thermophile is a method for sealing the root canals of a tooth with a heated gutta percha on a plastic carrier, which is called an obturator. When heated, the gutta percha becomes plastic and, due to this property, the tooth channel is sealed tightly. Tightness reduces the risk of microorganisms in the root canal. This system gained its popularity after the appearance of tools, with the help of which it became possible to mechanically process the tooth canal.
The procedure for filling the root canals with thermophilic is as follows: the plastic pin with the heated gutta percha is slowly introduced into the root canal, and the gutta percha fills all the lateral tubules and branches under pressure. By the way, hence the second name of this technique - volumetric filling, since at the same time the whole root system of the tooth is filled at once.
The heated gutta percha is very plastic and therefore perfectly seals not only the main canal of the tooth, but also small lateral tubules, irregularities on the inner surface of the tooth canal. The result is simultaneous high-quality filling of the main and all additional channels of the tooth. This allows to achieve high sealing integrity, which significantly reduces the risk of development in the root canal pathogens. In addition, the Thermophil system involves the use of less toxic filling pastes and in a smaller amount, and this allows to significantly reduce the intensity of pain in the tooth after the procedure of filling the canals. In addition, when using the Thermophil system, the treatment time is significantly shortened, which creates additional comfort for the patient. Of course, the technique requires a lot of material costs: a drill with an endodontic tip is needed, special gutta-percha heaters, high-quality, costly endodontic instruments( many of which can only be used a few times).Despite this, the Thermophil system has gained wide popularity in dentistry and is successfully used today in our country.
The main advantages of the Thermophile system:
• providing a higher sealing than the other sealing methods;
• less risk of inflammation after filling;
• less toxicity to the patient;
• no painful reactions after the root canal filling procedure;
• rapidity of treatment
Method of depophoresis
This method is used for tooth filling with difficult and curved canals of teeth. The method of depot digestion of copper and calcium hydroxide allows the preservation of completely hopeless teeth. With the aid of a special instrument, a drug substance is introduced into the root canal system. A medicinal depot is formed. Due to this, channel sterilization occurs, since the hydroxide - copper of calcium possesses the strongest bactericidal properties.
As follows from clinical observations, there is no ideal material for root canal filling to date. However, is the most optimal gutta percha , which is inert to surrounding tissues, almost does not change the volume, reliably obturates the canal, it is easy to handle.