Obturation of root canals: methods and materials
When removing the pulp of the tooth requires a quality obturation of root canals. What are the methods and materials in modern dentistry to perform the procedure described below.
Such manipulation is needed in order to fully block access of corrosive fluids to the interior of the tooth space, and also to stop the communication between her and the periodontal tissues that connect the root canals. Thus, the functionality of the tooth is maintained even when you remove his «heart».
The technique of obturation is that in the root cavities (channels) to impose an artificial pin, and the space between it and the natural tissue is filled with special plastic and hardened mass, which is called Siler. It consists of a two component paste, are able to close all the space, and in the hardened condition to securely hold the pin and to resist the aggressive influence of the surrounding fluids.
But the material of the rod may be different, but most often modern medicine stops at the gutta-percha. It used for filling root canals used the pasta with chlorophenol-camphor-menthol composition, the silver sealing materials and pastes on zinc and eugenol. Some of them are still popular in the endodontics of primary teeth as a temporary obstruction.
Modern materials for sealing must meet a large number of requirements:
- possess good sealing characteristics;
- to be non-toxic towards the body of the patient, not to cause allergic reactions or poisoning;
- not to irritate the tissues of the periodontium;
- not to be subjected to shrinkage;
- sometimes it is desirable for the increase of material in the channel branches;
- to possess antimicrobial characteristics to produce a disinfectant effect;
- to be visible in x-ray diagnostics;
- does not affect the color of the tooth to solid tissue is not darkened over time from oxidation;
- to be able to easily removed from the canal if necessary;
- fast enough to harden, facilitating the dentist’s work;
- not dissolve when exposed to natural fluids secreted by the tissue;
- strength and at the same time sufficient elasticity;
- the biocompatibility of the components.
To find such material for a rod and sealer, which would have all of these characteristics simultaneously, yet failed. But there are gutta-percha, which is used for this in various combinations using several of the most popular methods of obturation of root canals. Thus, it is possible to find the best option in each case to perform the procedure with minimal side effects.
All methods based on the use of gutta-percha, are of similar design. This requires the pin made from latex guttertoon tropical plants. Most often these goals take so-called beta-type material. Through it is achieved the desired plasticity, flexibility and elasticity.
Gutta-percha meets a greater number of these requirements – it is able to uniformly fill the root cavity, non-toxic, amenable to condensation that softens when heated and, most important, compatible with the human body without causing any adverse reactions.
When working with the pins of the gutta-percha must be used and Siler to fill the remaining space. Practically excluded the use of only a single stem, often need several pieces of different lengths. Experience and skills of the doctor it is very important, as working with such material requires care and precise movements.
Methods and application of gutta-percha
List the main methods of obturation used in modern dentistry:
- Standard technique.
- Soft and warm gutta-percha.
- Chemical technique.
- Lateral condensation.
- Two-stage biological method.
Each system has its pros and cons, especially in working with the material. In each case, the doctor should be able to choose which method is best to use, some dentists believe that a perfect result can only be achieved by combining two or more methods.
This method of treatment of the root canal appeared after apicalnam the ledge was able to create the desired cylindrical shape of the standard size. This simplifies the entire process of root canal and helps to choose the right diameter of the gutta-percha rod. Due to the coincidence of the dimensions of the pin and the channel ensures a snug fit of the material to the walls, which is similar to the clogging of the bottle stopper.
When this is performed closure of apical ledge and the summit of the canal zone with a suitable diameter of the tool used for modeling the desired area in the treated area. In this case, it is mandatory to use sealer.
The procedure involves the following stages:
- the formation of cylindrical apical focus, preparing the tooth cavity treatment;
- selection of the ideal size of the master pin;
- the verification of the accuracy of its occurrence, when there is a jamming of the rod, and removing it can only make efforts, its fit is checked using x-rays;
- on this pin is marked and removed from the channel;
- produce the processing of the rod or walls of the dental cavity with a special sealant and enter the master pin to the full depth;
- if fully inserted it does not work, you should clear the surface from excess material, and dentinal filings with the tool K-category with the same diameter as a cylindrical region;
- before you enter your next fill the cores, the main pin must be located precisely and fixed with the help of a sealer;
- further, by analogy, produce the filling of the root canal auxiliary terminals, using the spreader and sealer.
Method is quite simple and easy to use. The likelihood that the material will fall from a pipe or fall into the periapical area is minimal, and the reliability of the sealing is high. After the procedure correctly, you can ensure that it does not require the use of overly aggressive techniques, such as lateral condensation.
The disadvantage of such processing channels is substantial expansion and shape change of apical ledge to the desired dimensions. This is especially difficult to do in the treatment of incisors and premolars of the upper jaw.
Soft and warm gutta-percha
This method provides a reliable seal and tight filling of the cavity tubules. Because of this it is sometimes called three-dimensional, because regardless of the structure of the branches of the channels, they are filled with sealant. But it also has disadvantages – higher chance of diffusion of material into the periapical region, and sometimes there is shrinkage.
Heated gutta-percha differently among professionals is called termopolirovannogo. Its plasticization, i.e. a softening occurs after installation in the sealed region due to the impact on it of the special tool-coolant of a certain temperature.
For the convenience of the dentist forms the area of the processed channel in the form of a cone which widens considerably at the crown. This method assumes the existence of vast areas for the occurrence of the tool is large in diameter.
This technology requires and other features in the works – support the master-pin is trimmed with the creation of sharp peaks and select a smaller by 2-3 mm than the depth of the sealable channel. After removing the cavity wall is applied to the zinc-oxidability cement, and the pin after the re-introduction of cut with a hot tool.
Then warm the softened gutta-percha is injected into the side of the top of the tooth with cold plugger. The complexity of the procedure is that now you need to repeatedly insert and remove the rod fast enough and process it heated tool. Simultaneously with this is the same injection of the material in the direction of the apex by cold plugger.
When I carefully fill root canal 5-6 mm, complex manipulations can be stopped. If so, then the procedure ends. In the case of volumetric space, and a partial obturation is necessary to use fragments of the support pins and the same way to fill them with sealant and the remaining space until the entire channel will not be closed.
Due to this system is the most snug fit of the material to the walls of the root, but part of it can get into the periapical region, so the method is not considered ideal.
For obturation of the root canal with this method, we need the same rod of gutta-percha, as in other cases, but treat it with chloroform or other similar saline solution. The whole procedure takes the following steps:
- Disassembled apical ledge for the formation and preparation of a processed cavity.
- Select the master pin, the diameter of which should be more than 2-3 times, than a tool for processing, and a length of less than 2-3 mm from the full depth of the channel.
- Gutta-percha is immersed in the prepared cavity and after x-rays marked at the level of chewing or cutting part of the tooth.
- The following marking is done with a full immersion stem apical to the ledge.
- After the last extraction process the surface of the pin sealer and immersed in a solution of chloroform. To sustain the right time, which is determined depending on the size and diameter of the material.
- Now you need quickly and with force to enter a rod into the channel and push it to the apex to the point, while the label is not matched with the chewing surface of the crown. This would indicate a tight fit and quality pripravki of gutta-percha.
- If necessary, the remaining space in the channel filled with pieces of pins with Siler. It is often used lateral condensation as an auxiliary method filling the remaining area.
Methodology Termofil produce funnel-shaped obturation of the root canal, when there is formed a top. This can cause incomplete filling of the cavity, and the sealant to get beyond apical ledge. That this did not happen, you may want to block this part of the canal using softened gutta-percha is not.
Thermafil technique is done using a hypodermic needle filled with a liquid material, heated to a temperature of about 160 degrees. It is placed in a area filling with a dip to the apical third of the ledge and slowly released from it a liquid, simultaneously removing back tool.
Thus, it turns out to germetizirujut root canals of any complexity, volume and shape. But there are some nuances. To fill at a time is only 2-3 mm, cooling the material with a constant pressurizing force. Then repeat the manipulation until the entire treatment area.
One of the variations of this technology – conducting obstruction due to the softening of gutta-percha directly to the channel friction nozzles. However, this method is not the best, because very often such tools are broken, and to control the level of heating and the state of the web is almost impossible.
This method helps to avoid the shrinkage of material after cooling, as is often the case in previous versions. Also you can not be afraid of pushing gutta-percha in the apical zone, because it won’t soften and hermetically closes this part of the canal.
Processing sealable region suggests giving it a cone shape. Size accurately select the appropriate master pin and enter it to the full depth. X-ray check on the quality of pripravki.
Make a mark on the surface of the tooth, remove the rod and put it or on the walls Siler. Without prior softening, as is, enter the pin back into the apical area, so that the marking coincides with the designated level.
A spreader it is well to pin the rod to the side wall of the channel, and the space formed quickly to fill other pins coated with sealer to the top level of the extracted spreader. They made subsequent condensation of each installed terminal until, until it fills the entire space.
It is believed that such material, which did not respond to heat treatment, has a greater spatial stability. The hardest part of the job – obturation of the upper zone of the channel. After all, if it’s filled only with sealer, then gradually from the effects of natural fluids quickly depressurized.
Video: obturation of root canals with hot gutta-percha.
Two-stage biological method
Found a fairly complex structure of root canals when conventional technology is unable to efficiently germetizirujut all branches. Then the best way would be a two-step technique of filling each channel separately.
First make the filling first part of the pin with the circumcision of a heated instrument at the level where the channels branch out. Then repeat the procedure with another part and go on to the filling common area in the usual way.
In cases of treatment root resorption the doctor fills the segment of the channel located above the gaps. Then the rod is cut at the level of the lower limit of resorption and sealed the defect itself and the top of the channel using vertical condensation.
Another difficult case when the unformed apex has a radius much larger than any available core to seal it. Then you have to compress two or more pins between them so that they become one and completely covered the desired space.
Method called «biological» obturation involves the use of a patient’s own cells. It is taking calcium supplements and other stimulants of growth of the hard tissues. Then take the periodontium of the material and wysiwyt it in the root cavity.
Also, this method may be performed using the filling of the channels of a special collagen gel that is able to increase the connective tissue. When this occurs, not only filling the entire region a natural material, but the processing of the walls of mineral composition.
Modern dentistry is able to provide every patient is a reliable method of treatment of dental roots and the preservation of the units even after the removal of the pulp. Whatever his age, individual characteristics, the structure of the channels and problems with the surrounding tissues, your doctor may perform the necessary medical manipulations.
The cost of the procedure is also different, usually obturation costs 5000-10000 rubles, depending on the number and structure of channels, the level of the clinic and the selected method. The most expensive is considered to be the lateral condensation, as a more complex but reliable method.