Root filling

definition

The root canal filling is the final step in the root canal treatment process and completes the treatment. The root canal, which has previously been freed of nerve tissue, rinsed, disinfected and expanded, is sealed airtight so that no bacteria can burden the tooth any more. But why exactly is a root filling and what are the chances of success of this treatment?

causes

A root canal filling as the final process of the root canal treatment is necessary in some scenarios in order to save the tooth. The vessels within the nerve chamber must be removed if they are inflamed. This can be the case if caries spreads through the tooth to such an extent that the vessels in the pulp are infected by the bacteria. The vessels perish due to the bacteria and the tooth is no longer supplied with nutrients. The tooth is no longer vital and no longer feels any cold or warmth.
You might also be interested in this topic: Dead tooth

The bacteria metabolize the blood vessels, which leads to unpleasant pain and pressure. As a result, the vessels must be removed from the nerve canal.
Read more on the topic: Root canal treatment

Since the canals are now empty, they have to be filled so that bacteria cannot re-enter the tooth and infect it with it. Even after a trauma such as a fall or a blow to a tooth, the nerve within the tooth can die, so that the tooth is no longer vital. In this case, too, a root canal treatment with subsequent root filling is necessary to preserve the tooth. Inflammation below the tip of the root, which is diagnosed by an X-ray, is also an indication for a root filling.
Find out more about the topic here: Root inflammation

Another indication for a root filling is a failed root filling that is too short and does not close the tooth optimally. In this case, the root filling must be completely removed and then filled again. Broken teeth, which result in an open nerve chamber, also require a root canal treatment with a root filling to restore the defect that has arisen.

Procedure of a root filling

The root canal filling is the final step in root canal treatment. After the nerve and blood vessels have been completely removed from the pulp, the nerve canal is treated further. It is extended either by machine or manually with hand files so that a prefabricated pen fits perfectly into it. However, this process can continue. The primary aim is to kill the bacteria from the tooth and to disinfect the tooth. This is achieved with various irrigation solutions and medical insoles. If the tooth is still causing discomfort, even after all vessels have been removed, a drug is placed in the canal and several days are waited for the tooth to be symptom-free.

Only then will the canal begin to be prepared and widened. Now the canals of the tooth are measured with an ohmmeter so that the length of the later root filling can be determined. To make sure of the measurement, an X-ray is often taken to find out the optimal length. After widening the canals, they are dried after a few rinses so that there is no more liquid. The root canal filling, which consists of gutta-percha or thermoplastic materials, is now placed in the canal with a sealer that compresses any gaps between the filling and the canal walls.

The protruding ends are cut off with a heating device and the root filling is pushed down so that it cannot escape from the canals. To close the hole, a filling is made with plastic in order to reintegrate the tooth into the row of teeth. After the treatment, a control X-ray of the tooth is always made to check the length of the root filling. If the result of the root filling is satisfactory and the tooth remains symptom-free for the next 2-4 months, the tooth should then be crowned.

Read more on the topic: Root canal treatment process

Concomitant symptoms

The root canal filling as the final step of the root canal treatment can cause accompanying symptoms, which can also result in pain and discomfort. During the treatment itself, preparing, rinsing and penetrating the files into the root canals can lead to sensitivity and slight discomfort. Since very aggressive rinses are used to disinfect the canal and kill the bacteria during rinsing, this often results in unpleasant complaints.

Read more on the topic: Pain after root filling

The penetration of the file into the canal can also lead to stabbing pain, because when the needle passes over the tip of the root, intact nerve tissue is again present, which can be painful when touched. The treating dentist can quickly remedy this by injecting an anesthetic directly into the canals, which numbs the tooth directly and thus removes all discomfort. Furthermore, this anesthetic variant also offers the advantage that only the tooth itself is anesthetized and hardly any areas or areas around it. Due to the fact that the tooth is no longer vital during the root filling, the patient may well not feel any discomfort during the treatment.

Treatment / therapy

Treatment and the route of therapy differ depending on the patient's situation. The duration of the treatment, the use of the irrigation solutions or medicinal inserts, and the materials for the root canal filling vary. With milk teeth, for example, a root filling is only made with absorbable materials such as calcium hydroxide, so that the milk tooth remains as a placeholder and the root and the filling are reabsorbed by the body when the permanent tooth follows.

Severely gangrenous teeth, in which the nerve has died and has already decayed for a while, a drug is necessary, which has a strong disinfecting and calming effect to remove all bacteria. The irrigation solutions also vary depending on the situation. In the case of calcified canals, these must be softened with a calcinase solution in order to be able to widen the canals at all.

In the case of acute nerve inflammation in a living tooth, a rinsing solution with a strong disinfectant effect is sufficient to treat the canal system. This includes, for example, sodium hypochlorite. In vital teeth with inflammation, the root canal filling can take place in the same or the next session, while in non-vital, gangrenous teeth, several medical inserts and rinses are often necessary in order to be able to close the tooth.

How painful is the treatment?

The root canal filling as the last step of the root canal treatment does not have to be painful. If any nerve tissue has been removed from the canal system in advance and a medicated insert has calmed the tooth, the root canal can be filled without local anesthesia, as there is hardly any pain.

In cases of severe inflammation such as gangrene or abscess, it can take a long time for the inflammatory germs to all disappear, which is why the root filling can be painful that requires anesthesia. Since inflamed tissue is much more difficult to numb due to the acidic pH value, the treatment can still be painful despite the anesthetic. In these cases it is advisable to take a painkiller beforehand in order to contain the symptoms in advance.

Also read the article on the topic: Pain during a root canal treatment

Duration of treatment

The duration of the entire treatment can vary depending on the individual case. The previous cause for the root canal treatment and the subsequent root filling is also decisive. In the case of severe inflammation of the teeth that are still alive, a pulpotomy, it can take one to two weeks for the symptoms to go away and the inflammation to subside. If necessary, a medication insert is inserted into the canal at an intermediate appointment until the tooth is symptom-free and only then is the root filling made.

Completely symptom-free teeth, which were diagnosed by chance on an x-ray and then need a root filling, can also be provided with a root filling immediately after expansion of the canals and disinfection.Teeth that are inflamed as a result of trauma are also usually treated in this way. A guideline is that the process from the start of therapy to the completion of the root canal filling requires one to three sessions, roughly every week. Nevertheless, it can be the case that a tooth needs more time until the symptoms are minimized, but the patient should not lose patience because the root filling has a positive prognosis thanks to modern therapy methods. Even if the tooth causes uncomfortable discomfort for some time, the effort and patience can be worthwhile.

For more information on this topic, see Duration of a root canal treatment.

Pain after a root filling

Especially directly on the day or after the application, the patient can experience light throbbing and knocking complaints, which usually disappear completely after two days. The root filling is only an attempt to save the affected tooth. The prognosis is very good, but it can always happen that the symptoms do not subside even after an optimal root filling. As a rule, the attending physician tries to assist with an antibiotic to ensure that the bacteria die off more quickly and the symptoms subside.

Find out more at: Antibiotics after a root canal treatment

If there is still no relief from the pain after two to four months, a new X-ray should be taken for diagnosis. If the root filling is optimal and an inflammation can still be seen under the root tip, the indication for a revision of a root canal treatment is given. The root canal treatment is carried out again.

If the revision was also unsuccessful, a tip resection can be considered. The inflamed area under the tip of the root is surgically exposed, cleaned and the tip of the root is cut off. If necessary, a retrograde root filling can also be made to seal the tooth tightly. The tip resection is considered the last resort to save the tooth from extraction.

Read more on the topic: Apical resection

Cost of a root filling

Most of the costs for a root filling are covered by health insurance. However, there are two benefits that are not covered by statutory health insurance. This includes the electrical resistance measurement to determine the length of the root canal and the activation of the rinsing solution using electrochemical methods. Both methods require expensive equipment that is covered by a private contribution. A little less than 10 euros per service is billed per channel. This means that with one channel an additional payment of around 20 euros has to be paid for both services, with three channels 60 euros.

Specialists in endodontics, which describes the theory of the diagnosis and treatment of pulp diseases, often use more expensive machine files or a thermoplastic filling, which they charge separately. This can be 50 to 200 euros per channel as an additional payment, which is justified by the additional effort and the higher quality materials that are used. These high-quality methods ensure that the prognosis of preservation of the tooth through an optimal root filling increases. The patient should inquire in advance and negotiate a price and be informed in order to be on the safe side.

For more information, see Root canal treatment costs.

What is a retrograde root filling?

A retrograde root filling is a treatment step that is also carried out during an apicectomy. With the tip resection, the gums below the tip of the affected tooth are exposed and exposed in order to treat them. After the tip of the root has been cut off during the resection, the existing root filling in the canal may not be sealed tightly.

Read more on the topic: Procedure for a root tip resection

The retrograde root filling is a measure that surgically and endodontically seals the tooth below the root. In this case, the channels are colored and displayed so that the areas that require sealing are visible. Retrograde root filling means that a root filling is made from below that tightly seals the root from the surrounding tissue so that no bacteria can penetrate the canal system of the tooth. The retrograde filling is made with special cements or similar materials such as MTA so that the visible root filling is covered at the severed root tip.

Materials of a root filling

The materials for a root filling are variable and can be divided into two subgroups. There are temporary, temporary filling materials that are used as a medicinal insert for a short period of time. These are in the root canal for a maximum of two weeks and ensure that the tooth calms down and existing pain symptoms disappear.

The second subgroup are the definitive or final filling materials. At the end of the treatment, these are inserted into the tooth to create a bacteria-proof seal for the canals. These definitive filling materials are very biocompatible and do not cause irritation of the tissue at the root tip. However, they are not absorbed by the body and remain. Furthermore, all materials used in the final filling are radiopaque, which means that they are visible in the X-ray image so that the length can be checked.

The commonly used filling materials include thermoplastic fillings, which are introduced into the tooth in liquid form and then harden, or classic gutta-percha points. The thermoplastic root filling consists of heated, liquefied gutta-percha, which is a rubber-like material, which is similar to rubber. When cold, the gutta-percha point is flexible and pliable. Other definitive filling materials are made of synthetic resin. The previously popular metal pins for filling the root canals are no longer used due to the poor prognosis.

Can a root filling be removed again?

A root filling can be removed from the tooth again. This is common when a root filling is too short or too long and does not fit perfectly with the tip of the root. Furthermore, a tooth that causes persistent symptoms after a completed root filling also offers an indication to remove the root filling and insert a new one. The expert calls this process a revision. During the revision, an attempt is made to remove the root filling from the canal with special hand files or machine files and to rid it of all residues.

It is easier to remove freshly placed root fillings than to loosen root fillings that have been in a canal for years. These are solidified by the sealer and are very hard, which means that a revision is usually only possible in several application dates. A calcinase is used as a rinse, which is supposed to loosen the old root filling. It is important to completely remove the tooth from all residues and to completely disinfect the canal system. Only after this step can a new attempt be made to insert a root filling. As a rule, attempts are made to prepare the canals further than the first attempt at root filling. If the root filling is optimally placed, it is quite possible that a tooth will be symptom-free. If you have any further complaints, you should consider resection of the apex.

What if the root filling is too long?

Too long a root filling that extends beyond the root tip of the affected tooth can cause symptoms, but it can also remain symptom-free. If only the gutta-percha post is a bit too long, the tooth can still calm down, because the biocompatibility of the filling materials means there are hardly any complaints. Another possibility is that the sealer, which closes the gap between the gutta-percha and the root canal wall, over-presses itself during the insertion process.

This can push the sealer past the tip of the root and cause discomfort. In the case of complaints of a root filling that is too long or overpressed material, the therapy is usually not the revision in which the root filling is removed from the canal. Mostly the tip resection is preferred, as it can succeed in removing protruding root filling material or overpressed sealer below the root tip. A retrograde root filling is often also performed in order to seal the cut root tip tightly.

The cut end of the root is tightly sealed with cement or similar materials, a kind of root filling from below. In the case of asymptomatic teeth, the practitioner can individually decide not to do anything, which is often the case when the root filling has been in place for a long period of time. In this situation, it can also be decided to crown a tooth with a too long root filling. But that depends on the initial situation and the patient's history.

Find out more about the topic: Are there alternatives to apicectomy?

Root canal filling without anesthesia

Since the tooth has already been completely freed from all nerve tissue inside the canals during the root filling step, the tooth is not vital and therefore feels nothing. This means that the treatment can be carried out without local anesthesia, which is what happens in most cases. If the penetration of the files into the canals or rinsing with the rinsing solution is so painful for the patient that it cannot be endured, anesthesia can still be used directly in the canal.

The syringe is usually barely noticeable as it is not pierced directly into the tissue. Another advantage is that only the tooth is numb and not the surrounding tissue. Whether the injection is necessary or not depends on the individual situation and the pain perception of the patient. If a severe inflammation under the root tip or in the nerve chamber is the cause of the root filling, pain may well arise during the treatment, as the inflammation needs time to completely subside.

When can I smoke again?

You can smoke it again immediately after the treatment. If an anesthetic has been put in place, you should not smoke if you still feel numb. If the numbness has disappeared, you can smoke again.