When to fill a denervated tooth? Nerve extraction is one of the vital treatments in dentistry, which is performed with the aim of saving damaged or infected teeth. Many patients think that the end of denervation is the end of treatment; While filling or covering the tooth after denervation is considered a vital part of the treatment. If this step is not done on time, all the treatment efforts may be ineffective.

Why should we fill a denervated tooth?

• Preventing the penetration of bacteria: After the pulp is removed, the tooth becomes empty and vulnerable.
• Increasing tooth resistance: Filling or coating makes the tooth resistant to chewing pressure.
• Prevention of treatment failure: Delay in filling can lead to cracking or fracture of the tooth.
• Preserving the beauty of the smile: Filling or veneering restores the natural appearance of the tooth.

The best time to fill a denervated tooth

• 3 to 7 days after nerve extraction: in most cases, it is recommended to fill the tooth during this period of time
• 1 to 3 weeks after treatment: If there is inflammation or swelling, the dentist may delay the filling.
• Immediate filling (same day): In some cases, the dentist can fill the tooth immediately after nerve extraction, especially if the condition of the tooth is stable.

Points you should not ignore

Points that you should not ignore after nerve extraction and before tooth restoration:

• When root canal treatment is done, the job is not over yet. The quality and durability of the result depends on the timing and type of repair after denervation. This section is the point that is usually ignored and becomes a problem later.

The importance of timing of recovery after denervation

• Not filling in time:

  If after denervation, the final restoration (permanent filling or veneer) is not done in time, the possibility of saliva and bacteria penetration through microleakage into the treated canals increases. This can lead to re-infection, the need for re-treatment or even tooth loss. In addition, the structure of the tooth is more fragile after the discharge of the pulp and will be prone to cracking or breaking due to chewing pressure.

• Logical time frame:

  After the root canal treatment is completed, a temporary restoration is usually placed first. This temporary repair is only designed for a short-term period and does not provide complete protection. A long time to permanent restoration increases the chance of treatment failure. If pain and inflammation are unstable, short-term patience is reasonable; But "long delay" multiplies the risk.

• Useful tip:

  If the coating is going to be done, it is better to start cutting and molding after the tissues have stabilized and the sensitivity has been removed; And until the veneer is delivered, appropriate temporary restoration and controlled occlusal height should be used to prevent fracture.

Choose between padding and padding; Decision based on real risk

• Posterior teeth usually need veneers:

  Molar teeth and premolars are at risk of microscopic cracks and fractures after denervation due to the loss of internal structure and high chewing forces. A veneer with full coverage of the cusps significantly reduces this risk. In contrast, simple fillings may be sufficient for anterior teeth with better access and less forces.

• When is filling enough?

When the amount of dental tissue removal is low, the walls remain healthy and strong, we do not have extensive cracks or caries, and the occlusal contacts are not severe. In this scenario, composite or amalgam filling can be an economical and effective choice.

• When is a cover necessary?

In the presence of previous large restorations, weak or thin walls, severe wear, pressure habits (grinding/bruxism), and fracture history, veneers with or without postcover are recommended. If a large part of the crown is missing, first a "blind build-up" is done to restore the base and then the veneer.

• Selecting the restorative material:

For blind and intracoronal filling, composites with high filler or resin-modified glass ionomers can be good options. In veneers, reinforced ceramics, zirconia or metal-ceramic are chosen depending on aesthetics, budget and occlusal conditions. Proper bonding and good insulation are as important as material selection.

Attention to symptoms after treatment; What is normal and what is a warning

• Naturals:

Some sensitivity to pressure or throbbing in the first 2-3 days, transient sensitivity when chewing, and mild discomfort around the gingiva near the treated tooth are usually normal and will improve with occlusal control and simple care.

• Warnings:

Pulsing pain that increases, swelling of the face or gums, fever, purulent discharge, or severe pain on palpation are signs of residual/secondary inflammation or infection and require immediate evaluation. In this situation, postpone the final restoration until the situation stabilizes.

• Occlosal (height of contacts):

Too much occlusal contact on the temporary restoration is one of the causes of pain after treatment. With correct occlusal adjustment, unwanted pressure is reduced and pain subsides. Before the final restoration, it is necessary to ensure the occlusal balance.

• Short-term care:

Until permanent repair is made, chew hard/sticky foods with the opposite side, maintain good oral hygiene, and use a night guard for bruxism if you have one.

Dentist consultation; The final decision is personalized

• Specific evaluation of each patient:

Severity of initial infection, canal anatomy, amount of residual tissue, occlusal patterns, crack or fracture history, and esthetic needs can all alter the decision. This evaluation is sometimes completed with radiographs and clinical tests.

• Phase scheduling in difficult cases:

If the inflammation is severe or the canals are complicated, the root canal treatment may be completed in several sessions and dressings and intracanal drugs are used between sessions. In this case, the final restoration is done after the symptoms stabilize and the treatment success is confirmed.

• postcover; Only when necessary:
  

Intracanal post placement is recommended only when there is insufficient coronal tissue. The post does not strengthen the tooth; It's just a blindfold. Choosing the type of post (fibrous, casting) and its length/diameter should be conservative and in accordance with the principles so as not to increase the risk of root fracture.

Short practical checklist before final restoration

• Symptom status: Pain and swelling are controlled.
• Occlusal: Contacts should be adjusted and without pressure points.
• Isolation: It is possible to have suitable insulation for sticking.
• Remaining fabric: Assessing the strength of the walls; The decision of filling or covering.
• Follow-up program: The schedule of the examination and, if necessary, the next imaging should be clear.

Complications of not filling teeth after nerve extraction

• crack or broken tooth.
• Infection re-infection and the need for re-treatment.
• The possibility of tooth extraction in case of severe damage.
• Decreasing the lifespan of root canal treatment.

Is it possible to have nerve removal and filling in one session?

Performing nerve extraction and tooth filling in one session depends on the extent of tooth damage and the patient's condition. If the decay is superficial and the infection has not penetrated into the root or deep layers of the tooth, usually both steps can be done at the same time and there will be no problem.

However, in cases where the decay is extensive and the root canals need careful treatment, immediate filling after nerve extraction is not recommended; because it may cause complications and treatment failure.

In certain situations, especially when the tooth has a severe infection, root canal treatment is usually done in several sessions. In this case, after draining the infected canals, the dentist will dress them with temporary materials to reduce the inflammation. After improving the condition of the tooth, the final step, i.e. filling or restoration with permanent materials, will be done.

Frequently Asked Questions

1. Can a denervated tooth be filled the same day?

Yes, in some cases it is possible, but usually the dentist will wait a few days for the inflammation to subside

2. What happens if we fill the tooth late?

A delay of more than 3 weeks can increase the risk of treatment failure and the need for tooth extraction

3. Is it better to fill or cover?

Filling is usually sufficient for front teeth, but posterior teeth require veneers due to high pressure

4. Does it hurt to fill a denervated tooth?

No, because the nerve of the tooth is removed, fillings or veneers are usually painless.

Final words

Filling or veneering a denervated tooth is a critical step in completing the treatment. The best time for this is usually between 3 and 7 days after root canal treatment, but depending on the patient's condition, it can be delayed up to 3 weeks. Ignoring this step can cause treatment failure and tooth loss. Therefore, after nerve extraction, be sure to consult your dentist about the right time to fill or cover and do this on time.