US 1711952 A
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May 7, 1929. KULIK 7 METHOD OF AND APPARATUS FOR FILLING I'EETH Filed Feb. 11, 1924 2 Sheets-Sheet 1 May 7, 1929. KULIK 1,711,952
METHOD OF AND APPARATUS FOR FILLING TEETH Filed Feb. 11, 1924 ,2 Sheets-Sheet 2 INVEN r0 2.
//V//79 u/ik ATT RN 5.
Patented May 7, 1929.
PQATENT'OFF IRVING KULIK, 0F BROOKLYN, NEW YORK.
METHOD OF AND APPARATUS FOR FILLING TEETH.
f Application filed February 11; 1924. SerialtNo. 691,899.
one" or more channels leading to the tips of the several roots of the tooth. The chamber referred to is known'as the pulp chamber and the canals are technically termed the root canals. The pulp in a normally healthy con-' I dition fills the pulp chamber and extends through the root canals and is generally known to the layman as the nervesoffthe tooth. WVhen a tooth breaks or wears away at its grinding surface sufiiciently to expose or form an opening into the pulp chamber,
filling of the toothisrequired to properly pre-f serve the tooth against further'decay and it is essential to the proper filling oi the tooththat all of the'pulp contained in the pulp chamber and root canals be removedand the fillingmac terial, whatever it may be, must, to insure proper results-be introduced so as to completely fill the chamber and especially every portion of the root canals.
It isvery common in teeth for the root canals to each have several small branches which are generally adjacent the tips of the roots and is absolutely essential that these minute i If the pulp is not entirely removed or the root canals and their branches'completely branches, as well as the main root canals be absolutely filled with a filling substances.
filled, breaking down of the 'organic imatter present within the canals or 1 later seeping thereinto will result in putrefaction, the pro duction of gas and consequent abscesses and fistulas with resulting pain, discomfort and danger to the health. I v
Under P1101 practice, it has been 7 usual in the preparing of a toothvfor filling to grind j away that portionof the tooth'which is bro-' ken, so as to produce a cavity extending into the pulp chamber and suitable to receive the filling and the pulpis removed from the pulp H it is borne in mind that the chloropercha chamber by means of suitable scrapers and from the root canals through the employment of appropriate broaches.
After the cleanmg has been accomplished,
to the satisfaction ofthe dentist, it has been the practice to force various agents into the root canals to sterilize and fill the canals. The
most approved agents for steriliZing t-he canals and filling the fine openings are ammo- 7 dental profession, the human tooth is provided inte v riorly with a chamber from which extends,
niacal silver nitrate and formalin, while the most approved agents'for filling all of the remaining areaof the root canals and pulp chamber are gutta percha and chloroform. Atter the pulp has been removed fromthe 1 pulp chamber and root canals, ammoniacal silvern t-iate is introduced into the canals and is followed by the introduction of formalin, the function of which is to sterilize the passages and to precipitate out the metallic silver from the ammoniacal silver nitrate.
The precipitated silver is supposed to fill the fine root canal branches; The root canals are then filled with chloropercha (gutta percha probe. After the dentist has poked, sufiicient chloroperclia intothe roots to convince him that the roots are fairly full, a tapering jsohd gutta percha-point in the form of a' Wedge is forced into the canal, presumably to the end of the root of thetooth. This completes the filling of th'e'root canals and is pre- Slllllfitl 'tO produce a satisfactory filling. c The tooth is capped or crowned.
' My long experiencelin root canal work and a thorough study of thefsubject have con vinced me that it is practically impossibleto properly fill root canalsin the manner com mon toprior practice as above specified and scesses which occur after the filling er teeth by some of the most skilled practitioners. A very careful study of the subject has con- 'vincedt methat the cause of the abscesses dissolved chloroform) this being ofcreamy consistency and usually poked into the canals through the employment of a this statement is borne out by themany abwhich too frequently occur" after I filling are y the direct result of inability to entirely fill the root canals andthe branches thereof in the manner described andI have concluded after most'exhaustive experimentation that in folflowing the practice outlined, it is practically I impossible to effect a complete filling of such canals. The reason for this is'apparent when when introduced ina pasty form rapidly so? lid ifies when brought incontact with organic matter and it will thus be apparent that as soon as the rhloropercha is introduced it beto solidiiy and part-akes of astringy semi-solid condition which renders it impossible to force it to 'the roots of the toothby a 9 probe or otherwise. Moreover,*when the gutta percha is introduced into the root, it is brought into direct engagement with said chloropercha and is immediately softened thereby, so that the point of the wedge rolls up and does not penetrate. the rootto its base. As a result, a considerable portion of the root canal of the tooth as well as the root canal branches remain unfilled and decomposition takes place in this unfilled area with consequent deleterious results. i
The present invention is intendedto overcome the foregoing disadvantages in produc tion of a method and apparatus for the complete filling of root canals and their branches in a simple, economical and efiicient manner and in such a way that the root canalsand their branches will be completelyfilled in a positive manner in contradistinction to the hit or miss practice heretofore commonf My theory which underlies thepresent invention is based onthe propositionthatthe gutta. percha or other material employed as the bodyofthefilling for the cavity androot canalsshould be introduced in a substantially solid form, so that it may be tightly packed within the spacestobe filled by withstanding the pressure of a tool sufiiciently to force its entry into the most minute and distant portionsof the cavity or canal. After the tooth is thus preliminarily filled with the gutta percha the liquidconstituents which enter into the proper filling areintroduced in proper sequenceand under suficient pressure to insure their entry into the most re mote interstices. silver nitrate isforced through the packed gutta .percha which no matter how tightly packed will have interstices between the parts thereof which will permit the thorough impregnation of such filling material with the. silver nitrate.
The formalin is next introducedand combining with the silver nitrate precipitates metallic silver from the nitrate intothe most remote and smallest root cavitiesor branches. The surplus silverlnitrate and formalin are preferably then exhausted and chloroform is forced intothe packed mass of guttapercha. This chloroform i1n modiately acts asa solvent for the gutta per:
cha thereby softening the same and atthe same timeproducing a swell ng of the gutta percha as it takes up thechloroform. As a I result of'this-action the swelling, of the gutta percha within the pulp chamber, root channel and branches enerates a relatively high internal autogenous pressure which forces the homogeneous mass thus formed into every remote channel and fissure wherein it hardens in the form of a complete filling forevery space within the tooth. Absolutely no cavities are left or no spaces remain. The filling is complete and deterioration of the unhealthy and dangerouscondition due to the breaking down of cellular tissuecannot take place as heretofore.
In practice, v ammoniacal Aside from the broad general method of introducing the bodyofthe filling in a substantially dry state and thereafter introducing the liquid constituents, the invention is directed tov certain novel and highly efficient forms of material and apparatus whereby this method ma 7 he carried out to advanta e and illQSQ l QLKtUIQS also form a part of the inventionf Others which I have not referred tospecii'ically will be apparent from the following detailed description and appended claims, when read in conjunction with the accompanying drawin s. i
The accompanying drawings illustrate one practical embodiment of the invention, but the construction therein shown, is to be un derstood as illustrative,only, and not as defining the limits of the invention.
Figure 1 shows a tooth broken away to form a cavity such as is commonly found.
Figure 2 shows the same tooth-with a cavity prepared for filling.
' Figure 3 shows a hollow gutta percha point or wedge which I use and which forms part of the present invention.
Figure 4t shows a piece of guttapercha in hollow cylindrical or tubular form, alarge numberof whichare used in the filling of teeth in accordance with this'invention.
Figure 0 illustrates a filling tube used in the introduction of the liquid constituents entering into the filling and constituting a part of the present invention;
Figure 6 illustrates adental impression tray also constituting apart of: the present invention.
Figure 7 shows a pneumatic percussion de-, vice of novel construction adapted to coop crate with the impression tray'to allow the application of external pressure to the filling,
through the pulp chamberQ. Fromthe pulp chamber 2, the root canals 3 lead to the apex of the respective tooth roots and near tae apex of such roots] divide .into a number of branches a. A molar toothis shown having.
three roots with a corresponding number of root canals. The preparation of the cavity is accomplished in the usual manner and at the conclusion of such preparation thetooth appears, as shown in Figure 2 wherein the cavity is designated 1.
--low with the exception that thereis an addi- I tional purposein the latter instance,-namely,- to permit "the solvent to penetrateas far as Prior to the preparation of the cavity, it maybe necessary to devitalize the pulp or nerve of the tooth through the carrying out chamber 2, the root canals 3 and the branches 4 and this operation should o. be carried on with great care so that all passages or open-' ings in thetooth willbe completely devoid of pulp content. After this has been accomplished, the toothis ready. for'ifillingand is proceeded with as follows percha points such as shown in-Figure 3, which are novel and differ from those of prior practice in that they are hollow or tubular for the greater portion of their'length.
These points are designated generally by the reference character 5 and have a hollow interior 6. I forceas many of these gutta.
percha points as possible into the root canals of the tooth while the points are in a dry or substantiallydry' condition and have suf ticient inherent resistance to withstand the pressure of an instrument against their blunt.
ends. By virtue of this fact, the points may fill the root canals as far as possiblefwhi'le dry andat such time that pressure onthe gutta percha points may be efficiently applied to force thepoints into the most remote I withinthe cement abutment 8 'unt-ilsuch' time portions of the tooth. g After as many of. the points forced into position have been inserted, the pulp chamber is packed as tightly as possible with a large number of relatively small )ieces of utta ercha which in ractice are' preferably of hollow cylindricalform although they may be of other form if desired. The reason for making them hollow is to furnish maximum superficial surface to be subsequently acted upon by a solvent so that they may be'properly dissolved or softened to a sufiicient extent to unite with one another in-a substantially homogeneous mass.
It may be here stated that this is the purpose of making the gutta percha points '5 holpos'sible into the root canals. v 1
After the pulp chamber has been-thoroughly packed with, the guttapercha cylinders designated 7, as shown in detail in'Figure 4,1 cover the compacted mass with a cement. partition such as shown inFigure 8,
wherein it is designated by the reference character 8 and so position a filling tubet) that it' will extend through this partition as can be or abutment. ;This may be accomplished by :investingthe smaller end of the tube 9 with suitable cementand packing this cement around the tube and into the cavity sufficiently to close or partition off the pulp chamber in which the gutta' percha packing is-positioned. 4 i
The cementabutment 8should be carefully placed in position and should make a proper bondwith the tooth so as to form an air tight 7 the abutment 8, thedentist may find it in- I first take a sufficient number ofguttaw bodies a ring 9 of sufficient diameterto allow ittoembrace the tube 9, to which it is adapted to be secured by set screws 9". Spring aws 9 extend fromthe ring and are adapted to gripthe tooth and hold the tube .9 in position until the cement abutment hardens. The retainer may thereupon be removed from the tooth and tubei Perforations 9 in the spring jaws are for the reception of spurs on the forceps and facilitatethe positioning on to withstand the action of such acids as may I 3 contact therewith. The tube 9 is tapered and at itssmaller endwis preferably threaded as;
shown at 10 so that it will retainits position as lUlSrdGSiFGd tQ positively remove thetube therefrom; Thelarger end of the tube is ,exteriorlythreaded and theopen end is closed by a diaphragm 11 preferably ofrubber and heldin place by athread'ed cap 12 cooperating with the threads on the exterior of the tube, 6 w i Assoonas the cementabutment 8 is sufliiciently hardened to insure-its permanency,
the needle 14: of a hypodermic syringe 15 containing ammoniacal SllVGl; nitrate is .thrustlthrough the diaphragnrll as shown in F1gure"8. Inasmuch as the syringe is graduated, the operator cantell how much aininoniacal silver nitrate contained therein. Byoperating the syringe the nitrate'of silver is forced into the tube fillsthe latter and is thereupon forcedthrough thesmaller end ofthe tube into the pulp chamber. As the piston of the syringe is'forced inwardlyy an appreciable pressure is generated within: i
packed within the pulpichamber. Noamat- "gter how tightly these cylinders arepacked,
- therein,penetrating to the .extreme ends of the: root canals and their branches.
After a sutlicientrperiod has been allowed ffor the complete penetration ofthe silver nitrate, the syringe is removed and a second syringe 15 of the suction type, shown in Figure 8,-is en'iployed. This syringe difi'ers t'rom-the syringe 15 mainly iinithat it isprovided with a yoke ;l 6 to enable its-operation as; a suction syringe. Its barrel is graduated and while its-needle-117 is forced through the perforatable diaphragnn the piston of such syringe ,iiiaybe retracted to withdraw from the tube and tooth surplus silver nitrate. The quantitywithdrawn canbemeasuredlby virtue of the scale on-thepiston of the syringe so that an accurate account may be :kept of the requirements of the :particular filling .which will guide a dentist in his future ovork.
After :the surplus silver .nitrate Elias been \Vlthdl'dWIh' formalin is introduced 1n 'the same manner as shownby the syringe 15 in Figure 8. Just enough :formalin should be injected as-is necessary toapertorm the chemi cal reaction of precipitating the metallic, silver-from the amnioniacalsilvernitrate. The next step in :the process consists in Withd rawing'the surplus "formalin it there-be any .through'the.employment ofa suction syringe. 'Chlorot'orm is now injected by means of a pressure syringe. Duringthisoperation sufficient pressure is again applied to insure that the chloroform enters the-inostremote parts of the tooth inorder that the contact ofthe chloroform with thegutta percha will be positively assured. At this point, an important action takes place. Chloroform is a solvent "for gutta percha. and serves to soften the gutta percha and at the same time cause ciently surplus chloroform is drawn oil through the employment of a suction syringe of-thetype shown at 15.
FMy experience has convinced me that a :to ranrthe:fillingtightly into place. ifurther steps are to be carried on, the tube 9 pression.
toothsubjected -to the method described will 'be positive'lyfullyfilled so far-as'its pulp cavity,aroots:and ,branchroot channels are concerned by thetimethe last mentioned step of theeprocess has been completed andthe dentist may-here ceaseand simply provide a suit- .courseis removed and the opening in the partition left bytheremoval ofthe tube is filled.
However, in order to insure againstthe slightest possibility of inadequate filling, further stepsmay be taken intended more particularly If these isatemporarily'leftEin place and a dental impression tray and pneumatic percussion device brought intouse. The impression tray which I employ is preferablyprovided at its =sides with an inturned edge shown at 18 in Figured In this figure as in theother'figpres ot the drawings, the impression tray;is
designated byithereferencecharacter 19. It hasasuitable handle QOand its baseis per- :foratedatQl. The perforation is surrounded on theunder side ofithe tray with abossor flange 'exteriorlyithreaded at 22. The pertoration -21.is slightly greater in diameter than the diameter of the tube'9 and'permits the impression tray .to be filled with plaster and passedoverthe tube as shown in Figure 9, sons to completely embed the end of the tooth which is being operated upon-and also preferably an adjacent toothin order that the impression tray may be firmly in position and efiiciently held to its worlc After'the tray is :in positionandthe plaster hardened therein, a percussion device designated'23issecured'by means of a couplingQL :to thethreaded .post 22 ofthe tray. The device 28 is in the form of a tube preferably bent and .itssfree end isprovided with a diaphragm 25 preferably of'rubber and held in place on the tubebymeans of a threaded cap 26. Associated with the same end of the tube v:isa hose 27 adaptedto be coupled to the air pressure supply at the dental switchboa'rd common in offices of practitioners. Inasmuch as the tiller tube 9 is provided at its .bebulged in the same direction by virtue of the intermediate air beingplaced under com- When the parts areassemblechas shown in Figure'9, the valve at the switclnboard 1s 1ntermittently opened and closed to place the diaphragm 25 under a pulsating pressure and :this pulsating pressure is communicated to failing to properly fill out every portion of the space within the'tooth.
At the conclusion ofthe'ramming operation. the percussion instrument is removed and is followed by the dental tray. A slight turn of the tube 9 is next accomplished through the employment of pliers or the like andthe tube readily breaks away from the partition or abutment 8 and is withdrawn. The hole in the abutment which is left by the tube packed with suitable cement or composition and that portion of the tooth exteriorly of the partition is built out of such cement or composition. to the dotted line position shown at 28 in Figure 9 at which time the tooth is ready to be capped or crowned as may be desired.
Although the method of the present inventi on in its preferred complete form embodies a number of steps, it is found in practice that the filling of a tooth in the manner described is much simpler and less tedious than when filling a tooth under prior well recognized practice for the reason that the results are assured and the uncertainty incident to present day methods is absent.
In carrying out the present invention in its preferred form, I employ apparatus shown in the drawings but I wish it understood that other forms of apparatus may be employed without departing from the invention. However, the apparatus disclosed and the conformation of the substances constitute an important part of this invention as they embody considerable novelty and a marked departure from prior constructions. The present invention is to be understood as not restricted to the specific showing of the drawings but is to be construed as broadly novel as is commensurate with the appended claims.
Having thus fully described the invention, what I claim as new and desire to secure by Letters Patent is: v
1. The method of filling teeth which consists in introducing into the space to be filled gutta percha in a dry state and in the absence of a solvent, and thereafter sub ect1ng said guttapercha to the action of a solvent to effect a swelling or expansion of the gutta percha.
2. The method of filling teeth which consists in packing gutta percha in solid form into the space to be filled and in the absence of a solvent and thereafter subjecting the gutta percha to the action of a solvent for the purpose of expanding the gutta percha within the space to be filled.
3. The method of fillingiteeth which con sists in introducing into the space to be filled a filling material in solid form and in the absence of a solvent therefor, andthereafter impregnating said material witha solvent.
4. The method of filling teeth which consists in introducinginto the space: to be filled gut-ta perch'a in solid form and'in the absence r of a solvent, and thereafter impregnating the gutta percha with a solvent for the pur-] pose of setting'up autogenous pressure and thereby forcing the gutta percha to entirely fill the space to'be filled. 5. The method of filling teeth which consists in packing the space to be filled Witha number ofpieces of gutta percha in the absence of a solvent and thereafter subjecting the gutta percha to the action of chloroform for the purpose of generating autogenous pressure to expand the gutta'perclia so as to entirely fill the space to be filled thereby and simultaneously form "the. pieces of gutta percha in a homogeneous mass.
6. The method of filling teethwhich con in a dry condition into the rootcanalsof sists. in forcing hollow gutta percha points the tooth, thereafter packing hollow gutta percha pieces in the root canals and pulp chamber, then placing a closure over the open face of the chamber and thereafter forcing a solvent through the closure and causing it to permeate the packing of gutta percha.
7. The method of filling teeth which consists in packing the space to be filled with divided gutta percha, thereafter sealing such space, and thereafter impregnating the pack ing of gutta percha with a solvent.
8. The method of filling teeth which con sists in packing the space to be filled with a number of pieces of gutta percha in solid state and in the absence of a solvent, and thereafter impregnating said pieces of gutta percha with a solvent tocause the same to form a homogeneous mass.
9. The method of filling teeth which consists in introducing gutta percha into the space to be filled in the absence of a solvent, and thereafter introducing into contact with the gutta percha ammoniacal silver nitrate, formalin and chloroform.
10. The method of filling teeth which consists in positioning a filling material in the root cavities and pulp chamber-in the absence of a solvent, then sealing the pulp chamber, then introducing ammoniacal silver nitrate under pressure, then introducing formalin under pressure to precipitate metallic silver in the most remote cavities, and thereafter introducing a solvent under pressure to act upon the filling material and cause it to form a homogeneous mass, which, under the resulting autogeneous pressure, is caused to completely conform to and fill the space to be filled.
11. The method of filling teeth which conroot cavities, thereafter packing the pulp chamber with divided gutta percha, thereafter sealing the pulp chamber and subsequently introducin in succession ammoniacal silver nitrate, formalin and chloroform.
13. The method of filling teeth which consists in forcing gutta percha points into the root cavities, thereafter packing the pulp chamber with divided gutta percha, thereafterosealing the pulp chamber and subsequently introducing in succession ammoniacal silver nitrate, formalin and chloroform, and thereafter ramming the filling.
lt. The method of filling teeth which con sists in forcing gutta percha points into the root cavities, thereafter packing the pulp chamber With divided gutta percha, thereafter sealing the pulp chamber and subsequently introducing in succession ammoniacal silver nitrate, formalin and chloroform, and thereafter subjecting the filling to pulsating air pressure.
.15. The method of filling orifices and the tubuli ramifying from the root canals of a tooth which consists in introducing liquids under pressure and in sequential order so as to cause the liquids to infiltrate said orifices and tubuli and to precipitate out materials to at least partially fill the orifices and tubuli.
16. The method of filling teeth Which consists in introducing expandible materials in non-expanded form into the root canal of a tooth and thereafter causing a liquid to infiltrate the root canal for the purpose of expaiuling the material therein.
17. In the art of filling the root canal of a tooth the method which consists in inserting a gutta percha point into the root canal While the canal is free from artificial foreign substances and the absence of asolvent, and thereafter introducing the solvent.
In testimony whereof I have signed the foregoing specification.