Fixing one's Teeth with Supergel and Cernit

This is an article about how to fix teeth at low cost in a way which keeps them sterile and avoids chronic infections.

Traditional dentistry is based on fixing caries (holes due to dental decay) by radical removal of any dentine that is deemed to be compromized. Over a lifetime this can result in virtually all one's teeth becoming so fragile and drilled out that any further work will require removal, or insertion of implants directly into the bones of one's skull or jaw.

After a number of episodes of recurrent dental work leaving my teeth severely compromized in my sixties, I began a course of action that might seem perilous or even foolhardy, but has in fact resulted in over a decade of relatively trouble-free life. Several of my teeth have had root fillings and some have in the past had recurrent infections, but currently the only intermittent trouble I have is from one upper molar which my dentist has declined to do a complete root canal treatment on, kindly doing a clean out for $75 after a seven year interval. My own work is currently infection-free.

The aim of this method is to build up the integrity of one's teeth before they become lost altogether - by additive repair improving or stabilizing their condition, rather than subtractive drilling, which reduces teeth to bare near-pulp remnants or increasingly brittle root-filled shells.

The method works very well with teeth that have already had root canal treatments, but can also preserve vulnerable live teeth, avoiding infection and/or further serious dental attack. A key point here is that dentine, although it can become porous to infection when the enamel is eaten away, also has protective responses rather like a tree trunk with an area of decay, which puts up barriers to infection, attempting to block off the assault.

Fig 1: Reparative dentin illustrated.

Surface repair of dentine and caries: This means that it is often possible to arrest the decay of exposed dentine without drilling, by applying a suitable antiseptic liquid and then sealing the exposed area to prevent further infection. To do this I use Savlon liquid (chlorhexidine + cetrimide) and then seal the area with superglue (cyanoacrylate) gel. Firstly I clean and disinfect the area, dry it and then apply a small amount of gel and cover it for 75 seconds with a piece of a polythene bag to promote polymerization. I then scrape any excess off surrounding gum or tooth areas quickly and use dental floss to make sure there is none stuck between neighbouring teeth. I do a lot of this work along the inner gum line where the enamel has eroded and the dentine has become exposed and sometimes eroded away leaving undercutting caries. In all cases so far, this has resulted in the tooth settling down and not forming an abcess in the case of a live tooth. Teeth, even when they have started to become painful to the bite, indicating a degree of nerve/pulp inflammation, generally settle down again if promtly treated.

Major repair and replacement of damaged teeth: I have also had to do major repair of teeth which have suffered previous damage, root canal treatment and/or structural collapse due to excessive drilling. Major tooth repairs are listed 1 to 9 in fig 2. In some cases, such as 1 and 5, the tooth is still alive. In others such as 2 and 3 the root has been removed but no complete root canal treatment has been performed. In the rest the teeth have at one time or another had a full pulpotomy treatment. Some like 8 have shattered after a root treatment resulting in secondary infection prior to repair. Chronic infection and gingivitis can lead to health issues that can increase death risk e.g. from heart conditions generated by circulating bacteria, so it is paramount to avoid serious chronic infection and take these cases to a qualiified dentist who can do a complete repair. That said, my experience is that one's immune system begins to build up a resistance over time to root infections, which are generally not caused by highly pathogenic organisms, but just leakage of common mouth bacteria into the tooth. Thus mild inflammation, if forced to become acute e.g. by chewing on a sore tooth(wrigley revenge) often settles down for me, especially if it is a minor inflammation of an already root canal treated tooth with little nutrient avaliable for bacteria and no erupting pulp.

Fig 2: Two views of my mouth with the fully repaired teeth listed 1-10 on the right.

My method of repair is to use four ingredients:

1. Cyanoacryllate gel.
2. Cernit modeling plastic
3. Surgical stainless steel wire.
4. Savlon (chlorhexidine + cetrimide) liquid.

Neither of the plastics appear to be a significant health risk. Cernit claims to be free of estrogenic BPA (bisphenol-A) and I undestand cyanoacryllate was used as a medical repair polymer in the Vietnam war and is also non-toxic.

Given a collapsed tooth with a compromized root, I endeavour to fully clean out the root canal down as far as any gutta percha filling, sterilizing it with repeated disinfectant liquid before drying it and occasionally inserting a small fragment of antibiotic if the root is infected. I may use a small drill bit turned by hand using a small wooden sleeve to open the canal sufficiently to accept a short length of stainless steel wire to form a sealing peg that will help hold a new crown in place. In some teeth I may omit this step if the tooth seating is stable and a crown can be glued directly onto the root in a stable fashion.

Cernit crowns: The next stage is to mould a crown using Cernit, which is a harder version of the oven-fired modeling plastic called Fimo that was originally used to make plastic jewelry. This needs to be first kneeded without introducing cracks or splits, to break up internal 'crystals'. I then fashion it in place and press it to make a good fit with the root base and give it the right size and shape. This can require several tries and needs to be done as dry as possible to retain the integrity of the Cernit. When fashioned, this is then fired for around 30 mins at around 125C and allowed to cool. The tooth and surrounding gum is then given a final disinfection and dried as completely as possible before the tooth is pressed into place using supergel. Teeth 2 and 3 are built in this way with 3 having a stainless wire insert. The canine 5 is a live tooth that was severely truncated after fillings fell out which has only a thin layer of dentine prone to irritation, so here I have made a V-shaped crown to completely surround the dentine. The bicuspid 9 is a cernit crown built on a re-inserted titanium peg around which the tooth has collapsed. 10 has just been reparied after this article (see below).

Supergel sculpting: Supergel can also be used and sculpted in surprising ways to provide additional support. One can apply wet gel to an area to be built up, e.g. between a tooth like 1 and an uneven root are, and I then cover it with a polythene film for 75 seconds and then press it into shape when it is turning white but is not yet set hard. Teeth 4 and 8 consist of moulded supergel topped in the case of 8 by a small piece cut from a button onto a root with a steel wire insert. In the case of 4 there is a cernit tip with a supergel surround built on a stainless steel screw after the previous titanium peg crown was lost in a bike accident. Incisor 1 is a live tooth with an old crown repaired by building up supergel to hold it in place.

Rebuilding collapsed molars: Varous other strategies have been used to rebuild severely damaged molars. Molars 6 and 7 have been root-filled and then collapsed leaving only pieces of root or the skirt of a collapsed tooth complete with good root fillings in the gum. In these cases, I have built a Cernit crown to insert into the roots by moulding and then fixed it into place using supergel.

Finishing off proud teeth: I also have a diabolical battery-powered dremel rotary sanding tool, which I can use to grind down any cernit crowns that end up being too proud to make an even bite. The two crowns need to be shaped as much as possible so it is possble to grind sideways as you chew. My number 6 was fashioned by moulding it to the upper molar but that only allows direct up and down chewing and causes it to periodically get bruised by sideways knocks, which I really need to sand down some more.

Ongoing repairs: The end result of this process is a high degree of autonomy and almost vanishing costs, as long as one takes any serious root work to a dentist promptly, if any cause trouble. However such repairs are never permanent and need to be repeated whenever a tooth starts to become wiggly and risks falling out, or becoming compromized by bacteria. This depends on how good the job is, but the average repair done this way probably lasts only about six weeks, although many can be quickly glued back in. The one thing to avoid rigorously is accientally inhaling a loose tooth in the night, so I am always vigilant and prepared to find I have to devote 45 mins to a late night repair to stay safe and sound. Gel repairs have a creeping tendency to make the teeth get taller, so may need to be scraped out to keep the correct length.

Fig 3: My last dental X-ray.

My last dental X-ray three years ago, after I fell of my pushbike and knocked all my front teeth out, showing 1 and 5 still alive, although truncated, 2 and 3 are dead but have had no root canal plug, and 4 does have a short sealing plug beyond where the titanium peg used to be (now replaced by a honed down stainless steel screw). On the lower row, 6 has since had a root canal treatment and then disintegrated, 7 shows only two separate remaining well-plugged root fragments covered by a home-made crown (originally made from cut perspex but since replaced with Cernit). 8 shows a broken root not properly root filled and 9 has since disintegrated, being replaced by a Cernit crown over the reinserted titanium peg. The only slightly inflamed tooth is second to the right above, where a root filling has not been completed, but was recently re-cleaned out. 10 is a bicuspid which was root filled and collapsed just after completing this article. It as been restored with a large Cernit filling shaped to the tooth and then fired and set with supergel running down the sidefrom the cusp to the gum.

New Zealand has a nominal ACC accident compensation scheme, but when I crashed my pushbike avoiding a car emerging from a driveway and seriously hit my head on the pavement without a helmet, knocking out all my teeth, the only compensation offered was to pull out all the roots of my front teeth - no offer to replace the intact roots with professional crowns, on the basis my other molars were already too far gone and I should have a partial plate or full false teeth. Fortunately after leaving accident and emergency after seven hours of observation for concussion, I had insisted on returning to the scene and picked up my broken crowns from the footpath at 1.30 am, which were duly superglued back into place after the X-ray and have since been upgraded with new Cernit crowns.