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U SS I*,
I*,Trimurni
TrimurniAbidin**
Abidin**
SU
Resident at Conservative
Conservative Dentistry
Specialist
Program
**Resident
Dentistry
Specialist
Program
**Lecturer
Lecturer at
Department
**
at Conservative
ConservativeDentistry
Dentistry
Department
13-14 NOVEMBER 2015, SINI II COSMOS - GRAND CLARION MAKASSAR - INDONESIA
PENDAHULUAN
Pra perawatan
Diagnosis
Seleksi kasus
Prognosis yang buruk
Selama perawatan
Preparasi akses
Kesalahan preparasi
Pengisian saluran akar
kegagalan
perawatan
Pasca perawatan
Desain restorasi yang
buruk,
kerusakan restorasi,
Trauma dan fraktur yang bukan
karena perawatan
endodontik. Asgeir, 2009
Introduction
Pre-operative treatment.
Diagnosis
Case selection
Poor prognosis
During operative treatment.
Access preparation,
Root canal preparation
Obturation
The
failure of
endodonti
c
treatment
Post-operative treatment.
Restoration design
Restoration damage,
Trauma and fracture caused by
non-endodontic treatment.
Asgeir, 2009
Kegagalan
perawatan
saluran akar
akibat trauma
Kesalahan perawatan
orthodonti Pergerakan
gigi Tekanan >>
kelalaian atau
pengetahuan operator
yang kurang.
Pasien yang tidak ko operatif.
Endodontic treatment
failure caused by
trauma
Orthodontic treatment
failure .Tooth movement
pressure >>
negligence or lack of
knowledge of the operator.
Uncooperative patients.
Case
Report
Patient
22 y.o
Keluhan
Utama
Riwayat
medis
13-14 Nopember 2015
Case
Report
Patient
22 y.o
Main
Complai
nts
Medical
history
13-14 Nopember 2015
Noncontributory
9
Pemeriksaan Objektif
Tes sondasi (-), Tes termal (-), Perkusi (+), Mobiliti (2).
10
# 12 :
- Response to thermal test (-)
-Percussion & palpation (+)
- 2st grade Mobility
13-14 Nopember 2015
11
Pemeriksaan Radiografis
Gigi #12 :Pergerakan gigi 12 tilting, Lesi periapikal, dan Gigi telah
dirawat saluran akar dengan hermetis.
12
13
PENATALAKSANAAN KASUS
Diagnosa # 12
endodontik.
14
KUNJUNGAN PERTAMA :
-BAP
First Visit :
- Negotiation of canals
- Irrigation (NaCl 2, 5% ,EDTA 17% & CHX 2%)
- Working radiograph length.
- Cleaning & shaping Rotary protaper insruments
Hybrid technique
- Dressing with Ledermix+Temporary cements 3
weeks
Follow-up
Kunjungan ke tiga
Follow-up
Kunjungan ke enam
13-14 Nopember 2015
Follow-up
Kunjungan ke empat
Follow-up
Kunjungan ke lima
18
-Pre-obturation examination:
Pain : (-)
Palpation : (-)
Percussion : (-)
-Intracanal Dressing removed
-Root canals were dried with
paper points master cone
fitted
-Obturation Lateral
condensation technique
MAC:
20
FINAL VISIT
21
Discussion
Tekanan yang diberikan alat orthodonti akan menekan
membran periodontal yang terletak diantara gigi dan tulang
alveolus.
Schwarz, 1932 tekanan yang diberikan dalam perawatan
orthodonti tidak boleh melebihi tekanan darah kapiler (20-25
g/cm2)
bila tekanan yang diberikan melampaui ambang batas
fisiologis dapat mengakibatkan terputusnya ligament
periodontal dan terjadi kerusakan sel-sel pada tulang
sehingga terjadi resorpsi tulang alveolar
Cobourne MT, DiBiase AT, 2009
22
Discussion
Pressure that given by orthodontic equipment will push
periodontal membrane which is located between tooth and
alveoar bone.
Schwarz, 1932. pressure that given in orthodontic treatment
shouldnt exceed capillary blood pressure (20-25 g/cm2)
Pressure exceeds physiologic treshold may lead to
periodontal ligament tear and damage the cells in the bone
resulting alveolar bone resorption
Cobourne MT, DiBiase AT, 2009
23
Gambar 6. Skema pergerakan gigi (a) gaya eksternal diaplikasikan, (b) daerah aposisi serat yang
merengang (c) setelah aplikasi gaya yang lebih lama terlihat pembentukan tulang oleh osteoblas
pada sisi aposisi dan resorbsi tulang oleh osteoklas pada sisi repososi. (Hanneman, 2008)
24
Gambar 6. Skema pergerakan gigi (a) gaya eksternal diaplikasikan, (b) daerah aposisi serat yang
merengang (c) setelah aplikasi gaya yang lebih lama terlihat pembentukan tulang oleh osteoblas
pada sisi aposisi dan resorbsi tulang oleh osteoklas pada sisi repososi. (Hanneman, 2008)
25
26
27
28
29
Rhodes J ,2006
Johnson WT, 2002
30
Rhodes J ,2006
Johnson WT, 2002
31
Pertimbanganperawatan
perawatanulang
ulang
Pertimbangan
saluranakar
akar
saluran
Sisa jaringan
gigi
Kebutuha
n restorasi
Kooperative
pasien
Keadaan
periodont
al
32
Restoratio
n needs
Cooperative
patients
Periodontal
condition
33
Perawatan konvensional
(ortograd) Perawatan ulang
saluran akar konvensional
dilakukan dengan mengulang
perawatan melalui akses
mahkota
Bedah (retrograd)
Menutup rapat saluran
akar pada apeks gigi.
Pilihan
perawatan
Conventional treatment
(orthograde) conventional
root canal treatment done by
repeating the treatment
through access of the crown
Extraction This is
done when surgical
treatment is not
possible anymore
Surgical (retrograde)
Tightly close the root
canal of tooth apex
Treatment
options
36
37
38
39
Kalsium hidroksida
Mekanisme antimikroba kalsium hidroksida terjadi dengan
pemisahan ion calcium (Ca2+) dan hydroxyl (OH) .
Ion calcium (Ca2+) bereaksi dalam enzimatik pada bakteri dan
jaringan, menginhibisi replikasi DNA serta bertindak sebagai
barrier dalam mencegah masuknya bakteri dalam sistem
saluran akar.
Difusi ion hydroxil (OH) menyebabkan lingkungan alkaline
sehingga tidak kondutif bagi pertahanan bakteri dalam saluran
akar, serta mengadakan difusi ke dalam tubulus dentin .
Berkitten , Okar , Berkitten . 2000
Cwikla . 2000
13-14 Nopember 2015
40
calcium hydroxide
The antimicrobial mechanism of calcium hydroxide
occurs with separation of calcium ions (Ca2 +) and
hydroxyl (OH).
Calcium ions (Ca2 +) reacts in the enzymatic reaction
of bacteria and tissue, inhibits DNA replication and acts
as a barrier to prevent the bacteria from entering the
root canal system.
Hydroxyl ion (OH) diffusion cause an alkaline
environment that is not conducive to the defense of
bacteria in the root canal, and diffuses into dentinal
tubules.
Berkitten , Okar , Berkitten . 2000
Cwikla . 2000
13-14 Nopember 2015
41
KESIMPULAN
42
KESIMPULAN
43
Daftar Pustaka
1.Asgeir Sugurdsson.Evaluation of Success and Failure.Dalam: Walton
RE,Torabinejad M (ed).Principles and Practice of Endodontics 3rd
,Philadelphia:WB Saunders.2002:331-344.
2.Dumsha TC, Gutmann JL; Clinicians Endodontic Handbook.2000 .LexiComp.Ohio.P 140-3, 213-9.
3.Thilander B, Rygh P, Reitan K. Tissue Reactions in Othodontics. In: Graber
TM, Vanarsdall RL, Vig KWL, editors. Orthodontics. Current Principles and
Technique. St. Louis: Elsevier Inc; 2000.p. 203-11
4.Sameshima GT, Sinclair PM. Predicting and preventing root resorption:
Part II. Diagnostic Factors. Am J Orthod Dentofacial Orthop 2001; 119:50510
5.Siqueira J F, Rocas IN, Favieri A, & Lima KC: Chemomecanical reduction of
the bacterial population in the root canal after instrumentation and
irrigation with 1%, 2,5%, and 5,25% Sodium Hypochlorite, J Endod 2000;
26 : 331-334
6.Siqueira J F, Rocas IN, Sauto R, Uzeda M, & Colombo, AP: Actinomyces
Spesies, Streptococci, And Enterococcus faecalis in primary root Canal
Infection, J Endod 2002; 31 : 312-317
13-14 Nopember
2015
7.Balajhi.
SI, Iyyer
BS. Biology in Tooth Movement. In: Orhodontic The Art
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