•VSI AS' l NDODOMIC lull - staff.ui.ac.idstaff.ui.ac.id/system/files/users/anggraeni.margono/publication/... · Seminar Ilmiah Internasional Ikatan Konservasi Gigi Indonesia Asean

SEKRETARIAT PANITIA DEPARTEMEN ILMU KONSERVASI GIGI FAKULTAS KEDOKTERAN GIGI UNIVERSITAS MAHASARASWATI DENPASAR Jl. Kamboja 11 A Denpasar Telp (0361)

•VSI AS' l NDODOMIC COVGHISS lull • INDOMSU 2016

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PROSIDING

SEMINAR ILMIAH INTERNASIONAL

IKATAN KONSERVASI GIGI INDONESIA

ASEAN ENDODONTIC CONGRESS (AEC) 2016

“Getting to The Roots of Endodontic Towards Asean Economic Community ”

Denpasar, 18-19 November 2016

Editor:

Dr.drg Dewa Made Wedagama,Sp.KG

Prof.Dr.drg.Latief Mooduto,MS.,SpKG(K)

drg M.Rulianto,MS.,SpKG(K)

Dr.drg. Dian Agustin Wahyuningrum, SpKG

Dr.drg. Ira Widjastuti,M.Kes.,SpKG(K)

ISBN 978-602-19108-5-6

diterbitkan oleh:

PENGURUS PUSAT IKATAN KONSERVASI GIGI INDONESIA

(PP IKORGI)

2016

111

KATA PENGANTAR

Sejawat yang terhormat,

Seminar Ilmiah Internasional Ikatan Konservasi Gigi Indonesia Asean Endodontic

Congress (AEC) 2016 merupakan ajang pertemuan ilmiah akbar ilmu kedokteran gigi

khusus dalam bidang konservasi gigi. Lebih dari 70 makalah lengkap masuk ke Seksi

Ilmiah Seminar Ilmiah Internasional Ikatan Konservasi Gigi Indonesia Asean Endodontic

Congress (AEC) 2016 dari sejawat berbagai institusi pendidikan, rumah sakit dan praktisi

dokter gigi spesialis maupun umum. Kami mengucapkan terima kasih atas partisipasinya

para sejawat sekalian.

Pada penyelenggaraan Seminar Ilmiah Internasional Ikatan Konservasi Gigi

Indonesia Asean Endodontic Congress (AEC) 2016 ini panitia memberikan kebebasan

kepada para kontributor naskah untuk memilih publikasi yang diinginkan. Kontributor

naskah dapat mempublikasikan makalahnya dalam prosiding. Buku prosiding ini memuat

makalah lengkap yang dipresentasikan dalam Seminar Ilmiah Internasional Ikatan

Konservasi Gigi Indonesia Asean Endodontic Congress (AEC) 2016.

Kami mohon maaf bila dalam pegelolaan dan penerimaan makalah banyak terdapat

kekurangan. Masukan dan kritik membangun sejawat kami harapkan untuk perbaikan

dimasa mendatang. Akhir kata semoga prosiding ini dapat bermanfaat bagi kita semua.

Selamat seminar, sampai jumpa di Seminar Ilmiah Internasional Ikatan Konservasi

Gigi Indonesia Asean Endodontic Congress (AEC) 2016 di Bali.


Dr.drg Dewa Made Wedagama,Sp.KG

Ketua

PROSIDING SEMINAR ILMIAH INTERNASIONAL IKATAN

KONSERVASI GIGI INDONESIA ASEAN

ENDODONTIC CONGRESS (AEC) 2016

"Getting to The Roots of Endodontic Towards Asean Economic Community"


iv

DAFTAR ISI

The effect of micro leakage in class V cavity using self adhering flowable composite with the addition of acid etch

Dennis, Darwis Aswal dan Anastasia ..................................................... 1-6

Hemisection and restoration as a treatment option: a case report

Dhea Adittya dan Ruslan Effendy .......................................................... 7-12

Apexification on Right Upper Incisor Tooth with Periapical

Lesions Suspect Radicular Cyst ( Case Report)

Diani Prisinda dan Rasyid Ridha Hilman .............................................. 13-18

Immature tooth management using mta and all Porcelain

crown reinforced with fabricated fiber post

Evy Tri Utami dan Pribadi Santosa ....................................................... 19-27

Bioviabilitas Ekstrak Daun Mangrove (Sonneratia Alba) Terhadap

Kultur Sel Fibroblas Cell Line BHK-21

Arlita Gladys Tricia Charyadie, Aprilia, dan Widyastuti .................... 28-37

The Internal Bleaching Treatment With Walking Bleach Technique

On Maxillary Left Central Incisor

I Gede Astika Andhi Yasa dan Rahmi Alma Farah Adang ............... 38-45

Endodontics Surgical Treatment Of Root Canal Filler Material Extrusion

: Case Report.

Harris Rahmadi dan Ratna Meidyawati ................................................ 46-50

Success Endodontic Treatment of Post Pulp Mummification Molar

with Narrow Canals by Sonic Irrigation Technique Endoactivator

Hartanti Putri Utami dan Laksmiari Setyowati .................................... 51-58

The Effectiveness of Starfruit Leaves Extract (Averrhoa bilimbi L)

as Antibacterial Against Mix Bacteria of Root Canals.

I Gusti Ketut Armiati .............................................................................. 59-65

Management Of Separated File Instrument In Root Canal With

Conventional Endodontic Treatment

Illmilda dan Dini Asrianti........................................................................ 66-73

Sitotoksisitas ekstrak daun mangrove daruju (Acanthus

ilicifolius) sebagai bahan irigasi saluran akar

Ratna Putri, Twi Agnita Cevanti dan Henu Sumekar .......................... 74-80

Management Of Periapical Cyst With Endodontic Surgery ...................... 81-85

The Effectiveness of Endoactivator and Irrigation Solutions to

Remove Root Canal Calcification of Geriatric Patients

Wahyu Ellia Probowati dan Tamara Yuanita ....................................... 86-92






1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12. 13.

5

14. Penggunaan Pasak Fiber Oval pada Gigi dengan Saluran Akar Berbentuk

Oval yang Telah Dirawat Endodontik: Laporan Kasus

Wahyuni Suci Dwiandhany ...................................................................... 93-100

15. Effect of light curing cycle with a time gap on microleakage of class ii

bulk-fill composite restoration (in vitro)

Widi Prasetia, Angel................................................................................. 101-107

16. Aesthetic rehabilitation of failed composite resin restoration In four

maxillary incisors

Yongki Hadinata W dan Ira Widjiastuti ................................................... 108-116

17. Apical Plug Dengan MTA Pada Gigi Insisivus Sentralis Maksila Apeks

Terbuka

Irawati Siregar .............................................................................................. 117-122

18. The Use of Removable Denture in Patients with Dementia

Kadek wirayuni ............................................................................................ 123-126

19. Endodontic and Esthetic Management of a Deep Crown Fracture of a

Maxillary Anterior Teeth.

Kartika kusumaningdiah dan Moch. Mudjiono ............................................ 127-135

20. Diastema Closure and Reshaping Peg-shaped Teeth Using Direct

Composite Veneer: A Case Report

Lingga Restu Anandia dan Opik Taofik Hidayat ..................................... 136-140

21. Perawatan lesi periapikal gigi molar kiri rahang bawah pada pasien SLE

Lipur Kurniawati dan Anggraini Margono................................................... 141-148

22. Esthetic Rehabilitation on Maxillary Anterior teeth with Multiple

Diastema

Mertha Rizky Puspita dan Karlina Samadi .............................................. 149-155

23. Antibacterial effect extract etanol of coconut fiber (cocos nucifer. L)

asmedicament alternative in root canal in the case of endodontic flare-ups

Mike Wijaya, Nevi Yanti dan TrimurniAbidin ............................................ 156-166

24. Clinical Management of Endodontic Retreatment

Mochammad Kennedy dan Trimurni Abidin ............................................... 167-172

25. Mineral trioxide aggregate (MTA) sebagaiapical plug padagigi anterior

rahangatas:laporan kasus

Muhsanah Santa dan JuniJekti Nugroho ...................................................... 173-178

26. Reimplantation: Clinical Implications and Outcome of Dry Storage of

Avulsed Teeth

Nevi Yanti .................................................................................................... 179-188



6

Identification Multiple Root Canals using SLOB Rule

Ni Kadek Ari Astuti ...............................................................................

Perawatan endodontik gigi molar kedua rahang bawah pada pasien

dengan reflek muntah tinggi

Novita Shintarini dan Munyati Usman .................................................

Esthetic Rehabilitation of Complicated Crown Fractures in Maxillary

Incisors

Profilia Shinta dan Edhie Arief Prasetyo .............................................

Endodontic Management of Mandibular First Premolar with Vertucci

Type V Canal Configuration A Case Report

Putri Yulandari ......................................................................................

External bleaching on discolored tooth : a case report

Sarahfin Aslan dan Nurhayaty Natsir ..................................................

Penatalaksanaan Lesi Periapikal Kronis dengan Pendekatan Terapi

Endodontik Non Bedah (Laporan Kasus)

Saskia Budi Nurina dan Irmaleny Satifil..............................................

M a n a g e ment of Open Apex: A Case Report of Permanent Anterior

Teeth

S r i E k a S a r i dan Aries Chandra Trilaksana .................................

Penatalaksanaan pengambilan peeso reamer yang patah pada gigi

kaninus maksila dengan teknik syringe tip and glue : laporan kasus

Steven Wijaya dan Trimurni Abidin ....................................................

Management of aesthetic problem and endodontic treatment on tooth

fracture in maxillary incisors

Sunniyah Harum Adiba dan Adioro Soetojo .......................................

Perawatan saluran akar lesi endo-perio klasifikasi simon tipe I pada gigi

premolar pertama rahang bawah laporan kasus

Teguh Santoso dan Nilakesuma Djauharie ..........................................

Sitotoksisitas ekstrak daun mangrove daruju (Acanthus ilicifolius)

sebagai bahan irigasi saluran akar

Ratna Putri, Twi Agnita Cevanti dan Henu Sumekar ........................

Fiber-Reinforced Direct Composite Restoration Pada Gigi Anterior

(Laporan Kasus)

Arnold Kyoto dan Opik Taofik Hidayat ...............................................

Perawatan Endodontik Non Bedah Pada Perforasi Furkasi Menggunakan

Biodentine: Laporan Kasus

Atria Mya Kelani dan Nila Kesuma Djauharie ...................................






27.

28.

29.

30.

31.

32.

33.

34.

35.

36.

37.

38.

39.

189-193

194-199

200-207

208-214

215-218

219-226

227-233

234-241

242-248

249- 2

49

250- 2

50

251- 2

56 257-

7

Bedah Endodontik Sebagai Altematif Perawatan Pada Kasus Overfilling Material Pengisi Saluran Akar Laporan Kasus Ayu Sandini dan Ratna Meidyawati ...................................................... 263-270

Pengangkatan Instrumen Patah Menggunakan Instrumen

Endodontik Ultrasonik Pada Gigi Premolar Rahang Atas

Brinna Listiani dan Ratna Meidyawati ................................................. 271-277

Antibacterial effect of ethanol extract of the avocado seed (persea

americana mill.) As an alternative root canal irrigants against

porphyromonas gingivalis (in vitro)

Cut Nurliza, Dennis dan Wulandari Savitri ...............................

Endodontic Retreatment of a Maxilla Second Premolar with two

Separate Canals

Dania Vergeina Putri dan M. Rulianto .................................................. 288-292

Treatment of periodontal tissue Due to the overhanging fillings of class II

Dewi Haryani IGA .................................................................................. 293-293

Dealing with External Apical Root Resorption Associated with

Trauma from Occlusion ; Brief Review and Case Report

Dewi Isroyati Sugiana dan Kamizar ...................................................... 294-299

Perubahan Warna Gigi Setelah Perawatan Ortodontik

Ayu Wulandari dan Munyati Usman .................................................... 300-307

Penutupan Diastema Dengan Mahkota Pasak Inti; Laporan Kasus

Bani Imran dan Endang Suprastiwi ...................................................... 308-312

The development of coconut fiber waste as an alternative medicament for

application in endodontic treatment

Ellyda Nasution, Nevi Yanti dan TrimurniAbidin ............................... 313-325

Extruded ion nickel from apical foramen during instrumentation with

various irrigant

Eltica Oktavia dan Trimurni Abidin ..................................................... 326-337

Endodontic microsurgery for radicular cyst management with

combination of platelet rich fibrin (prf) and bone graft - a case report

Emmanuella G. Untoro dan Bambang Nursasongko ........................... 338-344

When shrinkage is a problem, this restoration can be a choice: a case

report

Eriana Sutono dan Christine A. Rovani ................................................ 345-351

Immature tooth management using mta and all Porcelain crown

reinforced with fabricated fiber post

Evy Tri Utami dan Pribadi Santosa ....................................................... 352-361






40.

41.

42.

43.

44.

45.

46.

47.

48.

49.

50.

51.

52.

viii

53. 3-in-1 Treatment of Traumatized Tooth with Open Apice and

Discoloration

Fadil Abdillah dan Nanik Zubaidah ...................................................... 362-369

54. Mineral Trioxide Aggregate as an Obturation Material in Horizontal

Root Fracture

Febri Marice Fransiska dan Agus Subiwahjudi .................................... 370-378

55. Treatment of root resorption using bioactive materials (a literature

review)

Fitri Yunita Batubara dan rimurni Abidin ............................................ 379-386

56. Correlation between educationlevel of parents to the caries of first

permanent molarin children

I Putu Indra Prihanjana .......................................................................... 387-387

57. The effect of smoke inhalation ways towards smoker’s melanosis that

detriment the aesthetics

Intan Kemala Dewi .................................................................................. 388-388

58. Perbedaan sitotoksisitas sediaan serbuk teripang emas (Stichopus

hermanii) ukuran partikel mikron dan nano pada kultur sel fibroblas BHK-21

Bella Djaufiar Risvi, Linda Rochyani dan Twi Agni Cevanti .............. 389-399

59. Endodontic Management of Mandibular First Premolar with Vertucci

Type V Canal Configuration A Case Report

Putri Yulandari ........................................................................................... 400-406

60. Effect Of Tooth Bleaching Procedures In Achieving Optimal Tooth

Shade, Brightness, And Enamel Hardness

Fitri Yunita Batubara, Rehulina Ginting dan Yendriwati ................... 407-414

61. Functional and Esthetic Management of Fractured Anterior Teeth

Caused by Dental Trauma

Reyn Pasenda Muljadi dan Latief Mooduto ............................................. 415-424

62. Case Report : Mineral Trioxide Aggregate as an Apical Plug Material in

Tooth with Open Apex

Risya Dini Marsa......................................................................................... 425-431

63. Esthetic Rehabilitation of Multiple Cases in Maxillary Anterior Dentition

Rizki Fanny Aviandono dan Cecilia G.J. Lunardhi .............................. 432-439

64. Perawatan non-bedah gigi insisif rahang atas dengan kista radikular:

laporan kasus

Rizky Amalia dan Anggraini Margono ..................................................... 440-447






9

Perawatan lesi endo-perio concomitant kelas 2 pada molar pertama

rahang atas melalui pendekatan non-bedah: laporan kasus

Rosdiana Nurul Annisa dan Nila Kesuma Djauharie .......................... 448-456

Root Canal Treatment in Left Third Mandibular Molar with

Curvature Using Niti Instrument (a Case Report)

Rusdiana dan Munyati Usman .............................................................. 457-463

Minimally invasive post core removal with ultrasonic device

Sandy Ratna Asri dan Dini Asrianti ...................................................... 464-471

Chronic Periapikal Lesion Management With Non Surgical Endodontic

Approach (Case Report)

Saskia budi nurina .................................................................................. 472-479

Apicoectomy in Management of Unerupted Maxillary Central Incisor

with Labioangular Root Dilaceration

Wandania Farahanny dan Trimurni Abidin ........................................ 480-487

Indirek Veneer Porselen Pada Gigi Anterior Rahang Atas

Dengan Hipoplasia Email : Laporan Kasus

Andi Hermianti Aco dan Juni Jekti Nugroho ...................................... 488-493

Fluorosis Dental Treatment (Anterior Upper Jaw) with Porcelain

Veneer (Indirect)

Anggy Anggarini dan Nirawati Pribadi ................................................ 494-501

Penggantian Beberapa Mahkota Metal Porselen untuk

Mendapatkan Warna yang Lebih Natural

Anis Dien Hartini dan Endang Suprastiwi ........................................... 502-507

Management of Crown Fracture and Multiple Diastema on Maxillary

Anterior Teeth

Arif Setiawan dan Ari Subiyanto ........................................................... 508-517

Bioviabilitas Ekstrak Daun Mangrove (Sonneratia Alba) Terhadap

Kultur Sel Fibroblas Cell Line BHK-21

Arlita Gladys Tricia Charyadie, Aprilia, dan Widyastuti ................... 518-529

Restoration of esthetic complex case with direct composite veneers:

A case report.

Elfira Megasari dan Taofik Hidayat ..................................................... 530-536

The Radix Entomolaris Managing the endodontic treatments

with magnification (microscope) and Endosonic tips - Case

Reports

Gary Wijaya dan Trimurni Abidin ....................................................... 537-545

Endodontic Treatment During Pregnancy : Rationale And Consideration Andina

Rizkia Putri Kusuma, drg., SpKG ........................................................ 546-553

PROSIDING SEMINAR ILMIAH INTERNASIONAL IKATA

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71.

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10

PERIAPICAL LESION TREATMENT OF MANDIBULAR TEETH WITH

SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

A Case Report

Lipur Kurniawati1, Anggraini Margono2

'Post Graduate Student, Department of Conservative Dentistry, Faculty of Dentistry, Indonesia University

2Chairman, Department of Conservative Denstistry, Faculty of Dentistry, Indonesia Uni-

versity

ABSTRACT

Intoduction: Endodontic treatment in patients with a medical history of Systemic Lupus

Eryhthematosus (SLE) require several things to be considered, including the consumption

of corticosteroids in the long term that can affect the healing response. Aim : The purpose

of this study was to report a case of treatment and healing of periapical lesions in patients

with SLE. Case Report : A 51 year old female came with a chief complaint discomfort on

left mandibular first molar since 2 weeks ago. On clinical examination there was a big

cavity, and the tooth loosing the distal and bukal crown. Radiograph examination showed

radiolucency on mesial and apical region. Conclusion : SLE patients required prudence in

its treatment with systemic medication being consumed and the healing reaction slower

than normal patients. Elimination of infection should be done with maximum to avoid more

severe conditions.

Keywords: periapical lesion, systemic lupus eryhthematosus, wound healing, immuno-

suppressant.

INTRODUCTION

Systemic Lupus Erythematosus (SLE)

is a syndrome of acute and chronic inflam-

matory conditions of autoimmune diseases

of unknown cause. 1Patients with SLE ex-

perience amyriad of symptoms. The most

common pattern is a mixture of constitu-

sional complaints of skin, musculoskeletal,

hematologic and serologic involvement.

The clinical course of SLE is variable

and may be characterized by episodes of

recurrent acute or chronic inflammation,

and intervening periods of remission.

Woment, aspecially those in their 30s and

40s, are affected more frequently than men

(average ratio 10:1). The worldwide preva-

lence of SLE ranges between 12 and 50 per

100.000, depending on location and eth-

nicity.5 Frequency in black women is three

times greater than white women. 1Genetic

factors and specific gene loci are important

in the pathogenesis of SLE.5In predisposed

11



ENDODONTIC CONGRESS (AEC) 2016 "Getting to The Roots of Endodontic Towards Asean Economic Community" Denpasar, 18-19 November 2016

persons, enviromental triggers, including

exposure tu sunlight (photosensitivity),

drugs (pharmacogenetics) and infections

(particularly with Epstein-Barr virus), are

thought to precipitate the development of

SLE. The diagnosis of SLE requires several

compatible clinical features and supportive

laboratory studied.5 Corticosteroids and

other drugs that immunosuppresan is a

major form of therapy in cases.2

In this condition, preventive dental

care and monitor patients with SLE must

enforce closely for head and neck infections

because they are predisposed to severe

infections. This infections are often silent

and difficult to detect because of a paucity

of pain and swelling. Through clinical ex-

amination is required to avoid overlooking

infections. Infections can progress rapidly in

patients with SLE bacause of disease or

therapy-related immunosuppresan.5

To further complicate matters, patients

with SLE can have a superimposed

antiphospholipud antibody syndrome that

predisposed them to thromboembolic

events. It is therefore important to document

whether these patients are managed with

anticoagulation therapy, aspirin or warfarin

before dental surgery.

Healing of periapical lesions in pa-

tients with SLE can be achieved through

conventional endodontic treatment consid-

ering the general conditions. Side effect of

long-term corticosteroid intake is Compro-

mised immunity.9,10It can lead to delays in

the healing process of periapical lesions.

Successful root canal treatment de-

pends on the elimination of infection from

the root canal system through chemo-

mechanial preparation using copious irri-

gation solution NaOCl 2,5% which serves

to dissolve organic tissue and has a broad-

spectrum antibacterial and intracanal me-

dicament Ca(OH)2 between visits. Ca (OH)2

has ability to remineralization and has

antibacterial capability. Evaluation is done

periodically to see the healing of the

periapical region.

CASE AND MANAGEMENT

A 51 years old female came to Uni-

versity Dental Hospital -Faculty of Den-

tistry Universitas Indonesia Female with

complaints about her left Mandibular First

Molar occasionally feels pain and discom-

fort.On clinical examination, it was sensi-

tive on percussion.Patient had SLEsince

2012 and regularly consuming methylpred-

nisolone 8 mg 4 times a week and vitamin

D 2x a week.

At objective examination 36, there

wasa big cavity. pulp sensitivity tests nega-

tive and sensitive to percussion. Based on

the x-ray images, there is periapical lesions

in regio 36. Diagnosis 36 are chronic apical

abscess et causa pulp necrosis (Figure 1).

The treatment plan in this case is the

conventional endodontic and metal-ceramic

dowel crown restoration.

12

Once the diagnosis established, treat-

ment start by improving canal access with

diamendo bur (Dentsply Maillefer, Swit-

zerland). Patency of the canal was checked

with # 10 K-File for mesiolingual and

mesiobuccal root canal and # 15 K-File for

the distal root canal with a reference point

the remaining walls 36 and then the radio-

graphs was takento determine the working

length was found pulp canal obliterations on

the distal and mesiolingual root canal.

Operators using the file C +

(DENTSPLY) with lubricant RC-Prep

(Premier® Dental Products Company) 15%

to the file can be entered within the length of

employment. Canal shaping was done by a

crown down technique with ProTaper Hand

Use (Dentsply Maillefer, Switzerland) until

file # F2 / 19mm mesiolingual root canal, #

F2 / 15 mm for the distal root canal and # F2

/ 17mm for mesiobuccal root canal. Between

each file, canals were irrigate with 2,5%

sodium hypoclorite (NaOCl). After

preparation is complete, irrigation return

with 2.5% NaOCl and distilled water and

then dried with paper points. Calcipex II

(Nippon Shika Yakuhin Co., Ltd., Yama-

guchi, Japan) water-based paste calcium

hydroxide as intracanal medicament was

injected into the canals.

Prophylaxis antibiotics Dexyclav 500

mg 3x daily for 5 days given to these

patients. One week later, the patient had no

complaints of pain or discomfort and

percussion tests showed negative results.

The root canals were obturated using F2

Gutta-percha (Dentsply Maillefer) and AH

Plus resin sealer (Dentsply).

Figure 2Initial radiograph

(a) I (b)

Figure 1 (a). Preoperative clinical photo (b).

Preoperative radiograph

Figure 3 Master cone

radiograph

13

One week later, metal-porcelain crowns was ready to be inserted cementation using GIC

cement (Fuji I, GC). At the 3 month follow-up evaluation after first visit, the patient did not

report any clinical symptomsand control three months later.

On the next visit, there was no subjective

complaints with negative results on

percussion test. Dowel space preparation

was made by removing gutta percha using

peeso reamer. This was followed removal

exessive soft tissue arround the tooth us-

ing electosurgery unit( Bonart Art

Electrosurgery Unit, Bonart Medical

Technology Inc.) and crown preparation.

Metal post

core was made by acrylic resin

(Duralay, reliance).Cementation using

Glass Iono- mer Cement(GIC) material

(Fuji I, GC). Radiolucency was observedat

the apical of the tooth which indicates the

healing process. An impression prosedure

for fixed restoration which provide an

accurate registration using putty wash

technique with polyvinyl siloxane material

(Exaflex-GC).

Figure 5 Radiograph 2 weeks

after obturation

Figure 4 Radiograph after

obturation

Figure 6 Cementation metal post core

14



ENDODONTIC CONGRESS (AEC) 2016 “Getting to The Roots of Endodontic Towards Asean Economic Community"


Gambar 8 Radiograph 6 months

At the time control after 6 months of

treatment, radiograph was taken at a differ-

ent angle, visible image more radiolucent

reduced. But in the apical portion of the

distal side still looks the rest of radiolucent.

Showed that the lesions in the healing

process.

DISCUSSION

Initial stage of treatment should be

done is appropriate diagnose. In this case it

was found that SLE patients have been

diagnosed since 2012 and has been con-

suming corticosteroids routinely, methyl

prednisolone 8 mg 4 times a week and vi-

tamin D 2 times a week. Test sensitivity of

the pulp obtained negative results. Ra-

diographic picture shows that there is a ra-

diolucency at the apical of the tooth 36. It

was diagnose as periapical abscess et causa

pulp necrosis.

The principle of treatment should be

done is to eliminate the infection, the

necrotic pulp tissue and elimination of

pathogenic microorganisms as possible

using root canal irrigation and appropriate

medications.6,7 Obliteration of the distal and

mesiolingual root canal must be eliminated

in order to do the appropriate preparation

long working so we did the maximum care

and periapical lesions can be cured.

Antibiotic prophylaxis (dexyclav 500 mg)

was also administrated for 5 days to prevent

secondary infection. NaOCl is irrigation

materials are widely used in endodontic

treatment because it has many advantages,

among others, can dissolve organic tissue

and high antibacterial properties. The use of

irrigation solution did not affect systemic

conditions if used according to the

procedure. Medicaments used is Ca (OH)2

because it is the gold standard in dentistry

and the most biocompatible with body

tissues other than medicaments.

Infections in patients with SLE de-

velop rapidly because of the general situ-

ation and therapy immunosuppresan .. It is

important to document whether these

patients are managed with anticoagulation

therapy, aspirin or warfarin before dental

surgery.5In this case, patient is not taking

anticoagulant medication so operators can

be directly electrocauterygingival arround

the tooth.

15

Understanding of wound healing is as

important as knowingthe pathogenesis of

disease, because satisfactory wound

healingis the ultimate goal of treatment.

Interestingly, healing begins as soon as

inflammation starts.When irritants (micro-

bial and nonmicrobial) in the canalsystems

or in the periapical tissues are eliminated by

nonsurgical or surgical endodontic therapy,

inflammatory mediators areno longer

produced in the periapical tissues because of

reduction of immunoinflammatory cells.

Inflammatory mediatorsalready present are

inactivated by the body’s control mecha-

nisms to prevent an inflammatory reaction

from goingunchecked.7

Wound healing of apical periodontitis

lesions after propernonsurgical root canal

therapy follows the general principle of-

wound healing of connective tissues else-

where in the body,with the formation of

fibrovascular granulation tissue, removal of

necrotic tissue and dead bacteria by

activated macrophages,and finally repair

and/or regeneration of the wounded

tissue.The process of periapical wound

healing after nonsurgical root canal therapy

may be similar to wound healing) depend on

the activity of osteoblasts. Osteoblasts are

derived from mesenchymal cells in the bone

marrow. With the influence of bone

morphogenic proteins (BMP), induced stem

cells that differentiate and form a spindle-

shaped osteoprogenitor cells.

Osteoprogenitor cells accumulate in the area

to be formed of bone, BMP trigger

osteoprogenitor cell differentiation into

osteoblasts cuboid shape and coating the

surface of bone that produces osteoid, which

will be mineralized and transformed into

bone.7

Local and systemic factors may affect

periapical wound healing.Infection will

complicate and prevent wound healing.

Impaired nonspecific immuneresponse and

disorders of the vascular system appeared to

havea significant influence on the success

rate of nonsurgical rootcanal therapy on

teeth with apical periodontitis.However,

immunocompromised patients, responde-

das well as counterpart patients after non-

surgical endodontic.7After RCT there may

be a slight increase in the size of the ra-

diolucency followed by in-fill of less orga-

nized bone proceeding from the outside to

the center and eventually the laminadura

and periodontal ligament (PDL) return to

normal. Healing of the periapical lesion

usually occurs with hard tissue regeneration

that is characterised by reduction of the

radiolucency on follow up radiograph. 14

In 50% of cases showed a clear sign of

healing at 6 months. But at the root con-

ventional treatment, complete and advance

healing in the first 3 months only shown in

21% of cases and 78.4% were experiencing

the early stages of healing, while at 6

months of complete and advance healing

already terjdi at 38.7% .11 Radioopacity

starting to look increase after 38 days and

radioopacity similar to the surrounding bone

tissue occur within 105 days.12




16




In this case, radiography after 3

months of treatment showed healing re-

sponse. However, at 6 months after treat-

ment, bone density in the distal part of the

mesial root was not complete heal. Healing

response in SLE patient lower when com-

pared with normal patients. Autoantibodies

can affect the protein in bone cell differen-

tiation process. Autoantibodies in patients

with SLE can influence the formation and

inhibit healing.13For teeth that have been

treated with necrotic pulp status prior to

treatment, said to succeed if the teeth re-

mained asymptomatic, meyembuh apical

lesions and no new lesions are apical. If new

symptoms appear or enlarged lesions in the

apical dental root canal treatment denotes

failure.

CONCLUSION

SLE patients required prudence in its

treatment with systemic medication being

consumed and the healing reaction slower

than normal patients. Elimination of in-

fection should be done with maximum to

avoid more severe conditions.

REFERENCES

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Andersen Phelan, DDS, Oral Pathol-

ogy for the Dental Hygienist 4th ed.

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2004:109-111

2. Cawson’s esssentials of Oral Pathol-

ogy and Oral Medicine, 8th ed. Else-

vier, 2002:365-366

3. Von Feldt JM. Systemic lupus ery

thematosus. Recognizing its various

presentations. Postgrad Med 1995;

97(4):79, 83, 86 passim.

4. Estes D, Christian CL. The natural

history of systemic lupus erythemato-

sus by prospective analysis. Medicine

(Baltimore) 1971; 50(2):85-95.

5. Jonathan B. Albilia, DMD; David K.

Lam, DDS;Cameron M.L. Clokie,

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11. Zvi Metzger, DMD, Ronen Huber, DMD, Dragos

Slavescu, DMD, Dan Dragomirescu, DMD,Idan To-

bis, BSc Eng,and Hadar Better, MD, DMD.Healing

Kinetics of Periapical Lesions Enhanced by the

Apexum Procedure: A Clinical Trial,2009

12. Giorgio Pagni, Gaia Pellegrini, William V.

Giannobile, and Giulio Ras- perini, International

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13. Barbara William Patrick, Department Univetsity

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14. M.B.M. Thomas, S.J. Hayes and A.S.M. Gilmour,

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