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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
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.
Denpasar, 18-19 November 2016
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"
Denpasar, 18-19 November 2016
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
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
1.
2.
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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
PROSIDING SEMINAR ILMIAH INTERNASIONAL IKATAN
KONSERVASI GIGI INDONESIA ASEAN
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 ...................................
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
27.
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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
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
40.
41.
42.
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45.
46.
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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
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
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
65.
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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
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
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
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
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 (dexy- clav 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 os- teoprogenitor 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
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
16
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
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.
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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
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