bedah perio by sp. perio

7/25/2019 bedah perio by sp. perio

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BEDAH PERIODONTAL

drg. Ahmad Syaify, Sp.Perio (K)Spesialis Konsultan Bedah Perio & Estetik


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Materi Kuliah Pengantar Bedah Perio

Kuretase dan ENAP

Gingie!tomy " #ro$n %enghtening &rene!tomy

&lap Surgery


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Periodontal Surgery Salahsatu 'omponen periodontal treatment mumnya dila'u'an seagai therapi fase 'edua Motiasi pasien dan home !are

*arus didahului therapi fase a$al +ida' sering dan tida' radi'al Perdarahan harus minimal *asilnya se!ara morfologis harus ai' *ilangnya aringan harus seminimal mung'in

-ndi'asi harus tepat Prognose ai' Kontrol dan re!all se!ara teratur


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The art and science

of periodontal surgery Purposes and goal of periodontal surgery

-ndi!ations for and methods of surgery

e/ealuation after initial therapy is !omplete Preparation for periodontal pro!edure

0arious standard surgi!al te!hni1ues

(Klaus et.al.1994)


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Purpose and goals of surgi!al

therapy oot !leaning and smoothing (planing) $ith

dire!t ision edu!tion or elimination of pla1ue/retentie

area that promote infe!tion, espe!iallyperiodontal po!'et

Eliminations of inflamation and po!'et a!tiity Enhan!ing the regeneration of periodontal

tissues #reation of physiologi! morphology of the

marginal periodontal and the mu!ogongialorder

(Klaus et.al.1994)


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-ni!ations and methods

ENAP pro!edure, open !urettages Gingie!tomy " gingioplasty &rene!tomy Partial fap refle!tion &ull flap refle!tio $ith ariale flap

repositioning Mu!ogigial surgery

#omined " spe!ial operations


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e/ealuasi -nisal therapy harus optimal #e' proing depth, atta!hment loss,

inflamasi gingia, a'umulasi pla'.

2*- paling tida' 345 +ida' ada leeding (B2P / ) Pertimang'an penya'it sistemi' adiotherapi dan anti/'oagulan

Premedi'asi tentatif %uas area diatasi


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Atlas of surgi!al te!hni1ues

Gingial !urettage

ENAP (open !urettage)

Modified 6idman &lap (M6&) &lap pro!edures

Gingie!tomy (G0)


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Pemilihan teni !edah perio +ergantung tipe " 'eparahan

-nisial terapi harus sempurna

7iagnosa harus !ermat dan a'urat

Pertimangan prognose

Efe'tiitas dan efisiensi

-nformed !onsent


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"IN"I#AL $%RRETA"E

drg& Ahmad 'yaify( 'p&Perio )*+


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7efinisi

Kuretase (!urretage) / s!raping

/ pengeru'an

/ peng'uretan

Memuang dinding po'et yg mengalami

granulasi8firolasti'8angiolasti' dan

inflamasi.


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6hat is Periodontal Po!'et9

7efinition

#lassifi!ation ased on :

/ epithel atta!hment " gingial margin

/ aleolar !rest

/ type of enlargement

/ deep of po!'et

/ area of po!'et


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Mengapa perlu 'uretase9 Mengamil8memuang ar granulasi yang

mengalami inflamasi 'ronis pada dinding

po'et

;aringan granulasi / 'oloni a'teri

/ sugingial 'al'ulus

/ destru'si epit sul'us / destru'si epit atta!h


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-N7-KAS- KE+ASE

Po'et dang'al < moderat (=/> mm)

2edematous, inflamasi, non firoti'

Kontur gingia relatif ai'Ada 'ontra indi'asi edah perio lanut

e!all isit untu' maintenan!e po'et yang

re'uren


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Periodontitisditandai terentu'nyapo'et periodontal, resorsi tulang

aleolar, 'egoyahan gigi

Ne$man d'', 2000. Clinial Periodontolo!"


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K2N+A -N7-KAS-

7inding po'et firoti'

Po'et yang dalam

Keterliatan per!aangan a'ar

7aerah sulit diang'au 8 asesiilitas??


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ELI,INA'I PO*ET D"N *%RET

E&EK PENGKE+AN

NE6 A++A#*MEN+ 8 E/EP-+E%-SAS-

+uuan 'uretase (Naers " Stal'ers, @4)

@. Memersih'an aringan granulasi

. Memersih'an aringan inflamasi

=. Mengurangi 'edalaman po'etC. Mengamil papilla interdental yg rusa'


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Teni uretase Kelanutan s'eling dan root planing

Menghilang'an aringan granulasi

Memuat lu'a aru

#losed method 8 lind method


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Tata lasana uretase

@. -ndi'asi

. S'eling dan root planing 'unungan -

=. Anaestesi lo'al dgn !ytoe!t

C. Masu''an 'uret 88 a'sisi gigi sampai dasar po'et,

sisi taam pada epitel sul'uler@. %a'u'an pengero'an ('uret) rp 'ali

. -rigasi

=. +e'an daerah operasi =/> menit

C. Suturing tentatie

>. Apli'asi periodontal dressing

D. Kontrol @ minggu


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Penyem!uhan pasca uretase Perai'an epitel sul'us / hari

Perai'an epitel !e'at > hari

Peng'erutan gingial margin hari Penyemuhan sempura minggu

Carranza & Newman,1996)


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KE%EMA*AN KE+ASE

@. P2SE7 S%-+ SE#AA +EKN-S

. B+* 6AK+ F %AMA

=. PENEMB*AN *AMP- SAMA 7GN

-NS-S-8BE7A*

C. *AS-%NA +7K +E%A% S-GN-&-KAN

7-BAN7-NGKAN SKE%-NG " 22+ P%AN-NG

SA;A

Lindhe, 1984


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ENAP(EH!isional Ne$ Atta!hment

Pro!edure)

drg& Ahmad 'yaify( 'p&Perio )*+


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ENAP #odi$ikasi kuretase den!an insisi

dindin! poket E%P ' open kuretase


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ENAP


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INDI*A'I ENAP

-ndi'asi umum I 'uretase

;i'a diperlu'an e'sisi

gingia 'eratin ade'uat lo!aliJed regio anterior, papilla

interdental

periodontitis ringan8sedang


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*ontra indiasi ENAP

periodontitis erat po'et dalam po'et infraony gingia 'eratin sempit

'erusa'an tulang aleolar aringan hiperplasti' 'eterliatan fur'asi daerah interpro'simal suli

diang'au


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*E%NT%N"AN ENAP

AKSES-B-%-+AS F KE+ASE PENGAMB-%AN ;A GAN%AS- F 2P+-MA%

7AN +EK2N+2% B-SA N+K P2KE+ G %EB-* 7A%AM

(7-BAN7-NGKAN KE+ASE) E&EK+-& N+K P2KE+ SPAB2N ANG

2E7EMA+S (;GA &-B2S-S -NGAN) SE7-K-+ KESAKAN PA7A ;A-NGAN %NAK MEPAKAN P2SE7 G PE7-#+AB%E

N+K E%-M-NAS- P2KE+


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*ELE,AHAN ENAP +d' untu' po'et 88mu'ogingial un!tion

+ida' untu' defe' tulang

+ida' untu' 'erusa'an daerah api'al

po'et

Menimul'an resesi gingia

Sulit tentu'an daerah epithel atta!hment


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PRO'ED%R ENAP

@. S'eling dan root planing @ minggu slmnya. #e' 'edalaman po'et, Jona er'eratin !u'up

=. Anestasi lo'al

C. -nsisi miring 'e dalam dgn s'alpel sampai dasar

sul'us>. ;aringan granulasi diamil dgn s'aler dan 'uret

D. %a'u'an s'eling dan root planing lagi

. Suturing interupted pada interpro'simal

3. 7ite'an dgn 'apas steril =/> menit

. Periodontal dressing

@4. Medi'amentosa

@@. Kontrol @ minggu


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"IN"I#E*TO,I -

"IN"I#OPLA'TI

drg. Ahmad Syaify, Sp.Perio


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GINGIVEKTOMI

E'sisi gingia yg enlargement

+uuan elimininasi po'et a'iat

enlargement gingia, enis po'et false 0isiilitas " a'sesiilitas FFF

untu' pengamilan 'al'ulus sugingia

dan root planing


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INDI*A'I "IN"I#E*TO,I

ELIMINASI SUPRABONI POCKET

KEDALAMAN > 4 MM

SUPRABONI POKET DENGAN DINDINGPOKET FIBROUS

ELIMINASI ENLARGEMENT GINGIVA

ELIMINASI ABSES PERIODONTAL

INTERDENTAL GINGIVAL CRATER


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*ONTRA INDI*A'I

2*- SE%A% ;E%EK

-N&%AMAS- AK+

;-KA 7-PE%KAN BE7A* +%ANG A%0E2%A

7ASA P2KE+ 7-BA6A* M#2G-NG-0A%;N#+-2N

&EKENS- KA-ES +-NGG-

&EKENS- MA%P2S-S- ANG +-NGG-

K2N+A -N7-KAS- PENAK-+ S-S+EM-K


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PRO'ED%R "IN"I#E*TO,I

-N-+-A% P*ASE +*EAP +EN+KAN KE7A%AMAN P2KE+ 7ENGAN P2BE

PE-272N+A% +EN+KAN B%EE7-NG P2-N+ 7ENGAN P2#KE+

MAKE EKS+ENA% BE0E% -N#-S-2N 7- AP-KA% B%EE7-NG

P2-N+ (oran, 'ir'land 'nies) AMB-% 7-N7-NG P2KE+ ANG S7A* 7- EKS-S- KE+ASE

PE-272N+A% 7ESS-NG


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.RENE*TO,I

Bedah perio untu' 'ore'si perle'atan

frenulum anormal

+uuan : @. Mengatasi mu'ogingial prolem

. 2ptimasi 'eersihan mulut

=. Petimangan esteti'

C. Keperluan pera$atan ortodonti'


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Perle'atan frenulum laialis

@. renulu noral

Perle'atan sampai atas mu'ogingial un!tion

2. renulu sedan! &rene'tomi tentatif. Perle'atan sampai atta!hed gingia, free

gingial grooe

*. renulu tin!!i &rene'tomi mutla'.

Perle'atan sampai free gingia, interdentalpapilla, palatum


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