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S U S I*, Trimurni Abidin*** Resident at Conservative Dentistry Specialist Program

** Lecturer at Conservative Dentistry Department

13-14 NOVEMBER 2015, SINI II COSMOS - GRAND CLARION MAKASSAR - INDONESIA

ENDODONTIC RETREATMENT WITHPERIAPICAL ABSCESS WITH FISTULA

RESULTING FROM FAILURE OF FIXEDORTHODONTIC APPLIANCE : A CASEREPORT

S U S

I*, Trimurni Abidin*** Resident at Conservative Dentistry Specialist Program

** Lecturer at Conservative Dentistry Department

13-14 NOVEMBER 2015, SINI II COSMOS - GRAND CLARION MAKASSAR -INDONESIA

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PENDAHULUAN

Selama perawatanP reparasi akses

Kesalahan preparasiPengisian saluran akar Pasca perawatanDesain restorasi yangburuk,

kerusakan restorasi,Trauma dan fraktur yang b ukan

karena perawatanen o ontik!

Pra perawatan

Diagnosis"eleksi kasus

Prognosis yang buruk

Asgeir, 2009

kegagalanperawatan

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During operative treatment. Access preparati n,

! t cana" preparati n #bturati n Post-operative treatment. !est rati n design !est rati n damage, Trauma and fracture caused by

n n$end d ntic treatment%

Pre-operative treatment.

Diagn sis&ase se"ecti n

P r pr gn sis

Asgeir, 2009

Thefailure f

e!" " !#i$

#rea#%e!#

#ntro u$tion

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' Kegagalanperawatansaluran akarakibat trauma

' Kesalahan perawatan

ortho onti Pergerakangigi %ekanan &&

Sameshima GT, Sinclair PM,2010.

kelalaian ataupengetahuan operatoryang kurang!

Pasien yang ti ak ko -operati'!

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' (rtho onti$ treatment

'ailure !%ooth mo)ement pressure &&

Sameshima GT, Sinclair PM,2010.

negligen$e or la$k o'knowle ge o' the operator!

*n$ooperati)e patients!

End d ntic treatment

fai"ure caused bytrauma

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+im this $ase

' aporan kasus Perawatan ulang

saluran akar gigi insisi)us lateralkanan maksila Non )ital enganabses periapeks isertai stula

%rauma ari perawatan ortho onti$ekat!

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A$$i"e!#

Trauma fr m e(cessi)e f rce byfi(ed rt* d ntic app"iance%

End d ntic re$treatment f a n n )ita" t t* nrig*t ma(i""ary "atera" incis r +it* periapica"

abcess and fistu"a

+im o' this $asereport

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Patient & 22 y!o

! -., & nser)ati)e Dentistry / - U U

KeluhanUtama

Riwayatmedis

Pasien akit 1 bengkak pada gingi)a bagian"abia" gigi 32 4 ta*un yang "a"u, perna* dira+atsa"uran akar

-igi 23, 22 perna* menga"ami a)u"si pada saat

berusia 32 ta*un%

Pasien tidak ada masa"a*%

a'eRe( r#

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Patient & 22 y!o

! -., & nser)ati)e Dentistry / - U U

Me"i$alhi'# r)

32 e)ere pain and upper "abia" gingi)a"s+e""ing, +*ic* *ad been treated f ur years ag %

T*e patient a"s inf rmed t*at at t*e age f 32years "d s*e *ad an accident and t*e teet* f 23,22 *ad a)u"sed%

N nc ntribut ry

a'eRe( r#

Mai!C %(lai

!#'

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Pemeriksaan klinis dan PemeriksaanOb ekti!

/istu"a pada bagian "abia" gigi 32

Pasien sedang me5a"ani pera+atan rt* d nti%

Tes s ndasi 6$7, Tes terma" 6$7, Perkusi 687, . bi"iti 627%

Pemeriksaan #b5ektif

Pemeriksaank"inis

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Cli!i$al * O+,e$#i-eE.a%i!a#i !

/istu"a n "abia" gingi)a" surface f t*e rig*tma(i""ary "atera" incis r%

Patient is current"y underg ing rt* d ntictreatment%

O+,e$#i-eE.a%i!a#i !

Cli!i$alE.a%i!a#i !

12 - esponse to thermal test --Per$ussion palpation 6- 2st gra e 7obility

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Pemeriksaan !adi grafis

"ambar.# a. Panoramik sebelum perawatan. b. Radiogra!i sebelum Perawatan.

-igi 32 Pergerakan gigi 32 ti"ting, Lesi periapika", dan -igi te"a*dira+at sa"uran akar dengan *ermetis%

a b

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"ambar.# a. Panoramik sebelum perawatan. b. Radiogra!i sebelum Perawatan.

! t ti"ting f 23 teet*, and pre)i us"y treated +it* *ermeticbturati n%

a b

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P$%&'&(&KS&%&&% K&SUS

13-14 Nopember 2015 14

Diagn sa 32 Abses apika" akut 8 fistu"a p st pera+atanend d ntik%

!encana Pera+atan Pu"pa !etreatment

!est rasi ak*ir build - up !esin k mp sit ma*k ta gigi

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32 Acute apica" abscess and fistu"a p st end d ntictreatment%

Pu"pa" Treatment End d ntic re$treatment %

/ina" rest rati n &r +n c mp site bui"d $ up

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/UN0UNGAN PERTAMA :-8+P- emo)e 9P "ol)ent 6 deobturation fles- penilaian ulang kanal- #rigasi Nao:l 2, 5; ,? 2;- Pan@ang ker@a ra iograpi!- pembersihan pembentukan otary protaperinsruments

>ybri te$hniAue- itutup engan e ermiB6%umpatan sementara

3 minggu

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Fir'# 1i'i# :-Proper a$$ess opening- emo)e 9P "ol)ent 6 deobturation fles- Negotiation o' $anals- #rrigation Na:l 2, 5; ,? 2;- Corking ra iograph length!- :leaning shaping otary protaper insruments

>ybri te$hniAue

- Dressing with e ermiB6%emporary $ements 3weeks

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Follow-up un5ungan ke tiga

Follow-up un5ungan ke "ima

Follow-up un5ungan ke enam

Follow-up un5ungan ke empat

+t 2 n , 3 r , 4 th 5 th )isit Dressing

:a (> 2uring 7onths a iographi$

lesion re u$tion

at 5th

)isit!

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-Pre-obturation eBaminationE Pain -

E Palpation -

E Per$ussion --#ntra$anal Dressing remo)e- oot $anals were rie withpaper points master $one

tte

-(bturation ateral$on ensation te$hniAue 7+:

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"br.# Sebelum perawatan

"br.# Sesudah perawatan

E-alua'i 'e+elu% "a! #i2a +ula! 'e#elah(era3a#a!

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"br.# Pre-operative treatment.

"br.# Post-operative treatment.

FINAL 1ISIT

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%ekanan yang iberikan alat ortho onti akan menekanmembran perio ontal yang terletak iantara gigi an tulangal)eolus!

"$hwarF, 1/32 tekanan yang iberikan alam perawatanortho onti ti ak boleh melebihi tekanan arah kapiler 20-25gG$m2

bila tekanan yang iberikan melampaui ambang batassiologis apat mengakibatkan terputusnya ligament

perio ontal an ter@a i kerusakan sel-sel pa a tulang

sehingga ter@a i resorpsi tulang al)eolar

Di'$u''i !

Cobourne MT, DiBiase AT, 2009

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Pressure that gi)en by ortho onti$ eAuipment will pushperio ontal membrane whi$h is lo$ate between tooth anal)eoar bone!

"$hwarF, 1/32! pressure that gi)en in ortho onti$ treatmentshoul nHt eB$ee $apillary bloo pressure 20-25 gG$m 2

Pressure eB$ee s physiologi$ treshol may lea toperio ontal ligament tear an amage the $ells in the boneresulting al)eolar bone resorption

Di'$u''i !

Cobourne MT, DiBiase AT, 2009

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Te ri 4#e ri #er,a"i!)a re' r('i

13-14 Nopember 2015 24

Ga%+ar 56 S7e%a (er2era7a! 2i2i 8a9 2a)a e7'#er!al "ia(li7a'i7a! 8+9 "aerah a( 'i'i 'era# )a!2%ere!2a!2 8$9 'e#elah a(li7a'i 2a)a )a!2 le+ih la%a #erliha# (e%+e!#u7a! #ula!2 leh '#e +la'

(a"a 'i'i a( 'i'i "a! re' r+'i #ula!2 leh '#e 7la' (a"a 'i'i re( ' 'i6 8Ha!!e%a! ;

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Te ri 4#e ri #er,a"i!)a re' r('i

13-14 Nopember 2015 25

Ga%+ar 56 S7e%a (er2era7a! 2i2i 8a9 2a)a e7'#er!al "ia(li7a'i7a! 8+9 "aerah a( 'i'i 'era# )a!2%ere!2a!2 8$9 'e#elah a(li7a'i 2a)a )a!2 le+ih la%a #erliha# (e%+e!#u7a! #ula!2 leh '#e +la'

(a"a 'i'i a( 'i'i "a! re' r+'i #ula!2 leh '#e 7la' (a"a 'i'i re( ' 'i6 8Ha!!e%a! ;

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2. Bone Bending and Piezoelectric Theory8Farrar >?==9Pada saat gigi diberi tekanan, tu"ang a")e "ar disekitarnya akanmenga"ami bengk kan%

Daera* cekung Arus negatif Dep sisi tu"ang %

&embung Arus p isitif !es rbsi tu"ang

Cobourne MT, 2009

2 B B di d Pi l t i Th

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2. Bone Bending and Piezoelectric Theory8Farrar >?==9;*en t*e t t* is pressuri

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Pada "ap ran kasus diatas untuk mencega* ter5adinya res rpsi yangberke"an5utan pada gigi 32 , maka di"akukan pera+atan end d ntik

u"ang%

3. Blood Flow Theory / Fluid dynamic theory, 6=ien , 39>>7

Pergerakan gigi timbul karena gerakan $airan yang inamisalam ligamen perio ontal!

Balajhi. SI, I er BS, 200!

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?n ab )e case rep rts, t pre)ent sustained t t* res rpti n n 32t*t t*, repeated end d ntic treatment is d ne%

3. Blood Flow Theory / Fluid dynamic theory, 6=ien , 39>>7

T t* m )ement caused by m )ement f f"uid dynamic in t*eperi d nta" "igament%

Balajhi. SI, I er BS, 200!

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America Association o Endodontist Glossary o Terms Perawatan en o ontik ulang a alah suatu prose ur yangmen$akup pembuangan material pengisi saluran akar, sertapengisi saluran akar!

Tu5uanya ada"a* untuk mengemba"ikan dan men5aga fungsi gigi dida"am "ingkungan yang bebas dari inf"amasi dan pat sis, se*ingga

pasien mempunyai kesempatan untuk memperta*ankan giginya"ebi* "ama di da"am mu"ut% "ho#es $ ,200!$ohnson %T, 2002

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America Association o Endodontist Glossary o Terms een o onti$ treatment is a pro$e ure that in$lu es root $anal

lling material isposal, as well as root $anal lling!

%he goal is to restore an maintain the 'un$tion o' the toothin an inIammation 'ree an pathosis 'ree en)ironment, so

that patients ha)e the opportunity to retain their teeth 'orlonger time in the mouth! "ho#es $ ,200!$ohnson %T, 2002

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Per#i%+a!2a! (era3a#a! ula!2

'alura! a7ar

13-14 Nopember 2015 32

isa 5aringangigi

Kebutuha

n restorasi

Kea aanperio ont

al

Ko-operati)e

pasien

&ar'rea(es ), Cohen S, 2011

Per#i%+a!2a! (era3a#a! ula!2'alura! a7ar

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Per#i%+a!2a! (era3a#a! ula!2

'alura! a7ar

epeate root $anal treatment$onsi eration

13-14 Nopember 2015 33

esi ualtooth tissue

estoration nee s

Perio ontal$on ition

:ooperati)epatients

&ar'rea(es ), Cohen S, 2011

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Pilihanperawatan

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%reatmentoptions

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eber*asi"an pera+atan sa"uran akar pada kasus gigi 32, 5ugadipengaru*i "e* pemi"i*an dan penggunaan ba*an irigasi danmedikasi yang tepat,

=a*an irigasi yang digunakan ada"a*Na#&L 6 dium *ip k" rit7 =a*an yang mempunyai daya

antibakteri yang "uas, dan mampu me"arutkan 5aringan rganik%

EDTA .ampu me"arutkan smear-layer %

&*" r*e(idine .erupakan ba*an irigasi yang efektif te*adap

bakteri Enterococcus faecalis yang merupakan bakteri utamapenyebab infeksi sekunder pada kegaga"an pera+atan sa"uranakar%

Taneja , )umari , * Par+ash. 2010Bansal , #++. 201

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%he su$$ess o' root $anal treatment in $ases o' tooth 12,

also inIuen$e by the sele$tion an use o' irrigation anproper me i$ation,

?rrigati n materia"s used areNa:l "o ium hypo$hlorite materials that ha)e broa

antiba$terial $apa$ity, an $apable o' issol)ing organi$tissue!

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=a*an medikamen yang digunakan pada kasus gigi 32 yaitumenggunakan Ledermi( dan ka"sium *idr ksida%

Pasta Ledermi(

Pasta Ledermi( merupakan k rtik ster id yang dapatmeng ntr " rasa nyeri dan inf"amasi serta demec" cyc"ine padapasta Ledermi( mengandung antibi tik yang efektif untukme"a+an bakteri%

Ber+i--en , +ar , Ber+i--en . 2000 C/i+la . 2000

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.edicaments materia"s used in t*e case f t t* 32 areLedermi( and ca"cium *ydr (ide%

Ledermi( Paste

e ermiB Paste is a $orti$osteroi whi$h $an $ontrol painan inIammation, an eme$lo$y$line on e ermiBpaste $ontaining antibioti$s eJe$ti)e against ba$teria!

Ber+i--en , +ar , Ber+i--en . 2000 C/i+la . 2000

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a"sium *idr ksida

.ekanisme antimikr ba ka"sium *idr ksida ter5adi denganpemisa*an i n calcium 6&a287 dan hydroxyl 6#H7 %

? n calcium 6&a287 bereaksi da"am en

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$al$ium hy roBi e

%he antimi$robial me$hanism o' $al$ium hy roBi eo$$urs with separation o' $al$ium ions :a2 6 anhy roByl (> !

:al$ium ions :a2 6 rea$ts in the enFymati$ rea$tiono' ba$teria an tissue, inhibits DN+ repli$ation an a$tsas a barrier to pre)ent the ba$teria 'rom entering theroot $anal system!

>y roByl ion (> iJusion $ause an alkaline

en)ironment that is not $on u$i)e to the e'ense o'ba$teria in the root $anal, an iJuses into entinaltubules!

Ber+i--en , +ar , Ber+i--en . 2000 C/i+la . 2000

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/ESIMPULAN

13-14 Nopember 2015 42

Hubungan yang k mpre*ensif antara rt d ntis danend d ntis merupakan *a" yang penting untukmemastikan *asi" yang baik ketika gigi yang te"a*dira+at end d ntik ter"ibat da"am pera+atan rt d ntikse*ingga dapat dik ntr " bagaimana k ndisi dari gigi

tersebut%

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/ESIMPULAN

13-14 Nopember 2015 43

:omprehensi)e relationship between theortho ontist an en o ontist is important toensure goo results when en o onti$-treateteeth in)ol)e in ortho onti$ treatment so the$on ition o' the tooth $an be $ontrolle !

Daftar Pustaka

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Daftar Pustaka

1!+sgeir "ugur sson!

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THAN/ @OU