DEFINISI : Operative Dentistry :

Adalah art and science suatu diagnosis, perawatan Adalah art and science suatu diagnosis, perawatan dan prognosis dari pada kerusakan gigi yang tidak memerlukan koreksi berupa full coverage restoration.

Hasil restorasi akan mengembalikan bentuk morphologi gigi, fungsi dan estetik sehingga morphologi gigi, fungsi dan estetik sehingga mempertahankan hubungan fisiologis yg harmonis dengan jaringan sekitarnya, yg tentunya akan mengembalikan kesehatan umum penderita.

Modern Operative Dentistry :

Diagnosis and treatment of many problems, not just caries

FILLING RESTORATIONFILLING RESTORATION

a. Obtain information about the patients medical a. Obtain information about the patients medical ..

Diagnosis:Diagnosis:

and dentaland dental historieshistories..

b. Ask pointed opened subjective questions about b. Ask pointed opened subjective questions about the patients pain:the patients pain:--> > History, location, severity, duration, History, location, severity, duration, character & eliciting stimuli.character & eliciting stimuli.character & eliciting stimuli.character & eliciting stimuli.

c. Perform an extra oral examination.c. Perform an extra oral examination.

d. Perform an intraoral d. Perform an intraoral examinationexamination..

Diagnosis:

d. Perform an intraoral d. Perform an intraoral examinationexamination..

e. Use e. Use palpation and percussion sensitivitypalpation and percussion sensitivity tests to tests to determine periapical status.determine periapical status.

f. Perform a f. Perform a pulp testingpulp testing examination.examination.

g. Interpret g. Interpret appropriate radiographsappropriate radiographs..

Riwayat Dental

Keluhan utama Alasan utama pasien datang ke klinik : lokasi gigi Alasan utama pasien datang ke klinik : lokasi gigi

Riwayat gigi terlibat

Gejala Subyektif

Keadaan saat ini dengan mengajukan pertanyaan pada penderita yang jelas dan terarah

Dokter gigi menanyakan pada penderita dengan suatu pertanyaan.suatu pertanyaan.

Pemeriksaan Objektif

Pemeriksaan oleh drg pada jaringan extra oral dan intra oral

Extra oral examination

Palpation test

Palpation of the submandibular lymph nodes. The clinician is positioned behind the patient and palpates the nodes gently with finger tips.

External sinus tract

INTRAORAL EXAMINATION

The buccal surface of the root is palpated inthe vestibule, and the patient is asked about any sensitivity.

Palpation of the palate follows the course ofthe root surfaces and adjacent tissues.

Internal sinus tract

Vitality test

Cold tests

- Cold tests are the most predictive. - Cold tests are the most predictive.

- Any exact differentiations between clinically healthy pulp, reversible pulpitis, or irreversible pulpitis is, however, usually not possible using this test alone

Heat tests

Application of Heat Expansion & movement of Dentinal fluid Increase in intrapulpal Pressure Increase in intrapulpal Pressure

Electric Pulp Testing

A

BC

DThe electrical sensitivity test is simple and reliable.The electrical sensitivity test is simple and reliable.The tooth surface must be dry. The end of the pulp tester probe must be moistened, e.g., with toothpaste. Using the device with rubber gloves can lead to false readings because of the insulation. Simplest is to permit the electrical circuit to close when the metal portion of an instrument handle contacts the clinicians hand.

Percussion sensitivity of a tooth is a sign ofthe presence of periapical inflammation.

Root fractures can also be detected by percussion Root fractures can also be detected by percussion or by the biting test.

The vital percussion test should also always be performed on the adjacent teeth for comparative purposes.

Cavity test

Cavity test : the last test Rationale : If the pulp is necrotic, the patient will not feel Rationale : If the pulp is necrotic, the patient will not feel

anything

Miller testMiller test

Pain

Elicited by thermal stimuli or referred

On mastication/tooth contact and well localizedPulpal

Peri-radicularThrobbing constant reacts to heat Dull short reacts to

cold&sweets

Irreversible pulpitis Reversible pulpitis

A.Pulpitis

Diagnosa klinik

A.Pulpitisi. Reversible pulpitis.ii. Irreversible pulpitis.

B.Pulp necrosisi. Without swelling.i. Without swelling.

ii. With swelling.

Reversible pulpitis:

It is a condition in which the patient is complaining of

sharp pain at specific site ,elicited by cold drinks.

ii. Irreversible pulpitis:

The patient is complaining of pain

Throbbing.

Of long duration.

Worsen at night.

With hot stimuli.

Throbbing.

Not relieved by analgesics.Not relieved by analgesics.

A-Pulp necrosis without swelling:

-These teeth may contain:

Vital inflammed tissues in the apical canal and have inflammed painful periradicular tissues(acute apical peridontitis),

Also, the lesion may have expanded and formed an Also, the lesion may have expanded and formed an abscess that is confined to bone.

Pulp necrosis with swelling(acute apical abcess)

The tooth isThe tooth isNon-vital

Tender

Mobile

Generalized pain May be absent, However, in many patients pain may

Be present as a result of pressure. Therefore, Drainage will relief the pain

Menegakkan Diagnosis klinis melalui : Pengisian form rekam medik Pengisian form rekam medik

Riwayat kesehatan umum pasien Gejala subyektif maupun obyektif Pemeriksaan obyektif rongga mulut Oklusi dan artikulasi Riwayat dental ybs Riwayat dental ybs Vitalitas gigi Keadaan kelainan periapikal

Dalam form medik perlu dijelaskan pula : Keadaan gb skeamatis gigi sebelum dilakukan Keadaan gb skeamatis gigi sebelum dilakukan

perawatan Desain skematis preparasi gigi, maupun desain

akses kavitas bila dilakukan perawatan endo Gb skematis restorasi gigi yg akan dibuat Prognosis

Bila diperlukan dpt dilakukan pembuatan : mock-up / studi model mock-up / studi model Photography :

membandingkan before / after

ODONTOGRAM

Gambaran seluruh keadaan gigi pasien pada awal kedatanganawal kedatangan

Pendataan ulang dilakukan setelah ada perubahan pada data awal ,misalnya sesudah 1 tahun atau pd wkt kontrol

OKLUSI

oklusi didefinisikan sebagai kontak antara gigi- oklusi didefinisikan sebagai kontak antara gigi-geligi yang saling berhadapan secara langsung (tanpa perantara) dalam suatu hubungan biologis yang dinamis antara semua komponen sistem stomatognatik terhadap permukaan gigi-geligi yang berkontak dalam permukaan gigi-geligi yang berkontak dalam keadaan berfungsi.

MACAM OKLUSI

Ada 2 yaitu : Oklusi statis : Oklusi statis :

Hub geligi RA dan RB dlm keadaan tertutup dan tidak berfungsi (statik)

Oklusi dinamis : Hub geligi RA dan RB saat gerakan mandibula kelateral

maupun kedepan (antero-posterior)maupun kedepan (antero-posterior)

RELASI ANTERIOR

Ditentukan oleh : Tinggi gigit (overbite) Tinggi gigit (overbite) Jarak gigit (overjet) Umumnya 2mm.