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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

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    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;- [email protected] [email protected] 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 [email protected] i kerusakan sel-sel pa a tulang

    sehingga [email protected] 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

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    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