•vsi as' l ndodomic lull -...
TRANSCRIPT
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
7462701 / (0361) 7424079 Email: [email protected]
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.
3.
4.
5.
6.
7.
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.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
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.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
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.
66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
10
NON-SURGICAL TREATMENT OF MAXILLARY INCISIVE WITH
RADICULAR CYST SUSPECT: CASE REPORT
Rizky Amalia1, Anggraini Margono2 1Resident of Conservative Dentistry Department, Universitas Indonesia, Jakarta, Indonesia 2Lecturer of
Conservative Dentistry Department, Universitas Indonesia, Jakarta, Indonesia
Corresponding E-mail: [email protected]
ABSTRACT
Background: Radicular cyst is the most common odontogenic cyst found on maxillae.
Objective: To report the non-surgical treatment for radicular cyst on maxillary incisive.
Case: Patient, woman, 25 years old, come to undergo endodontic treatment on her upper
left central incisor. Patient had a motorbike accident 11 years ago and complained about
her discolored tooth. Clinical and radiographic examination indicated radicular cyst. Next
step is the non-surgical treatment including elimination of the necrotic pulp tissue,
drainage, and usage of 2,5% NaOCl and 17% EDTA for irrigation and Ca(OH)2 for
intracanal medication between visits. Periodic evaluations conducted at one month and
three months after the root canal obturation. Conclusion: On the 4th month of evaluation,
radiographic examination showed healing in the periapical tissue. Radicular cyst can be
cured with non- surgical treatment by eliminating the infected pulp tissue and adequate
drainage.
Keywords: radicular cyst, Non-surgical treatment, Ca(OH)2
INTRODUCTION
A radicular cyst is generally
defined as a cyst arising from epithelial
residual (cell of Malassez) in the
periodontal ligament and is believed to
proliferate as a consequence of inflam-
mation, usually following the necrosis of
the pulp.(1,2)Radicular cyst is the most
common odontogenic cystic lesion
affecting the jaws, mostly on the maxillae.(1-
5)and comprise about 52% to 68% of all the
cysts affecting the human jaws.(1,5,6)The
radicular cyst could occur after physical,
chemical, or bacterial injury.(3)Their
prevalence is highest among patients in
their third to fifth decade of life, and higher
among men
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
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
than women.(1,4,5)Most of the radicular
cysts are symptomless and are discovered
when radiograph are taken on discolored
teeth or when patients complaint about a
swelling.(5)
It is not yet well-established
whether the treatment of radicular cysts
should be non-surgical or surgical.The
choice of treatment may be determined by
some factors such as extension of the
lesion, relation with noble structures,
origin, clinical characteristics of the lesion,
cooperation and systemic condition of the
patient.(5,7,8). Some authors stated that if the
endodontic infection is eliminated, the
immune system is able to promote lesion
repair. While other believe that surgical
treatment is necessary.(2,6,9)We can
conclude that the non-surgical treatment is
for single odontogenic cyst but surgical
treatment indicated for big and/or for cyst
on multiple teeth to prevent the cyst from
recurrent.(2,6,9-11)
The case of radicular cyst can be
successfully treated with non-surgi- cal
treatment, in this case is a conventional
endodontic treatment. By paying attention
to adequate drainage, elimination of
infected or necrosis pulp tissue and the use
of correct irrigation and root canal
medication, such as 2.5% NaOCl and 17%
EDTA andCa(OH)2.
Ca(OH)2is a widely used material in
endodontic treatment because its excellent
bactericidal and remineralization
effects.(12)Patient’s systemic condition also
affecting the healing process of radicular
cyst.(6)Further evaluation is done
periodically to see the healing process.
In this article, a case of non-sur-
gical treatment with calcium hydroxide on
radicular cyst suspect is reported.
OBJECTIVE
This article will report the non-
surgical treatment for radicular cyst
suspect on maxillary incisive.
CASE AND MANAGEMENT
A 29 year-old female patient came
to Conservative Clinic, Faculty of
Dentistry, Universitas Indonesia. She had
discoloration on her upper left maxillary
incisive since few years ago. Eleven years
ago she had a motorbike accident. She
claimed that she have no pain, but she felt
disturbed with the tooth’s color. She want
that tooth to be treated.
Intraoral clinical examination
revealed that tooth 21 had greyish dis-
coloration but no defect. Pulpal necrosis
was confirmed with cold sensitivity test,
and tender on percussion. The
13
radiographic examination showed the
presence of a roundradiolucent lesion on
the apex of tooth 21, with approximately
> 1 cm diameter and well-defined
sclerotic border.
The differential diagnosis is ra-
dicular cyst suspect et causapulp necrosis
(Figure 1). The definitive diagnosis of the
type of a periapical lesion can only be
made by a histological examination.
However, a preliminary clinical
diagnosis of a radicular cyst is reasonable
if all of the following condition exist: (i)
the periapical lesion involves one or more
teeth with necrotic pulps; (ii) the lesion is
greater than 200 mm2
in size; (iii) a straw-colored fluid is
produced upon aspiration or on drainage
through an access; and (iv) the fluid
contains cholesterol crystals (Eversole
1984)(2,12)
In the present study, the radio-
graph revealed that the tooth 21 had a
round, well-defined radiolucency with +
210 mm2 size. Aspiration of the fluid
sample from inside the canal itself was
simple to carry out, as the teeth had an
adequate drainage through the access of
the canal. Upon observing these findings,
a presumptive diagnosis of a radicular
cyst can be made.
There are 2 types of radicular
cysts: (i) ‘true’ cysts are those containing
cavities completely enclosed by epithelial
lining; and (ii) ‘pocket’ or ‘bay’ cysts are
those containing epithelial-lined cavities
that are open to the root canals (Simon
1980 & Nair et al. 1996).(1,6)
The treatment plan in this case is
non-surgical treatment. According to
Simon (1980) and Nair et al. (1996) As the
lumen of a ‘bay’ or ‘pocket’ cyst is open
to the root canal, it is likely to heal after
non-surgical treatment due to the
removal of intracanal irritants.(2,12) It is
not possible to distinguish between ‘true’
cyst or ‘pocket/bay’ cyst through
radiographic examination.(1,6) However,
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
(c.)
Figure 1. (a.) Clinical pre-operative photo.
The crown is intact but the grayish
discoloration is visible. (b) Radiographic
pre-operative. It showed round, well-
defined radiolucency on the apex of tooth
21. (c) Labial gingiva is slightly swelling
and reddish.
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
‘true’ cyst have a low prevalence rate of
10%. The majority of the cysts are
‘pocket/bay’ cysts. Thus, removal of the
etiological agent from root canal system
via non-surgical therapy creates a favorable
environment for repair of the lesion and it
has been accepted as the first line of
treatment.(6,11)Many studies have reported
that radicular cyst can respond well to non-
surgical treatment. (2,6,9-11)
Once the diagnosis is made, the
operator performed the access opening on
the palatal to reach the pulp chamber. After
the measurement of working length with an
apex locator PropexPixi
(DentsplyMaillefer, Switzerland) and then
do the radiograph to confirm the working
length # 30/21 mm with a reference point
on the incisal edge (Figure 3a).
Furthermore, shaping the root
canal with ProTaper Hand Use
(DentsplyMaillefer, Switzerland) with a
lubricant RC-Prep (Premier® Dental
Products Company) 15%. Obtained
#F5/21mm as master cone. (Figure 3b).
2.5% NaOCl irrigation and apical patency
with a K-file #10 performed during and
after the instrumentation. Further
evaluation with periapical radiographs
photo to see the main cone, then flushed
with 2.5% NaOCl and
dried with paper points and intracanal-
medications Ca(OH)2(Calciplex®, Si- ka-
Nippon Yakuhin, Shimonoseki, Japan)
then sealed with temporary filling (GC
Caviton).
Figure 2.Cyst’s liquid aspiration: the
straw-colored fluid, which is the
cyst’s characteristic.
Ca(OH)2 is the gold standard root
canal medicaments in endodontic
treatment.(11,13-15)In an aquaeous solution,
Ca(OH)2 dissociates into calcium and
hydroxyl ions. Various biological
properties have been attributed to this
substances, such as antimicrobial activity
(Bystrmet al. 1985) and induction of repair
by hard tissue formation (Foreman &
Barnes 1990)(14)Root canal treatment
including Ca(OH)2as thein- tracanal
medicament resulted in 78,3% complete
healing of large periapical lesions, which
was in accordance with previously reported
results (Sjogrenet al. 1990; alikan&en
1996).(2)
Two important enzyme properties
of Ca(OH)2 are the activation of tissue
enzymes, such as alkaline phosphatase,
causing a mineralizing effect and the
inhibition of bacterial enzymes causing an
antimicrobial effect. Its high
15
pH (12.4-12.8) inhibits essential enzyme
activities: metabolism, growth and
cellular division. The influence of pH
alters the integrity of the cytoplasmic
membrane by biomechanical injury to
organic components (proteins,
phospholipids) and transport of nutri-
ents.(15,16,13,14)
The optimum pH value for the
activation for this enzyme ranges from
8.6 to 10.3, what makes the release of
organic phosphatase (phosphate ions)
which reacts with calcium ions from the
circulating blood easier, creating a
sediment of calcium phosphate on the
organic matrix.(15) The formation of
mineralized tissue after contact of
Ca(OH)2 with conjunctive tissue has been
observed from about 7th to 10th day.
On the next visit, the obturation
is performed with master cone #F5/21
mm and AH Plus (DentsplyMaillefer,
Switzerland) as the sealer. (Figure 3c)
Continued with internal bleaching and
direct composite restorations. (Figure
4) Periodic observation done on the 1st
and 3rd month after obturation. (Figure
5)
(b.)
Figure 4.(a.) Before(b.) 3 days after inter-
nal bleaching (c.) 3 weeks after internal
bleaching
16
Matsumatoet al. (1987) has
demonstrated that the prognosis for the
treatment of large periapical lesions is
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
(a.)
(c.)
Figure 3. (a.)
Initial file
#30/21mm
(b.) Master
cone #F5/21
mm(c.) Post-
obturation.
(a.)
Figure 5.Radiographic evaluation post-
obturation.
(a.) 27thJune 2016 (b.) 15th August
2016
17
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
not as good as that of small lesions. In
contrast, Strindberg (1956) and Sjgrenet al.
(1990) found no significant differences in
healing frequency between lesions initially
larger than 5 mm and those smaller than 5
mm.(2)
Wound healing is the programmed
tissue response to injury of a living
organism that involves complex cellular
and molecular biological processes (Clark
1996; Majno&Joris 2004; Kumar et al.
2009). Wound healing process can result in
repair or regeneration. Achieving the
reconstitute of the original structure and
biological function is the ultimate goal of
wound healing (Martin 1997).(17,18)
On cyst healing process, the cyst
have to regress before the regeneration of
periapical tissue. It is not known what
matrix serves as a scaffold for endothelial
cells, fibroblasts, and osteoblasts to migrate
into the lumen of regressing cysts after
non-surgical root canal therapy. Complete
regression of radicular cysts after non-
surgical root canal therapy could be due to
any of several possible scenarios.
(19)Regres- sion of radicular cysts, part of
the cystic lining epithelium could
disintegrate due to apoptosis of local
epithelial cells stimulated by cytotoxic T
cells.(2,19,20) Together with degradation of
the basal
lamina by matrix metalloproteinases
(MMP), this could allow a fibrous con-
nective tissue capsule to grow into the
lumen of radicular cysts. Eventually, the
cystic lining epithelium will completely
regress or become remnants of epithelial
cell rests remaining in the periodontal
ligament.(19)
The formation of bone tissue at the
apex of the tooth (the same as in other parts
of the body) 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
osteoprogenitor cells. Osteoprogenitor cells
accumulate, then BMP trigger
osteoprogenitor cells differentiation into
cuboidal shape osteoblasts and coating the
surface of bone, then produces osteoid,
which will be mineralized and transformed
into bone.(17)
The process of bone healing time
starts at week-10 and began to fill the bone
at week 15. Increased radi- opacity began
to be seen on the 38th and began to look
like the normal surrounding bone the 105th
day.(21)In this case it appears that the
radiographic evaluation of alveolar bone on
the 1st month is starting to heal
characterized by re-
18
duced radiolucency of the lesion. Later in
the 3rdmonth evaluation also seen a healing
process that is still ongoing.
CONCLUSION
Radicular cyst can be successfully
treated with non-surgical treatment. In this
case, the cyst healed after the non-surgical
treatment using Ca(OH)2(calcium
hydroxide) as intracanal medicament.The
patient was evaluated on the first and fourth
month after the first Ca(OH)2 application
and showed the healing process by radio-
graphic regression of the lesion.
REFERENCES
1. Nainani P, Sidhu GK. Radicular
Cyst -An Update with emphasis on
Pathogenesis. J Adv Med Dent Scie Res.
2014;2(3):97- 101.
2. Caliskan MK. Prognosis of large
cyst-like periapical lesions following
nonsurgical root canal treatment : a clinical
review. Int Endod J. 2004;37:408-16.
3. Tak O, Yilmaz S, Ozel E, Kavak M.
Five Year Clinical Follow Up of a Patient
with Radicular Cyst in the Maxillary Ante-
rior Region. Eur J Prosthodont. 2016;4:17-
21.
4. Khan AU, Qayyum Z, Farooq MU.
Characteristics and Etiology of Radicular
Cyst — A Study. Pakistan Oral Dent J.
27(1):97- 102.
5. Kr H, Vk V, Deepa C. Radicular cyst
: A case report. Int J Appl Dent Sci.
2015;1(4):20-2.
6. Chaudhary S, Tripathi P, Upad-
haya Y, Seth P. Successful non- surgical
management of a large radicular cyst: A
case report with review of literature. Int J
Con- temp Dent Med Rev. 2015;4-7.
7. Domingos P, Jr R, Gon9alves ES,
Neto ES. Surgical Approaches of Extensive
Periapical Cyst : Considerations about
Surgical Technique. Salusvita, Bauru.
2004;23(2):317-28.
8. Azad A, Chourasia HR, Singh D,
Sharma I, Azad A, Pahla- jani V.
Management of a Large Periapical Cyst : A
Case Report. 2014;7(1).
9. Bansal R, Khursheed I, Bansal T.
Review Article Endodontic Management of
a Periapical Cyst- A Review. J Adv Med
Dent Scie Res. 2013;1(1):7-16.
10. Penumatsa NV, Nallanchakra- va S,
Muppa R, Dandem- pally A, Panthula P,
Report
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
19
PROSIDING SEMINAR ILMIAH INTERNASIONAL IKATAN
KONSERVASI GIGI INDONESIA ASEAN
ENDODONTIC CONGRESS (AEC) 2016
"Getting to The Roots of Endodontic Towards Asean Economic Community"
C. Conservative Approach in the
Management of Radicular Cyst in a
Child : Case Report.
2013;2013(Figure 1):2—5.
11. Valois CRA, Costa-junior ED.
Periapical Cyst Repair After
Nonsurgical Endodontic Therapy -
Case Report. Braz Dent J.
2005;16(3):254-8.
12. Bansal R, Khursheed I, Bansal
T. Endodontic Management of a
Periapical Cyst - A Review. J Adv
Med Dent Scie. 2013;1(1):7—16.
13. Kim D, Kim E. Antimicrobial Effect of
Calcium Hydroxide as an Intracanal
Medicament in Root Canal
Treatment : a Literature Review -
Part I . In Vitro Studies. Restor Dent
Endod. 2014;7658:1-12.
14. Jr JFS, Lopes HP. Mechanisms of
Antimicrobial Activity of Calcium
Hydroxide : A Critical Review. Int
Endod J. 1999;32:361-
9.
15. Calcio HDE, Baseado E, Evidences
EM. Calcium Hydroxide: Study
Based on Scentific Evidences. J Appl
Oral Sci. 2003;11(4):269-82.
16. Metzger Z, Basrani B, E. Good H.
Cohen’s Pathway of the Pulp 10th
Edition. Instruments, Ma
terials, and Devices. Elsevier
Mosby; 2011. p. 253-4.
17. Lin LM, Rosenberg PA. Repair and
Regeneration in Endodontics. Int
Endod J. 2011;44:889- 906.
18. Polimeni G, Xiropaidis A V., Wikesjo
UME. Biology and Principles of
Periodontal Wound Healing /
Regeneration. Peri- odontol 2000.
2006;41(24):30- 47.
19. M. Lin L, T-J Huang G. Cohen’s
Pathway of the Pulp 10th Edition.
Pathobiology of Periapeks. Elsevier
Mosby; 2011. p. 52954.
20. Lin LM, Huang GT-J, Rosenberg PA.
Proliferation of Epithelial Cell Rests,
Formation of Apical Cysts, and
Regression of Apical Cysts after
Periapical Wound Healing. J Endod.
2007;33(8):908-16.
21. Pagni G, Pellegrini G, Gi-
annobile W V, Rasperini G.
Postextraction Alveolar Ridge
Preservation : Biological Ba
sis and Treatments. Int J Dent.
2012;2012:1-13.
20