Perawatan Endodontik Pada Gigi yang Terkena Trauma

 

• Trauma pada gigi akan melibatkan pulpa secara langsung maupun tidak langsung, karena itu perlu pertimbangan perawatan endodonsia pd gigi tsb.
• Trauma gigi paling sering terjadi pd usia 8-12, kemudian usia 2-3 thn.
• Boys tend to injure their teeth more frequently than girls, by ratios varying from 2:1 to 3:1.
• Maxillary central incisors, followed by maxillary lateral incisors and then the mandibular incisors, are the teeth most frequently involved.
• The most commonly observed dental trauma involves fracture of enamel, or enamel and dentin, but without pulp involvement.

Klasifikasi

• WHO Classification of diseases and modified by Andreasen

  • Dentofacial Injuries
  • Soft Tissue
  • Tooth fracture
  • Luxation injuries
  • Facial skeletal injuries

• WALTON (based on Andreasen's modification)

  • Enamel Fracture
  • Crown fracture
  • Crown-root fracture
  • Root fracture
  • Luxation
  • Avulsion
  • Fracture of the alveolar process (mandible of maxilla)

  

• Klasifikasi Ellis

  • Klas 1: Fraktur email
  • Klas 2: Fraktur dentin tanpa terbukanya pulpa
  • Klas 3: Fraktur mahkota dgn terbukanya pulpa
  • Klas 4: Fraktur akar
  • Klas 5: Luksasi gigi
  • Klas 6: Intrusi gigi

• Pemeriksaan cedera dental

  • keluhan utama
  • riwayat penyakit sedang diderita
  • riwayat medis dan pemeriksaan klinis (jar. lunak, tulang muka juga gigi dan jaringan penyangga)

• Cedera Jaringan Lunak

  • Injuries to oral soft tissues can be lacerations, contusions, or abrasions of the epithelial layer or a combination of injuries.
  • If treatment is indicated, it consists of controlling bleeding, repositioning displaced tissues, and suturing.
  • Oral soft tissues heal rather quickly

Fraktur Gigi

• FRAKTUR EMAIL

  • Tidak berbahaya utk pulpa, prognosis baik.
  • Hanya perlu grinding n smoothing pd tepi yg tajam atau merestorasi struktur yg hilang.
  • Pulp vitality tests should be performed both immediately after the injury and again in 6 to 8 weeks.
  • It must be kept in mind that, even with minor traumatic injuries, such as enamel fractures, damage to the apical neurovascular bundle may have occurred.

• FRAKTUR MAHKOTA DGN PULPA BELUM TERBUKA (uncomplicated)

  • Biasanya tidak tdpt nyeri parah, umumnya tidak memerlukan perawatan segera.
  • Noted: proximity of the fracture to the pulp, surface area of dentin exposed, age of the patient, concomitant injury to the pulp’s blood supply, length of time between trauma and treatment, and possibly the type of initial treatment performed.Kedekatan fraktur ke pulpa, luas permukaan dentin yang terpapar, usia pasien, bersamaan dengan pasokan darah pulpa, lamanya waktu antara trauma dan perawatan, dan mungkin jenis perawatan awal yang dilakukan.
  • Prognosis baik, kec disertai luksasi.

  

  Restored crown fracture that does not involve the pulp directly. Exposed dentin is covered with a hard-setting liner followed by restoration of the missing tooth structure using acid-etched bonded resin.

• FRAKTUR MAHKOTA DGN PULPA TERBUKA (Complicated)

  • Melibatkan email, dentin dan pulpa.
  • The extent of fracture, the stage of root development, and the length of time since injury are noted.
  • Terapi:
  • TREATMENT EVALUATION AFTER 6 MONTHS AND THEN YEARLY.

• FRAKTUR MAHKOTA-AKAR

  • Enamel, dentin, and cementum are involved. If the pulp is also involved, the case is considered more complicated.
  • Pd gigi anterior: chisel-type fracture, dgn garis fraktur diagonal meluas ke subgingiva s/d ke permukaan akar.

  

  • Another variation is the fracture that shatters the crown.

  

  • Crownroot fractures often include the molars and premolars. Cusp fractures that extend subgingivally are common.

  

  Crown-root fracture with pulp exposure.

  A, Note loose mesial crown fragments, which are attached by periodontal ligament fibers.

  B, After anesthesia, loose fragments are removed and rubber dam applied. Note exposure of radicular pulp (arrow). C,The remainder of coronal pulp tissue is amputated and the surface of pulp allowed to coagulate. Cotton pellet (CP) aids by controlling initial bleeding. D, After surface coagulation, the area is irrigated and calcium hydroxide placed directly over pulp tissue. It helps to prepare a shelf around the pulp orifice to support the base and prevent the cement from being pushed into the underlying pulp tissue (arrows point to shelf in dentin).

  E, After placement of base, acid-etched composite will be used for final restoration.

• FRAKTUR AKAR

  Disebut juga: fraktur akar intraalveolus, fraktur akar horisontal, fraktur akar transversal. Jarang terjadi (3%) dan sukar dideteksi.

  

  • Stabilization of root fractures with a mobile coronal segment.
  • Successful treatment of pulp necrosis in a root-fractured incisor with root canal filling of coronal fragment.
  • Root fracture treated by root canal therapy of both apical and coronal fragments.

• CEDERA LUKSASI

  • Causa:

  ● Dpt menimbulkan trauma pd jar penyangga gigi dan mempengaruhi pasokan darah, saraf ke pulpa.

  • Concussion
  • Subluxation
  • Extrusive Luxation
  • Lateral Luxation
  • Intrusive Luxation

  

  Luxation injuries. A, Subluxation: the tooth is loosened but not displaced. B, Extrusive luxation: the tooth is partially extruded from its socket. Occasionally this is accompanied by an alveolar fracture. C, Lateral luxation: the crown is displaced palatally and the root apex labially. D, Intrusive luxation: the tooth is displaced apically.

  

• Tooth Avulsion

  • Gigi yg telah keluar seluruhnya dari soket.
  • misc
  • Medium Menyimpan
  • First Aid for Avulsed Teeth
  • Replantation

• Guidelines for Replantation

  Ideally, if an avulsed tooth can be replanted at the site of injury, the prognosis is better than waiting until the patient is transported to a treatment facility. The following advice can be given over the telephone to someone able to assist the victim:

  1. Rinse the tooth in cold running water. The purpose is to rinse off any obvious debris that may have collected on the root surfaces.
  2. Do not scrub the tooth. The less the root surface is touched, the less damage to fibers and cells. Suggest that the person applying these first-aid measures handle the tooth by holding on to the crown of the tooth and not the root.
  3. Replace the tooth in the socket.Many individuals, even parents, may be squeamish about this step. A relatively easy way out is for the first-aid person to place the tooth, root tip first, partly into the socket, then let the patient bite down gently on a piece of cloth such as a handkerchief to move the tooth back into its normal, or nearly normal, position.
  4. Bring the patient to the dental office right away to complete the treatment of replantation.

ONE VISIT ENDODONTIC

• INDIKASI

  ● Gigi vital uncomplicated

  ● Uncomplicated non vital teeth with sinus tract (fistula)

  ● Pasien yang sibuk dan mempunyai waktu terbatas untuk datang ke klinik gigi

  ● Tidak dibawah pengaruh obat seperti antibiotik prophylaxis

  ● Fraktur anterior yang membutuhkan estetik segera

  ● Pasien yang kooperatif

  ● Tidak dalam keadaan sakit atau akut

• KONTRA INDIKASI

  ● Abses alveolar akut dengan pus

  ● Saluran akar yang rumit

  ● Periodontitis apikalis dengan nyeri severe pada perkusi

  ● Gigi non vital nyeri tanpa sinus tract

  ● Kasus dengan kesulitan prosedur seperti kanal yang terkalsifikasi, curvature, ekstrakanal, dll

  ● Pasien dengan gangguan TMJ dan sulit membuka mulut

  ● Gigi dengan akses terbatas

  ● Kasus retreatment non surgical

• KEUNTUNGAN

  ● Dokter gigi mempunyai kewaspadaan yang tinggi terhadap anatomi saluran akar secara langsung setelah instrumentasi

  ● Tidak ada resiko kehilangan tanda-tanda(landmark)

  ● Saluran akar tidak pernah lebih bersih selain setelah instrumentasi yang sesuai

  ● Tidak ada resiko flare-up karena kebocoran tumpatan sementara

  ● Gigi lebih cepat untuk restorasi final sehingga mengurangi resiko pencabutan karena fraktur

  ● Kegelisahan/ketidaknyamanan sebelum dan setelahperawatan terbatas hanya satu kunjungan

  ● Waktu hemat untuk pasien dan dokter gigi

• KERUGIAN

  ● Ketidakmampuan untuk mengeringkan saluran akar sepenuhnya

  ● Waktu yang tidak cukup untuk menyelesaikan prosedur

  ● Kemungkinan peningkatan tekanan otot TMJ atau tekanan psikis pasien atau dokter gigi

• Evaluasi keberhasilan perawatan

  ● Tidak ada rasa nyeri

  ● Hilangnya fistel

  ● Fungsi tetap baik

  ● Tidak ada tanda kerusakan jaringan

  • *respon pulpa: 2-3 minggu

Tambahan dari Miw

• An open apex is in the developing root of immature teeth until apical closure occurs, which is approximately 3 years after eruption. In

• Apexogenesis

  —apexogenesis (vital pulp therapy)

  is defifi ned as a vital pulp therapy procedure

  performed to encourage continued physiologic develop

  ment and formation of the root end. The objective is to

  maintain the vitality of the radicular pulp. Therefore the

  pulp must be vital and capable of repair, which is often

  the case when an immature tooth sustains a small coronal

  exposure after trauma. A small exposure can be treated

  by pulp capping. The steps involved in pulp capping and

  apexogenesis with MTA

• apeksifikasi-apexification (root-end closure).

  Apexififi cation is the induction of a calcififi c barrier (or the

  creation of an artififi cial barrier) across an open apex.

  Apexififi cation involves removal of the necrotic pulp fol

  lowed by debridement of the canal and placement of

  an antimicrobial medicament (Figure 2-15). In the past,

  much emphasis has been placed on the type and proper

  • obat