Bikuspidisasi dan restorasi gigi molar satu kiri mandibula nekrosis pupa dengan lesi bifurkasi

SETYAWATI, Any, drg. Hj. Daniyah HS., Sp.KG

2006 | Tesis | PPDGS I Konservasi Gigi

Laporan kasus ini bertujuan mengetahui prosedur bikuspidisasi dan restorasi gigi molar satu kiri mandibula nekrosis pulpa dengan lesi bifurkasi sehingga gigi dapat dipertahankan dalam mulut, dan mengembalikan fungsi gigi. Penderita wanita 21 tahun datang ke klinik konservasi FKG UGM dengan keluhan gigi molar satu kiri mandibula pernah sakit 1 minggu yang lalu. Pemeriksaan objektif terdapat kavitas di oklusolingual, pulpa terbuka. Sondasi, palpasi, tes vitalitas, dan mobilitas semuanya negatif, perkusi positif. Pemeriksaan radiograf telah terjadi resorpsi tulang di bifurkasi tampak sebagai area radiolusen di bifurkasi diameter ± 4 mm, dan sedikit radiolusen jaringan periapikal akar distal. Probing dapat masuk ke furkasi ± 2 mm. Diagnosisnya adalah kavitas kelas I oklusolingual nekrosis pulpa dengan lesi bifurkasi derajat II tingkat 1. Perawatan gigi tersebut yaitu perawatan saluran akar, bikuspidisasi, dan restorasi mahkota penuh porselin fusi metal dengan penguat pasak tapered serrated (unimetric) dan inti resin komposit. Dua puluh sembilan hari pasca perawatan saluran akar tidak ada keluhan, dilakukan bikuspidisasi. Pada bikuspidisasi dilakukan insisi, pembuatan flap regio bukal gigi molar satu kiri mandibula, kuretase bifurkasi, pemotongan dari oklusal mahkota ke bifurkasi teknik vertikal arah bukal lingual hingga membelah gigi menjadi 2 bagian mesial dan distal. Flap dijahit, dan luka bekas operasi ditutup periodontal pack. Hasil kontrol 6 minggu pasca bikuspidisasi, radiolusen berkurang, selanjutnya dilakukan pemasangan pasak, pembuatan inti, dan preparasi tonggak berbentuk 2 premolar. Hasil restorasi akhir adalah mahkota penuh porselin fusi metal berbentuk 2 premolar yang menyatu

The aim of this case report is to inform the procedures of bicuspidization and restoration of mandibular left first molar with pulp necrosis and bifurcation lesion to restore tooth function. A 21 year-old female patient was referred to Conservative Dentistry Clinic Gadjah Mada University, who suffered painful symptom in her mandibular left first molar. Objective examination showed an occluso-lingual cavity with opened pulp, no response to vitality test, percussion, palpation, and mobility were negative. Preoperative radiograph indicated the presence of radiolucency on bifurcation which means alveolar bone resorption with diameter 4 mm. There was also found small periapical radiolucency of distal root. On probing of gingival sulcus of furcation, it extended 2 mm deep. The diagnosis was class I occlusolingual cavity, pulp necrosis with bifurcation lesion degree II level 1. The treatment included root canal treatment, bicuspidization, restoration using porcelain fused to metal crown with tapered serrated dowel (Unimetric) and resin composite core. The result showed that 29 days after root canal treatment the tooth was painless. The bicuspidization was then perfomed under local anesthetic via standard buccal approach, bifurcation was curetted, and the crown separated bucco-lingually using vertical technic. The flap was sutured and periodontal pack was placed. Six weeks after bicuspidization, the radiolucency developed more opaque. The tooth was prepared as two cores and restored as two bicuspids with attached proximal contact.

Kata Kunci : Bikuspidisasi,Nekrosis Pulpa,Lesi Bifurkasi, Bicuspidization, pulp necrosis, bifurcation lesion