Perawatan saluran akar teknik kombinasi crown-down dan passive stepback disertai restorasi resin komposit pada gigi kaninus kanan maksila nekrosis pulpa dengan akar panjang dan bengkok

SUSILO, Ivan Tirta, drg. Endang R, M.Kes.SpKG(K)

2009 | Tesis | S2 PPDGS 1-Ilmu Konservasi Gigi

Tujuan penulisan laporan kasus ini ootuk menginfonnasikan hasil evaluasi perawatan saluran akar dengan teknik preparasi kombinasi crown-down dan passive step-back disertai restorasi resin komposit dengan inti pasak resin komposit pada gigi kaninus kanan maksila nekrosis pulpa akar panjang dan bengkok dalam mengembalikan fungsi gigi. Pasien pria 35 taboo ingin merawat gigi kaninus kanan atas yang kadangkadang terasa sakit sewaktu mengunyah makanan sejak 3 minggu terakhir. Diagnosis gigi nekrosis pulpa disertai lesi periapikal, radiograf panjang akar 31 mm dan pembengkokan sepertiga apikal. Prosedur perawatan saluran akar preparasi teknik kombinasi crown-down menggunakan ProTaper Hand Use 81 sampai F3 dari titik referensi sampai batas pembengkokan saluran akar, panjang keIja sementara 25 mm, dilanjutkan teknik passive step-back menggunakan K-file # 15 sampai dengan # 55 panjang 31 mm yang telah dibengkokan terlebih dahulu menggunakan flexobend (Dentsply) panjang keIja 31 mm. IAF K-jile # 20, MAF # 35 panjang keIja 31 mm. Kfile terakhir # 55 panjang kerja 25 mm. Pengisian saluran akar teknik kondensasi vertikal dengan bantuan system B. Pengisian sepertiga apikal guttaperea nomor 35 (MAF) dan siler resin (I'op8eal) dimasukkan ke dalam saluran akar sesuai panjang keIja, kemudian guttaperca dipotong dari batas pembengkokan ke arah insisal kemudian dipadatkan menggunakan plugger system B ukuran keeil. Pengisian duapertiga koronal saluran akar menggunakan gutaperea khusus ProTaper F3, yang diukur ulang diameter ujung gutaperca menggunakan endo gauge, dipotong hingga diameter ujung gutaperca sebesar 0.55 mm. Gutaperca dimasukkan ke dalam saluran akar dari titik referensi sampai batas pembengkokan yaitu 25 mm. Gutaperea tarnbahan dimasukkan pada ruang bagian lateral yang dibentuk denganfinger plugger sampai penuh, dipotong 2 mm dari oritis ke arab apikal, dipadatkan menggooakan plugger system B. Gutaperca diambil sepanjang 5 mm dari oritis ke apikal, kemudian pasak resin komposit aktivasi kimiawi (Coremax - Dentsply-Sankin)dimasukkanke dalam saluran pasak sampai kamar pulpa sepanjang duapertiga korona sebagai inti. Restorasi kavitas bagian disto-palatal menggunakan resin komposit aktivasi sinar AJ. Evaluasi tiga bulan pasea perawatan tidak ada keluhan rasa sakit, perkusi, palpasi negatif, dan gigi dapat berfungsi nonnal. Gambaran radiografis periapikal pengisian saluran akar hennetis, gambaran radiolusen mengecil.

The purpose of this case report was to infonned the evaluation result of root canal treatment using combination technique preparation crown-down and passive step-ba~k with composite resin restoration and composite resin post core to restore tooth function on maxillary right caninuspulp necrosis with long and curve canal A 35 years old male patient wants to getting a treatment on his maxillary right caninus, that feels pain when chewing food on the last three weeks. The diagnosis was pulp necrosis with periapical lession, based on preoperative radiographic showed length of the tooth is 31 rom and there is curvature in apical third. The procedures of combination technique preparation was initiated with crown-down technique using ProTaper Hand Use S1 until F3 from reference point to curvature point, the estimated working length is 25 rom, continued with passive step-back technique using a 31 rom no.15 to no.55 K-files, that had been bent withjlexobend (Dentsply), working length 31 rom. IAF no.20 K-file, MAF no.35 K-file, working length 31 rom. The last K-file is no.55, working length 25 rom. The obturation using vertical condensation technique using system B. The obturation of apical third using standarized guttap-percha no. 35 (MAF) and resin sealer (TopSeal), that inserted in root canal to within curvature point and excess gutta-percha is seared off and compact it with system B plugger. The obturation of coronal two-thirds used F3 protaper gutta-percha point, that the guttapercha tip diameters had beed resizing to 0.55 rom using endo gauge. Gutta-perca inserted in root canal from reference point to curvature point (25 rom). The measured accessory gutta-percha cone is immidiately inserted into the lateral space that created by finger spreader until root canal fully obturated, excess gutta-percha is seared off about 2 mm nom orifice to apical, and compact it with system B plugger. Gutta-percha removed 5 mm from orifice to apical using peeso reamer. then chamically resin composite(Coremax- Dentsply-Sankin)insertedinto root canal to makea post until coronal two-thirds in pulp chamber as core. Restoration of disto-palatal cavity using light cured resin composite A3. The result of evaluation on three months after treatment showed no pain, no respone on percussion and palpation, and tooth function can be restored. Periapical radiographic evaluation showed hennetic obturation, and the size of radiolucency is reducing.

Kata Kunci : Perawatan saluran akar,Preparasi teknik kombinasi teknik crown,down dan passive step,back,Akar panjang dan bengkok,Restorasi resin komposit,root canal treatment, preparation combination technique crown-down and passive step-back, long and curve root, comp