Implan endodontik sebagai retensi restorasi mahkota jaket porselin fusi metal gigi insisivus sentralis kiri maksila fraktur mahkota pulpa nekrosis apeks terbuka

PURNAMA, Maria Angelina, drg. Endang Retnowati, M.Kes., SpKG(K)

2009 | Tesis | S2 PPDGS 1-Ilmu Konservasi Gigi

Tujuan laporan kasus ini untuk menginformasikan hasil evaluasi perawatan implan endodontik sebagai retensi restorasi mahkota jaket porselin fusi metal gigi insisivus sentralis kiri maksila fraktur mahkota pulpa nekrosis apeks terbuka. Pasien wanita berumur 21 tahun ingin merawat gigi depan kiri atas yang berubah warna serta lebih pendek dibandingkan gigi sebelahnya. Gigi tidak mengalami mobilitas, tes perkusi dan palpasi tidak sakit, tes vitalitas negatif. Pemeriksaan radiografis apeks masih terbuka. Diagnosis gigi 21 fraktur mahkota pulpa nekrosis apeks terbuka. Gigi 21 dilakukan perawatan saluran akar teknik konvensional circumferential filling menggunakan K File, Initial Apical File 120 panjang kerja 15 mm dan file terakhir 140. Digunakan dressing Ca(OH)2, ditumpat sementara, dilakukan preparasi tonggak, kemudian ditutup mahkota sementara. Obturasi tidak dilakukan karena implan endodontik dan siler digunakan sebagai bahan pengisi saluran akar. Bedah endodontik dilakukan untuk mengkuretase jaringan granulasi dan menghaluskan apeks gigi. Tulang periapikal dibur dengan pilot drill melalui saluran akar kemudian implan endodontik (Mini Dental Implant, IMTEC Co) panjang 18 mm lebar 1,8 mm dengan semen resin dimasukkan melalui saluran akar ke dalam tulang yang telah dibur. Mineral Trioxide Aggregate dan bonegraft diaplikasikan pada daerah apikal kemudian flap ditutup dan dijahit. Kepala implan dibentuk inti dengan resin komposit dan ditutup mahkota sementara. Jahitan dibuka 1 minggu kemudian dan setelah 1 bulan mahkota jaket porselin fusi metal dipasang dengan semen resin. Evaluasi 3 bulan pasca pemasangan implan tidak ada rasa sakit dan gigi dapat digunakan untuk mengunyah. Tes perkusi dan palpasi tidak ada rasa sakit. Tidak terdapat mobilitas gigi maupun oklusi traumatik. Jaringan gingiva di sekitar mahkota jaket normal. Pemeriksaan radiograf gambaran radiolusen pada apeks mengecil.

The purpose of this case report was to inform the treatment outcome using endodontic implant serves as a retaining porcelin fused to metal jacket crown on maxilarry left central incisor with crown fracture, necrotic pulp and open apex. A 21-year-old female want to treat her maxilarry left central incisor that has discoloration and shorter than the next tooth. The tooth had no mobility, no tenderness to percussion and palpation as well as no response to thermal test. Radiographic examination revealed that the apex remained open. The diagnosis was crown fracture, necrotic pulp, and open apex. Root canal treatment was conducted with conventional technique circumferential filling motion used K File, Initial Apical File 120, working length 15 mm and final size 140. Calcium hydroxide paste was used as dressing material before placement of temporary restoration. Tooth preparation was performed and followed by placement of temporary crown. Obturation was not conducted because endodontic implant and sealer was placed in the root canal. Endodontic surgery was performed and granulation tissue was curretaged. Pillot drill was used to make a hole and placed the endodontic implant (Mini Dental Implant, IMTEC Co) length 18 mm diameter 1,8 mm within periapical bone through root canal. Defect and void closure at periapical area utilized MTA and bonegraft followed by flap sutured. Head of implant and composite resin was used to establish core followed by placement of temporary crown. One week after, the suture was removed. One month after, porcelain fused to metal jacket crown was placed with resin cement. At the 3-month evaluation after implant insertion, patient had no dental complain and could chewed well. The tooth had no tenderness to percussion and palpation, no mobility and traumatic occlusion, as well as absence of gingival tissue inflamation around jacket crown. Radiographic examination demonstrated the size reducing of radiolucency at the apex.

Kata Kunci : Implan endodontik,Mahkota jaket porselin fusi metal,Pulpa nekrosis,Apeks terbuka, endodontic implant, porcelain fused to metal jacket crown, necrotic pulp, apen apex