1.png)
* Corresponding Author
Root canal obturation with bioceramic sealer after apexification with calcium-hydroxide
https://doi.org/10.22146/mkgk.49226 Rahmiwati Rahmiwati(1*), Ema Mulyawati(2)
(1) Program Studi Konservasi Gigi Program Pendidikan Dokter Gigi Spesialis, Fakultas Kedokteran Gigi, Universitas Gadjah Mada, Yogyakarta
(2) Departemen Konservasi Gigi, Fakultas Kedokteran Gigi, Universitas Gadjah Mada, Yogyakarta
(*) Corresponding Author
Abstract
An open apex on necrotic pulp is a common clinical cases. This condition complicates the root canal treatment by the risk of extrusion and the risk of fracture due to the thin canal walls. The aim of this case report was to describe the procedure of calcium hydroxide and bioceramic sealer use in the treatment of an open apex. A 24 years old male patient came to Oral and Dental Hospital Prof. Soedomo, Yogyakarta, Indonesia to have a treatment on his left maxillary central incisor that was injured 10 years ago. There was no pain history on the related tooth. An examination on element 21 showed an Ellis class IV fracture, fistula, discoloration, negative thermal test Chlor Ethyl (CE) and a radiolucent area around an open apex. Treatments were including apexification, bleaching, and direct composite veneer with Fiber-Reinforced-
Composite post. Apexification was performed using calcium hydroxide for 3 + 3 months. After 6 months, a rather dense calcified material that was slightly shorter than the apex was observed. A checking procedure by inserting a file into the root canal showed that a hard tissue barrier had been formed. Obturation was then performed using bioceramic sealer. Bioceramic sealer was expected to strengthen the root against the risk of fracture, to continue the stimulation of tissue formation and to fill the remaining void left by apexification. Although Mineral Trioxide Aggregate (MTA) is widely use to replace calcium hydroxide, the classic material was proven to be suitable for the treatment of open apex. This is particularly useful because MTA is not always easy to obtain.
ABSTRAK
Apeks terbuka pada nekrosis pulpa merupakan kasus klinis yang sering dijumpai. Keadaan ini menyulitkan perawatan saluran akar karena risiko ekstrusi serta risiko fraktur pada dinding saluran akar yang tipis. Tujuan laporan kasus ini adalah menunjukkan penggunaan kalsium hidroksida dan siler biokeramik untuk perawatan kasus apeks terbuka. Pasien laki-laki 24 tahun datang ke RSGM Prof. Soedomo, Yogyakarta, Indonesia untuk merawat gigi insisivus sentralis kiri maksila yang terkena benturan karena jatuh 10 tahun yang lalu. Gigi tidak pernah dirasakan sakit. Pemeriksaan pada gigi 21 menunjukkan fraktur Ellis kelas IV, fistula, diskolorasi, tes termal dengan Chlor Ethyl (CE) negatif dan area radiolusen di sekitar apeks yang terbuka. Perawatan yang dilakukan meliputi apeksifikasi, bleaching, restorasi vinir direk
komposit dengan pasak Fiber Reinforced Composite. Apeksifikasi dilakukan menggunakan kalsium hidroksida selama 3 + 3 bulan. Setelah 6 bulan gambaran radiograf menunjukkan adanya bahan terkalsifikasi agak padat yang terletak sedikit lebih pendek dari apeks. Pengecekan dengan file dalam saluran akar menunjukkan sudah adanya barrier jaringan
keras. Selanjutnya obturasi dilakukan menggunakan siler biokeramik. Siler biokeramik diharapkan dapat memperkuat akar dari risiko fraktur, melanjutkan stimulasi pembentukan jaringan, serta mengisi rongga yang tidak tertutupi dengan apeksifikasi. Walaupun Mineral Trioksid Agregat (MTA) telah banyak menggantikan kalsium hidroksida, namun bahan
klasik ini terbukti dapat digunakan untuk merawat apeks terbuka. Hal ini terutama bermanfaat karena MTA tidak selalu mudah didapat.
Keywords
Full Text:
PDFReferences
1. Rafter M. Apexification: a review. Dent Traumatol. 2005; 21(1): 1-8.
2. Trope M, Barnett F, Sigurdsson A, Civian N. The role of endodontics after dental traumatic injuries. In: Hargreaves KM, Berman LH, editors. Cohen’s pathways of the pulp. 11th ed. St. Louis: Elsevier Health Sciences; 2015. 758-792.
3. Trope M. Endodontic considerations in dental trauma. In: Ingle JI, Bakland LK, Baumgartner JC, editors. Ingle’s Endodontics. 6th ed. Ontario: BC Decker Inc; 2008. 1330-1357.
4. Parirokh M, Torabinejad M. Calcium Silicate– Based Cements. In: Torabinejad M, editor. Mineral trioxide aggregate: properties and clinical applications. Oxford: Wiley Blackwell; 2014. 281-332.
5. Bakland LK, Andreasen JO. Will mineral trioxide aggregate replace calcium hydroxide in treating pulpal and periodontal healing complications subsequent to dental trauma? A review. Dent Traumatol. 2012; 28(1): 25-32.
6. Trope M, Bunes A, Debelian G. Root filling materials and techniques: bioceramics a new hope?. Endod Topics. 2015; 32(1): 86-96.
7. Topçuoğlu HS, Tuncay Ö, Karataş E, Arslan H, Yeter K. In vitro fracture resistance of roots obturated with epoxy resin–based, mineral trioxide aggregate–based, and bioceramic root canal sealers. J Endod. 2013; 39(12): 1630-1633.
8. Ulusoy Öİ, Nayır Y, Darendeliler-Yaman S. Effect of different root canal sealers on fracture strength of simulated immature roots. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011; 112(4): 544-547.
9. Soares J, Santos S, César C, Silva P, Sá M, Silveira F, Nunes E. Calcium hydroxide induced apexification with apical root development: a clinical case report. Int Endod J. 2008; 41(8): 710-719.
10. Flanagan TA. What can cause the pulps of immature, permanent teeth with open apices to become necrotic and what treatment options are available for these teeth. Aust Endod J. 2014; 40(3): 95-100.
11. Felippe MC, Felippe WT, Marques MM, Antoniazzi JH. The effect of the renewal of calcium hydroxide paste on the apexification and periapical healing of teeth with incomplete root formation. Int Endod J. 2005; 38(7): 436-442.
12. Wang Z. Bioceramic materials in endodontics. Endod Topics. 2015; 32(1): 3-30.
13. Prati C, Gandolfi MG. Calcium silicate bioactive cements: biological perspectives and clinical applications. Dent Mater. 2015; 31(4): 351-370.
14. Zhang W, Li Z, Peng B. Effects of iRoot SP on mineralization-related genes expression in MG63 cells. J Endod. 2010; 36(12): 1978-1982.
15. Guven EP, Yalvac ME, Kayahan MB, Sunay H, SahIn F, Bayirli G. Human tooth germ stem cell response to calcium-silicate based endodontic cements. J Appl Oral Sci. 2013; 21(4): 351-357.
16. Fernández R, Restrepo JS, Aristizábal DC, Álvarez LG. Evaluation of the filling ability of artificial lateral canals using calcium silicate‐based and epoxy resin‐based endodontic sealers and two gutta‐percha filling techniques. Int Endod J. 2015.
17. Sağsen B, Üstün Y, Pala K, Demirbuğa S. Resistance to fracture of roots filled with different sealers. Dent Mater J. 2012; 31(4): 528-532.
18. Knupfer WH. Ein universelles biokeramisches Obturationsmaterial. Endodontie Journal. 2014; 13(1): 24-28.
19. Amin SA, Seyam RS, El-Samman MA. The effect of prior calcium hydroxide intracanal placement on the bond strength of two calcium silicate–based and an epoxy resin–based endodontic sealer. J Endod. 2012; 38(5): 696-699.
20. Rahmawati CL, Nugraheni T. Apeksifikasi menggunakan mineral trioxide aggregate dan bleaching intrakoronal pada insisivus sentralis kanan maksila. MKGK. 2015; 1(1): 54-62.
21. Afiati SD, Santosa P. Perawatan estetik pada insisivus sentral maksila dengan perforasi apikal. MKGK. 2015; 1(1): 71-78.
DOI: https://doi.org/10.22146/mkgk.49226
Article Metrics
Abstract views : 3895
| 
views : 10169
Refbacks
- There are currently no refbacks.
Copyright (c) 2019 MKGK (Majalah Kedokteran Gigi Klinik) (Clinical Dental Journal) UGM
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.