Non Carious Tooth Decay PrevDent KG UNSOED

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Oleh: drg Ali Taqwim NON-CARIOUS TOOTH DECAY PREVENTIV E DENTISTRY 2012/2013 DENTISTRY UNSOED

Transcript of Non Carious Tooth Decay PrevDent KG UNSOED

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Oleh: drg Ali TaqwimOleh: drg Ali Taqwim

NON-CARIOUS TOOTH DECAYNON-CARIOUS TOOTH DECAYPREVENTI

VE DENTISTR

Y

2012/2013

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Learning Objectives :

Tooth FractureTooth Surface Loss Tooth Discolorization

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Kerusakan jaringan keras gigi dan atau periodonsium karena sebab mekanis pada gigi-gigi anterior baik RA maupun RB.

Terjadi secara langsung maupun tidak langsung Menurut Fonseca&Walker (1991), keadaan yg dapat

menyebabkan fraktur di regio maksilofasial :o 43% Kecelakaan bermontor (lalu lintas)o 34% Kriminalitas (penyerangan, perkelahian, tawuran)o 7% Kecelakaan kerja o 7% Jatuho 4 % Kecelakaan olah raga

TOOTH FRACTURE

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FAKTOR PREDISPOSISI :

Menurut Jarvinen dalam Johnson (1992) : seseorang dgn OVERJET yg ekstrim (lebih dr 6 mm) mempunyai kemungkinan dua kali lebih besar resiko mendapatkan trauma gigi anterior.

Birch dan Huggins (1973) : predisposisi lainnya adalah keadaan yg memperlemah gigi seperti : HIPOPLASIA EMAIL, KARIES DAN RESTORASI YG LUAS.

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Klasifikasi WHO1. Fraktur Mahkota Fraktur email Fraktur mahkota yg tidak rumit (uncomplicated crown

fracture) : mengenai email & dentin Fraktur mahkota yg rumit (complicated crown

fracture) : mengenai email, dentin & pulpa2. Fraktur Akar3. Luksasi Gigi4. Fraktur dari prosesus alveolaris

Menurut Baart dan Kwast dalam Kruger, 1982

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FRAKTUR MAHKOTA

LUKSASI

FRAKTUR AKAR

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Klasifikasi Ellis

I. Fraktur mahkota sederhana yaitu fraktur yg mengenai email dan sebagian kecil dentin atau tanpa mengenai dentin

II. Fraktur mahkota yg luas, meliputi sebagian besar email dan dentin tanpa mengenai pulpa

III. Fraktur mahkota yang luas, meliputi dentin dan pulpa

IV. Gigi yg mengalami trauma menjadi non vital dengan atau tanpa hilangnya struktur mahkota

Menurut Ellis (1946)

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V. Tanggalnya gigi karena trauma

VI. Fraktur akar dengan atau tanpa hilangnya struktur mahkota

VII. Gigi bergeser tanpa disertai fraktur mahkota atau akar

VIII. Kerusakan karena benturan pada gigi sulungDENTISTRY

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I. Kerusakan mengenai email dan sebagian kecil dentin atau dentin tidak terkena (Simple fracture)

II. Kerusakan mengenai email dan sebagian besar dentin tanpa mengenai pulpa gigi (Extensive fracture)

III. Fraktur mahkota dengan pulpa terbuka

IV. Fraktur gigi dimana semua mahkota hilang

Klasifikasi Modifikasi EllisMc Donald (1994)

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EXAMINATION & DIAGNOSIS : Key Points

I. Patients history (when, where and how the injury occured)

II. Clinical examination (inspection, palpation, thermal testing, electric pulp testing/ EPT) ada perdarahan atau tidak, fraktur mengenai mana saja, gigi vital atau tidak vital

I. Radiographic examination

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1. Membersihkan luka akibat trauma (gunakan cairan antiseptik)

2. Merawat luka akibat trauma : anastesi lokal-penjahitan

3. Menghentikan perdarahan: penjahitan, pengikatan/ penjepitan pembuluh darah, penekanan, pemberian obat hemostatika

4. Menghilangkan rasa sakit : obat analgesik

5. Mencegah infeksi : obat antibiotik dan atau anti tetanus serum.

PERAWATAN DARURATPERAWATAN DARURAT

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PERAWATAN DEFINITIFPERAWATAN DEFINITIF

Pada dasarnya meliputi ;

1. Perawatan jaringan keras gigi;

2. Perawatan jaringan pulpa;

3. Perawatan pada gigi yang goyang dan berubah letak;

4. ImobilisasiDENTISTRY

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TATA LAKSANA FRAKTUR MAHKOTA

Gigi Vital

Mengenai email, dentin atau pulpa?

Gigi goyang atau tidak?

VITALITAS GIGI• Selective grinding?• Reattachment of tooth

fragment?• Restorasi GIC/ komposit?• Pulp capping?• Perawatan endodontik?

Ekstirpasi vital (pulpektomi)/ devital??

Bila goyang, lakukan reposisi dan fiksasi.

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TATA LAKSANA FRAKTUR MAHKOTA-AKAR

Jika fragmen mahkota masih berada di tempat dan tidak goyang, maka dapat dilakukan restorasi

Jika graris fraktur jauh ke arah apikal dan gigi masih

dapat direstorasi, maka dilakukan perawatan

endodontik terlebih dahulu

Jika disertai dengan fraktur tulang alveolar,

maka dilakukan ekstraksi.

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REATTACHMENT

Traumatized Teeth Textbook (Tsukiboshi,

2000)

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TATA LAKSANA FRAKTUR AKAR

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TOOTH SURFACE LOSS

Tooth surface loss (tooth wear) : Kondisi yang menunjukkan kerusakan gigi bukan disebabkan oleh plak, karies atau trauma.dapat terjadi akibat dari :ErosionAbrasion Attrition Abfraction

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ATRISIATRISI

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Causes: Bruxism Abrasive (gritty) diet Constant chewing – tobacco Malocclusion Loss of posterior teeth Occupational, dust/grit

mixed with saliva

Predisposing factors:1- Parafunctional habits2 –Developmental defects3- Coarse diet4- Coarse porcelain restorations5- Lack of posterior support

ATRISIATRISI

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Process of attrition is slow Men usually show a greater degree of

attrition than women Severe attrition is seldom seen in deciduous

teeth, (not retained for long) However if a child suffers from

dentinogenesis imperfecta (an hereditary disorder of the dentine) pronounced attrition may result from mastication

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Abrasion is the wear of tooth substance through biomechanical friction process other than tooth contact.

Predisposing factors :

1- Vigorous horizontal tooth brushing,

2- nail biting, pen biting and pipe smoking.

3- denture clasps in RPD.

4- Abrasive tooth paste and powders

5- Hard tooth brushes

ABRASIABRASI

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CLINICAL APPEARANCE : Angular “V” shaped cervical

lesion. The location and pattern of

abrasion is directly dependent upon its course.

Affect labial surfaces of prominent teeth

It usually occurs on the exposed root surfaces when gingival recession has exposed the cementum.

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Erosion is the progressive loss of hard dental tissues both enamel and dentin by chemical process not involving bacterial action, acids are most commonly involved in the dissolution process.

There are three major forms of erosive processes in the mouth.  These are Regurgitation of stomach contents into the mouth, Soda Swishing, and Fruit Mulling. 

EROSIEROSI

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Cause : Extrinsic factorsa. Habitual consumption of highly

acidic, low pH carbonated drinks, sports drinks or concentrated fruit juices

b. Acidic foods: pickles, sauces, vinegars, yoghurts, roasted vegetables

c. Chlorine, from gas chlorinated swimming pools

d. Medication: Vit C, Aspirin, Antidepresan, Antihipertensi

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Cause : Intrinsic factorsFrom within the body :a.Usually hydrochloric acid from

the stomach (pH 2)b.Reflux (GastroEsofageal Reflux

Disease)c.Flow saliva : xerostomia, sjorgen

syndromd.Regurgitatione.Vomitingf. Rumination

Idiopathic factors

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Reflux, Regurgitation and Vomiting of gastric contents

Anorexia Bulimia Pregnancy/Hormones Obesity Eating too much Drinking too much Alcoholism

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Wear associated with bulimia

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Occlusal stresses

 Defined as non carious cervical lesions caused

by tensile stress generated from occlusal

loading, and microfracture of cervical

enamel rods

ABFRAKSIABFRAKSI

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Penyebab dari abfraksi adalah tekanan kunyah yang berlebihan, yang menyebabkan fraktur mikro pada leher gigi.

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1. Diketahui sejak awal tahun 1700án dan menjadi misteri selama ± 150 tahun

2. 1907 - W.D. Miller

3. G.V. Black

4. 1990 – J.O. Grippo

“Abfraction : a new classification of hard tissue lesions of teeth” Grippo JO. J.EsthetDent.1991; 3:14-19

The loss of tooth substance may depend on the direction, magnitude, frequency, duration and location of the force on the teeth.

ABFRAKSIABFRAKSI

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How to diagnose ?

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1. Gangguan estetik2. Sensitif3. Berkurangnya tinggi muka4. Berkurangnya ukuran dimensi

vertikal

PATHOLOGIC

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Management

Immediate Therapy:Aimed to: 1- relieve sensitivity and pain 2- Identify aetiological factors 3- Protect remaining tooth tissue

Aims can be achieved by:• Diet analysis and counseling• Consumption of erosive beverages in a proper manner• Prescription of neutral sodium fluoride mouth rinse or gel• Close fitting occlusal splint• Restoration with composite or glass ionomer

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Clinical Indications for Restorative

management:

• Biological

- Loss of tooth substance leading to irregular

margins

- Pulpal exposure

- Weakening of tooth structure

• Functional

- Reduced masticatory function

• Aesthetic

- Aesthetically unacceptable

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Tidak semua kasus memerlukan restorasi

Lakukan restorasi jika keluhan seputar : estetik, sensitif atau bila perbaikan stuktur dapat memberikan hasil.

Restorasi : Composite vs. glass ionomer. Lesion margins in enamel-microfine

composite. Lesion margins involve cementum or

dentine-Dentine bonding with composite or GI.

Deep cervical lesion-layered technique (GI and composite)

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Tooth discoloration

See u in Aestethetic Dentistry block..

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