•VSI AS' l NDODOMIC lull -...

SEKRETARIAT PANITIA DEPARTEMEN ILMU KONSERVASI GIGI FAKULTAS KEDOKTERAN GIGI UNIVERSITAS MAHASARASWATI DENPASAR Jl. Kamboja 11 A Denpasar Telp (0361)

•VSI AS' l NDODOMIC COVGHISS lull • INDOMSU 2016

7462701 / (0361) 7424079 Email: [email protected]

mailto:[email protected]

PROSIDING

SEMINAR ILMIAH INTERNASIONAL

IKATAN KONSERVASI GIGI INDONESIA

ASEAN ENDODONTIC CONGRESS (AEC) 2016

“Getting to The Roots of Endodontic Towards Asean Economic Community ”

Denpasar, 18-19 November 2016

Editor:

Dr.drg Dewa Made Wedagama,Sp.KG

Prof.Dr.drg.Latief Mooduto,MS.,SpKG(K)

drg M.Rulianto,MS.,SpKG(K)

Dr.drg. Dian Agustin Wahyuningrum, SpKG

Dr.drg. Ira Widjastuti,M.Kes.,SpKG(K)

ISBN 978-602-19108-5-6

diterbitkan oleh:

PENGURUS PUSAT IKATAN KONSERVASI GIGI INDONESIA

(PP IKORGI)

2016

111

KATA PENGANTAR

Sejawat yang terhormat,

Seminar Ilmiah Internasional Ikatan Konservasi Gigi Indonesia Asean Endodontic

Congress (AEC) 2016 merupakan ajang pertemuan ilmiah akbar ilmu kedokteran gigi

khusus dalam bidang konservasi gigi. Lebih dari 70 makalah lengkap masuk ke Seksi

Ilmiah Seminar Ilmiah Internasional Ikatan Konservasi Gigi Indonesia Asean Endodontic

Congress (AEC) 2016 dari sejawat berbagai institusi pendidikan, rumah sakit dan praktisi

dokter gigi spesialis maupun umum. Kami mengucapkan terima kasih atas partisipasinya

para sejawat sekalian.

Pada penyelenggaraan Seminar Ilmiah Internasional Ikatan Konservasi Gigi

Indonesia Asean Endodontic Congress (AEC) 2016 ini panitia memberikan kebebasan

kepada para kontributor naskah untuk memilih publikasi yang diinginkan. Kontributor

naskah dapat mempublikasikan makalahnya dalam prosiding. Buku prosiding ini memuat

makalah lengkap yang dipresentasikan dalam Seminar Ilmiah Internasional Ikatan

Konservasi Gigi Indonesia Asean Endodontic Congress (AEC) 2016.

Kami mohon maaf bila dalam pegelolaan dan penerimaan makalah banyak terdapat

kekurangan. Masukan dan kritik membangun sejawat kami harapkan untuk perbaikan

dimasa mendatang. Akhir kata semoga prosiding ini dapat bermanfaat bagi kita semua.

Selamat seminar, sampai jumpa di Seminar Ilmiah Internasional Ikatan Konservasi

Gigi Indonesia Asean Endodontic Congress (AEC) 2016 di Bali.


Dr.drg Dewa Made Wedagama,Sp.KG

Ketua

PROSIDING SEMINAR ILMIAH INTERNASIONAL IKATAN

KONSERVASI GIGI INDONESIA ASEAN

ENDODONTIC CONGRESS (AEC) 2016

"Getting to The Roots of Endodontic Towards Asean Economic Community"


iv

DAFTAR ISI

The effect of micro leakage in class V cavity using self adhering flowable composite with the addition of acid etch

Dennis, Darwis Aswal dan Anastasia ..................................................... 1-6

Hemisection and restoration as a treatment option: a case report

Dhea Adittya dan Ruslan Effendy .......................................................... 7-12

Apexification on Right Upper Incisor Tooth with Periapical

Lesions Suspect Radicular Cyst ( Case Report)

Diani Prisinda dan Rasyid Ridha Hilman .............................................. 13-18

Immature tooth management using mta and all Porcelain

crown reinforced with fabricated fiber post

Evy Tri Utami dan Pribadi Santosa ....................................................... 19-27

Bioviabilitas Ekstrak Daun Mangrove (Sonneratia Alba) Terhadap

Kultur Sel Fibroblas Cell Line BHK-21

Arlita Gladys Tricia Charyadie, Aprilia, dan Widyastuti .................... 28-37

The Internal Bleaching Treatment With Walking Bleach Technique

On Maxillary Left Central Incisor

I Gede Astika Andhi Yasa dan Rahmi Alma Farah Adang ............... 38-45

Endodontics Surgical Treatment Of Root Canal Filler Material Extrusion

: Case Report.

Harris Rahmadi dan Ratna Meidyawati ................................................ 46-50

Success Endodontic Treatment of Post Pulp Mummification Molar

with Narrow Canals by Sonic Irrigation Technique Endoactivator

Hartanti Putri Utami dan Laksmiari Setyowati .................................... 51-58

The Effectiveness of Starfruit Leaves Extract (Averrhoa bilimbi L)

as Antibacterial Against Mix Bacteria of Root Canals.

I Gusti Ketut Armiati .............................................................................. 59-65

Management Of Separated File Instrument In Root Canal With

Conventional Endodontic Treatment

Illmilda dan Dini Asrianti........................................................................ 66-73

Sitotoksisitas ekstrak daun mangrove daruju (Acanthus

ilicifolius) sebagai bahan irigasi saluran akar

Ratna Putri, Twi Agnita Cevanti dan Henu Sumekar .......................... 74-80

Management Of Periapical Cyst With Endodontic Surgery ...................... 81-85

The Effectiveness of Endoactivator and Irrigation Solutions to

Remove Root Canal Calcification of Geriatric Patients

Wahyu Ellia Probowati dan Tamara Yuanita ....................................... 86-92






1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12. 13.

5

14. Penggunaan Pasak Fiber Oval pada Gigi dengan Saluran Akar Berbentuk

Oval yang Telah Dirawat Endodontik: Laporan Kasus

Wahyuni Suci Dwiandhany ...................................................................... 93-100

15. Effect of light curing cycle with a time gap on microleakage of class ii

bulk-fill composite restoration (in vitro)

Widi Prasetia, Angel................................................................................. 101-107

16. Aesthetic rehabilitation of failed composite resin restoration In four

maxillary incisors

Yongki Hadinata W dan Ira Widjiastuti ................................................... 108-116

17. Apical Plug Dengan MTA Pada Gigi Insisivus Sentralis Maksila Apeks

Terbuka

Irawati Siregar .............................................................................................. 117-122

18. The Use of Removable Denture in Patients with Dementia

Kadek wirayuni ............................................................................................ 123-126

19. Endodontic and Esthetic Management of a Deep Crown Fracture of a

Maxillary Anterior Teeth.

Kartika kusumaningdiah dan Moch. Mudjiono ............................................ 127-135

20. Diastema Closure and Reshaping Peg-shaped Teeth Using Direct

Composite Veneer: A Case Report

Lingga Restu Anandia dan Opik Taofik Hidayat ..................................... 136-140

21. Perawatan lesi periapikal gigi molar kiri rahang bawah pada pasien SLE

Lipur Kurniawati dan Anggraini Margono................................................... 141-148

22. Esthetic Rehabilitation on Maxillary Anterior teeth with Multiple

Diastema

Mertha Rizky Puspita dan Karlina Samadi .............................................. 149-155

23. Antibacterial effect extract etanol of coconut fiber (cocos nucifer. L)

asmedicament alternative in root canal in the case of endodontic flare-ups

Mike Wijaya, Nevi Yanti dan TrimurniAbidin ............................................ 156-166

24. Clinical Management of Endodontic Retreatment

Mochammad Kennedy dan Trimurni Abidin ............................................... 167-172

25. Mineral trioxide aggregate (MTA) sebagaiapical plug padagigi anterior

rahangatas:laporan kasus

Muhsanah Santa dan JuniJekti Nugroho ...................................................... 173-178

26. Reimplantation: Clinical Implications and Outcome of Dry Storage of

Avulsed Teeth

Nevi Yanti .................................................................................................... 179-188



6

Identification Multiple Root Canals using SLOB Rule

Ni Kadek Ari Astuti ...............................................................................

Perawatan endodontik gigi molar kedua rahang bawah pada pasien

dengan reflek muntah tinggi

Novita Shintarini dan Munyati Usman .................................................

Esthetic Rehabilitation of Complicated Crown Fractures in Maxillary

Incisors

Profilia Shinta dan Edhie Arief Prasetyo .............................................

Endodontic Management of Mandibular First Premolar with Vertucci

Type V Canal Configuration A Case Report

Putri Yulandari ......................................................................................

External bleaching on discolored tooth : a case report

Sarahfin Aslan dan Nurhayaty Natsir ..................................................

Penatalaksanaan Lesi Periapikal Kronis dengan Pendekatan Terapi

Endodontik Non Bedah (Laporan Kasus)

Saskia Budi Nurina dan Irmaleny Satifil..............................................

M a n a g e ment of Open Apex: A Case Report of Permanent Anterior

Teeth

S r i E k a S a r i dan Aries Chandra Trilaksana .................................

Penatalaksanaan pengambilan peeso reamer yang patah pada gigi

kaninus maksila dengan teknik syringe tip and glue : laporan kasus

Steven Wijaya dan Trimurni Abidin ....................................................

Management of aesthetic problem and endodontic treatment on tooth

fracture in maxillary incisors

Sunniyah Harum Adiba dan Adioro Soetojo .......................................

Perawatan saluran akar lesi endo-perio klasifikasi simon tipe I pada gigi

premolar pertama rahang bawah laporan kasus

Teguh Santoso dan Nilakesuma Djauharie ..........................................

Sitotoksisitas ekstrak daun mangrove daruju (Acanthus ilicifolius)

sebagai bahan irigasi saluran akar

Ratna Putri, Twi Agnita Cevanti dan Henu Sumekar ........................

Fiber-Reinforced Direct Composite Restoration Pada Gigi Anterior

(Laporan Kasus)

Arnold Kyoto dan Opik Taofik Hidayat ...............................................

Perawatan Endodontik Non Bedah Pada Perforasi Furkasi Menggunakan

Biodentine: Laporan Kasus

Atria Mya Kelani dan Nila Kesuma Djauharie ...................................






27.

28.

29.

30.

31.

32.

33.

34.

35.

36.

37.

38.

39.

189-193

194-199

200-207

208-214

215-218

219-226

227-233

234-241

242-248

249- 2

49

250- 2

50

251- 2

56 257-

7

Bedah Endodontik Sebagai Altematif Perawatan Pada Kasus Overfilling Material Pengisi Saluran Akar Laporan Kasus Ayu Sandini dan Ratna Meidyawati ...................................................... 263-270

Pengangkatan Instrumen Patah Menggunakan Instrumen

Endodontik Ultrasonik Pada Gigi Premolar Rahang Atas

Brinna Listiani dan Ratna Meidyawati ................................................. 271-277

Antibacterial effect of ethanol extract of the avocado seed (persea

americana mill.) As an alternative root canal irrigants against

porphyromonas gingivalis (in vitro)

Cut Nurliza, Dennis dan Wulandari Savitri ...............................

Endodontic Retreatment of a Maxilla Second Premolar with two

Separate Canals

Dania Vergeina Putri dan M. Rulianto .................................................. 288-292

Treatment of periodontal tissue Due to the overhanging fillings of class II

Dewi Haryani IGA .................................................................................. 293-293

Dealing with External Apical Root Resorption Associated with

Trauma from Occlusion ; Brief Review and Case Report

Dewi Isroyati Sugiana dan Kamizar ...................................................... 294-299

Perubahan Warna Gigi Setelah Perawatan Ortodontik

Ayu Wulandari dan Munyati Usman .................................................... 300-307

Penutupan Diastema Dengan Mahkota Pasak Inti; Laporan Kasus

Bani Imran dan Endang Suprastiwi ...................................................... 308-312

The development of coconut fiber waste as an alternative medicament for

application in endodontic treatment

Ellyda Nasution, Nevi Yanti dan TrimurniAbidin ............................... 313-325

Extruded ion nickel from apical foramen during instrumentation with

various irrigant

Eltica Oktavia dan Trimurni Abidin ..................................................... 326-337

Endodontic microsurgery for radicular cyst management with

combination of platelet rich fibrin (prf) and bone graft - a case report

Emmanuella G. Untoro dan Bambang Nursasongko ........................... 338-344

When shrinkage is a problem, this restoration can be a choice: a case

report

Eriana Sutono dan Christine A. Rovani ................................................ 345-351

Immature tooth management using mta and all Porcelain crown

reinforced with fabricated fiber post

Evy Tri Utami dan Pribadi Santosa ....................................................... 352-361






40.

41.

42.

43.

44.

45.

46.

47.

48.

49.

50.

51.

52.

viii

53. 3-in-1 Treatment of Traumatized Tooth with Open Apice and

Discoloration

Fadil Abdillah dan Nanik Zubaidah ...................................................... 362-369

54. Mineral Trioxide Aggregate as an Obturation Material in Horizontal

Root Fracture

Febri Marice Fransiska dan Agus Subiwahjudi .................................... 370-378

55. Treatment of root resorption using bioactive materials (a literature

review)

Fitri Yunita Batubara dan rimurni Abidin ............................................ 379-386

56. Correlation between educationlevel of parents to the caries of first

permanent molarin children

I Putu Indra Prihanjana .......................................................................... 387-387

57. The effect of smoke inhalation ways towards smoker’s melanosis that

detriment the aesthetics

Intan Kemala Dewi .................................................................................. 388-388

58. Perbedaan sitotoksisitas sediaan serbuk teripang emas (Stichopus

hermanii) ukuran partikel mikron dan nano pada kultur sel fibroblas BHK-21

Bella Djaufiar Risvi, Linda Rochyani dan Twi Agni Cevanti .............. 389-399

59. Endodontic Management of Mandibular First Premolar with Vertucci

Type V Canal Configuration A Case Report

Putri Yulandari ........................................................................................... 400-406

60. Effect Of Tooth Bleaching Procedures In Achieving Optimal Tooth

Shade, Brightness, And Enamel Hardness

Fitri Yunita Batubara, Rehulina Ginting dan Yendriwati ................... 407-414

61. Functional and Esthetic Management of Fractured Anterior Teeth

Caused by Dental Trauma

Reyn Pasenda Muljadi dan Latief Mooduto ............................................. 415-424

62. Case Report : Mineral Trioxide Aggregate as an Apical Plug Material in

Tooth with Open Apex

Risya Dini Marsa......................................................................................... 425-431

63. Esthetic Rehabilitation of Multiple Cases in Maxillary Anterior Dentition

Rizki Fanny Aviandono dan Cecilia G.J. Lunardhi .............................. 432-439

64. Perawatan non-bedah gigi insisif rahang atas dengan kista radikular:

laporan kasus

Rizky Amalia dan Anggraini Margono ..................................................... 440-447






9

Perawatan lesi endo-perio concomitant kelas 2 pada molar pertama

rahang atas melalui pendekatan non-bedah: laporan kasus

Rosdiana Nurul Annisa dan Nila Kesuma Djauharie .......................... 448-456

Root Canal Treatment in Left Third Mandibular Molar with

Curvature Using Niti Instrument (a Case Report)

Rusdiana dan Munyati Usman .............................................................. 457-463

Minimally invasive post core removal with ultrasonic device

Sandy Ratna Asri dan Dini Asrianti ...................................................... 464-471

Chronic Periapikal Lesion Management With Non Surgical Endodontic

Approach (Case Report)

Saskia budi nurina .................................................................................. 472-479

Apicoectomy in Management of Unerupted Maxillary Central Incisor

with Labioangular Root Dilaceration

Wandania Farahanny dan Trimurni Abidin ........................................ 480-487

Indirek Veneer Porselen Pada Gigi Anterior Rahang Atas

Dengan Hipoplasia Email : Laporan Kasus

Andi Hermianti Aco dan Juni Jekti Nugroho ...................................... 488-493

Fluorosis Dental Treatment (Anterior Upper Jaw) with Porcelain

Veneer (Indirect)

Anggy Anggarini dan Nirawati Pribadi ................................................ 494-501

Penggantian Beberapa Mahkota Metal Porselen untuk

Mendapatkan Warna yang Lebih Natural

Anis Dien Hartini dan Endang Suprastiwi ........................................... 502-507

Management of Crown Fracture and Multiple Diastema on Maxillary

Anterior Teeth

Arif Setiawan dan Ari Subiyanto ........................................................... 508-517

Bioviabilitas Ekstrak Daun Mangrove (Sonneratia Alba) Terhadap

Kultur Sel Fibroblas Cell Line BHK-21

Arlita Gladys Tricia Charyadie, Aprilia, dan Widyastuti ................... 518-529

Restoration of esthetic complex case with direct composite veneers:

A case report.

Elfira Megasari dan Taofik Hidayat ..................................................... 530-536

The Radix Entomolaris Managing the endodontic treatments

with magnification (microscope) and Endosonic tips - Case

Reports

Gary Wijaya dan Trimurni Abidin ....................................................... 537-545

Endodontic Treatment During Pregnancy : Rationale And Consideration Andina

Rizkia Putri Kusuma, drg., SpKG ........................................................ 546-553

PROSIDING SEMINAR ILMIAH INTERNASIONAL IKATA

65.

66.

67.

68.

69.

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71.

72.

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10

NON-SURGICAL TREATMENT OF MAXILLARY INCISIVE WITH

RADICULAR CYST SUSPECT: CASE REPORT

Rizky Amalia1, Anggraini Margono2 1Resident of Conservative Dentistry Department, Universitas Indonesia, Jakarta, Indonesia 2Lecturer of

Conservative Dentistry Department, Universitas Indonesia, Jakarta, Indonesia

Corresponding E-mail: [email protected]

ABSTRACT

Background: Radicular cyst is the most common odontogenic cyst found on maxillae.

Objective: To report the non-surgical treatment for radicular cyst on maxillary incisive.

Case: Patient, woman, 25 years old, come to undergo endodontic treatment on her upper

left central incisor. Patient had a motorbike accident 11 years ago and complained about

her discolored tooth. Clinical and radiographic examination indicated radicular cyst. Next

step is the non-surgical treatment including elimination of the necrotic pulp tissue,

drainage, and usage of 2,5% NaOCl and 17% EDTA for irrigation and Ca(OH)2 for

intracanal medication between visits. Periodic evaluations conducted at one month and

three months after the root canal obturation. Conclusion: On the 4th month of evaluation,

radiographic examination showed healing in the periapical tissue. Radicular cyst can be

cured with non- surgical treatment by eliminating the infected pulp tissue and adequate

drainage.

Keywords: radicular cyst, Non-surgical treatment, Ca(OH)2

INTRODUCTION

A radicular cyst is generally

defined as a cyst arising from epithelial

residual (cell of Malassez) in the

periodontal ligament and is believed to

proliferate as a consequence of inflam-

mation, usually following the necrosis of

the pulp.(1,2)Radicular cyst is the most

common odontogenic cystic lesion

affecting the jaws, mostly on the maxillae.(1-

5)and comprise about 52% to 68% of all the

cysts affecting the human jaws.(1,5,6)The

radicular cyst could occur after physical,

chemical, or bacterial injury.(3)Their

prevalence is highest among patients in

their third to fifth decade of life, and higher

among men

mailto:[email protected]

11






12






than women.(1,4,5)Most of the radicular

cysts are symptomless and are discovered

when radiograph are taken on discolored

teeth or when patients complaint about a

swelling.(5)

It is not yet well-established

whether the treatment of radicular cysts

should be non-surgical or surgical.The

choice of treatment may be determined by

some factors such as extension of the

lesion, relation with noble structures,

origin, clinical characteristics of the lesion,

cooperation and systemic condition of the

patient.(5,7,8). Some authors stated that if the

endodontic infection is eliminated, the

immune system is able to promote lesion

repair. While other believe that surgical

treatment is necessary.(2,6,9)We can

conclude that the non-surgical treatment is

for single odontogenic cyst but surgical

treatment indicated for big and/or for cyst

on multiple teeth to prevent the cyst from

recurrent.(2,6,9-11)

The case of radicular cyst can be

successfully treated with non-surgical

treatment, in this case is a conventional

endodontic treatment. By paying attention

to adequate drainage, elimination of

infected or necrosis pulp tissue and the use

of correct irrigation and root canal

medication, such as 2.5% NaOCl and 17%

EDTA andCa(OH)2.

Ca(OH)2is a widely used material in

endodontic treatment because its excellent

bactericidal and remineralization

effects.(12)Patient’s systemic condition also

affecting the healing process of radicular

cyst.(6)Further evaluation is done

periodically to see the healing process.

In this article, a case of non-sur-

gical treatment with calcium hydroxide on

radicular cyst suspect is reported.

OBJECTIVE

This article will report the non-

surgical treatment for radicular cyst

suspect on maxillary incisive.

CASE AND MANAGEMENT

A 29 year-old female patient came

to Conservative Clinic, Faculty of

Dentistry, Universitas Indonesia. She had

discoloration on her upper left maxillary

incisive since few years ago. Eleven years

ago she had a motorbike accident. She

claimed that she have no pain, but she felt

disturbed with the tooth’s color. She want

that tooth to be treated.

Intraoral clinical examination

revealed that tooth 21 had greyish dis-

coloration but no defect. Pulpal necrosis

was confirmed with cold sensitivity test,

and tender on percussion. The

13

radiographic examination showed the

presence of a roundradiolucent lesion on

the apex of tooth 21, with approximately

> 1 cm diameter and well-defined

sclerotic border.

The differential diagnosis is ra-

dicular cyst suspect et causapulp necrosis

(Figure 1). The definitive diagnosis of the

type of a periapical lesion can only be

made by a histological examination.

However, a preliminary clinical

diagnosis of a radicular cyst is reasonable

if all of the following condition exist: (i)

the periapical lesion involves one or more

teeth with necrotic pulps; (ii) the lesion is

greater than 200 mm2

in size; (iii) a straw-colored fluid is

produced upon aspiration or on drainage

through an access; and (iv) the fluid

contains cholesterol crystals (Eversole

1984)(2,12)

In the present study, the radio-

graph revealed that the tooth 21 had a

round, well-defined radiolucency with +

210 mm2 size. Aspiration of the fluid

sample from inside the canal itself was

simple to carry out, as the teeth had an

adequate drainage through the access of

the canal. Upon observing these findings,

a presumptive diagnosis of a radicular

cyst can be made.

There are 2 types of radicular

cysts: (i) ‘true’ cysts are those containing

cavities completely enclosed by epithelial

lining; and (ii) ‘pocket’ or ‘bay’ cysts are

those containing epithelial-lined cavities

that are open to the root canals (Simon

1980 & Nair et al. 1996).(1,6)

The treatment plan in this case is

non-surgical treatment. According to

Simon (1980) and Nair et al. (1996) As the

lumen of a ‘bay’ or ‘pocket’ cyst is open

to the root canal, it is likely to heal after

non-surgical treatment due to the

removal of intracanal irritants.(2,12) It is

not possible to distinguish between ‘true’

cyst or ‘pocket/bay’ cyst through

radiographic examination.(1,6) However,






(c.)

Figure 1. (a.) Clinical pre-operative photo.

The crown is intact but the grayish

discoloration is visible. (b) Radiographic

pre-operative. It showed round, well-

defined radiolucency on the apex of tooth

21. (c) Labial gingiva is slightly swelling

and reddish.

14






‘true’ cyst have a low prevalence rate of

10%. The majority of the cysts are

‘pocket/bay’ cysts. Thus, removal of the

etiological agent from root canal system

via non-surgical therapy creates a favorable

environment for repair of the lesion and it

has been accepted as the first line of

treatment.(6,11)Many studies have reported

that radicular cyst can respond well to non-

surgical treatment. (2,6,9-11)

Once the diagnosis is made, the

operator performed the access opening on

the palatal to reach the pulp chamber. After

the measurement of working length with an

apex locator PropexPixi

(DentsplyMaillefer, Switzerland) and then

do the radiograph to confirm the working

length # 30/21 mm with a reference point

on the incisal edge (Figure 3a).

Furthermore, shaping the root

canal with ProTaper Hand Use

(DentsplyMaillefer, Switzerland) with a

lubricant RC-Prep (Premier® Dental

Products Company) 15%. Obtained

#F5/21mm as master cone. (Figure 3b).

2.5% NaOCl irrigation and apical patency

with a K-file #10 performed during and

after the instrumentation. Further

evaluation with periapical radiographs

photo to see the main cone, then flushed

with 2.5% NaOCl and

dried with paper points and intracanal-

medications Ca(OH)2(Calciplex®, Si- ka-

Nippon Yakuhin, Shimonoseki, Japan)

then sealed with temporary filling (GC

Caviton).

Figure 2.Cyst’s liquid aspiration: the

straw-colored fluid, which is the

cyst’s characteristic.

Ca(OH)2 is the gold standard root

canal medicaments in endodontic

treatment.(11,13-15)In an aquaeous solution,

Ca(OH)2 dissociates into calcium and

hydroxyl ions. Various biological

properties have been attributed to this

substances, such as antimicrobial activity

(Bystrmet al. 1985) and induction of repair

by hard tissue formation (Foreman &

Barnes 1990)(14)Root canal treatment

including Ca(OH)2as thein- tracanal

medicament resulted in 78,3% complete

healing of large periapical lesions, which

was in accordance with previously reported

results (Sjogrenet al. 1990; alikan&en

1996).(2)

Two important enzyme properties

of Ca(OH)2 are the activation of tissue

enzymes, such as alkaline phosphatase,

causing a mineralizing effect and the

inhibition of bacterial enzymes causing an

antimicrobial effect. Its high

15

pH (12.4-12.8) inhibits essential enzyme

activities: metabolism, growth and

cellular division. The influence of pH

alters the integrity of the cytoplasmic

membrane by biomechanical injury to

organic components (proteins,

phospholipids) and transport of nutri-

ents.(15,16,13,14)

The optimum pH value for the

activation for this enzyme ranges from

8.6 to 10.3, what makes the release of

organic phosphatase (phosphate ions)

which reacts with calcium ions from the

circulating blood easier, creating a

sediment of calcium phosphate on the

organic matrix.(15) The formation of

mineralized tissue after contact of

Ca(OH)2 with conjunctive tissue has been

observed from about 7th to 10th day.

On the next visit, the obturation

is performed with master cone #F5/21

mm and AH Plus (DentsplyMaillefer,

Switzerland) as the sealer. (Figure 3c)

Continued with internal bleaching and

direct composite restorations. (Figure

4) Periodic observation done on the 1st

and 3rd month after obturation. (Figure

5)

(b.)

Figure 4.(a.) Before(b.) 3 days after inter-

nal bleaching (c.) 3 weeks after internal

bleaching

16

Matsumatoet al. (1987) has

demonstrated that the prognosis for the

treatment of large periapical lesions is






(a.)

(c.)

Figure 3. (a.)

Initial file

#30/21mm

(b.) Master

cone #F5/21

mm(c.) Post-

obturation.

(a.)

Figure 5.Radiographic evaluation post-

obturation.

(a.) 27thJune 2016 (b.) 15th August

2016

17






not as good as that of small lesions. In

contrast, Strindberg (1956) and Sjgrenet al.

(1990) found no significant differences in

healing frequency between lesions initially

larger than 5 mm and those smaller than 5

mm.(2)

Wound healing is the programmed

tissue response to injury of a living

organism that involves complex cellular

and molecular biological processes (Clark

1996; Majno&Joris 2004; Kumar et al.

2009). Wound healing process can result in

repair or regeneration. Achieving the

reconstitute of the original structure and

biological function is the ultimate goal of

wound healing (Martin 1997).(17,18)

On cyst healing process, the cyst

have to regress before the regeneration of

periapical tissue. It is not known what

matrix serves as a scaffold for endothelial

cells, fibroblasts, and osteoblasts to migrate

into the lumen of regressing cysts after

non-surgical root canal therapy. Complete

regression of radicular cysts after non-

surgical root canal therapy could be due to

any of several possible scenarios.

(19)Regres- sion of radicular cysts, part of

the cystic lining epithelium could

disintegrate due to apoptosis of local

epithelial cells stimulated by cytotoxic T

cells.(2,19,20) Together with degradation of

the basal

lamina by matrix metalloproteinases

(MMP), this could allow a fibrous con-

nective tissue capsule to grow into the

lumen of radicular cysts. Eventually, the

cystic lining epithelium will completely

regress or become remnants of epithelial

cell rests remaining in the periodontal

ligament.(19)

The formation of bone tissue at the

apex of the tooth (the same as in other parts

of the body) depend on the activity of

osteoblasts. Osteoblasts are derived from

mesenchymal cells in the bone marrow.

With the influence of bone morphogenic

proteins (BMP), induced stem cells that

differentiate and form a spindle-shaped

osteoprogenitor cells. Osteoprogenitor cells

accumulate, then BMP trigger

osteoprogenitor cells differentiation into

cuboidal shape osteoblasts and coating the

surface of bone, then produces osteoid,

which will be mineralized and transformed

into bone.(17)

The process of bone healing time

starts at week-10 and began to fill the bone

at week 15. Increased radi- opacity began

to be seen on the 38th and began to look

like the normal surrounding bone the 105th

day.(21)In this case it appears that the

radiographic evaluation of alveolar bone on

the 1st month is starting to heal

characterized by re-

18

duced radiolucency of the lesion. Later in

the 3rdmonth evaluation also seen a healing

process that is still ongoing.

CONCLUSION

Radicular cyst can be successfully

treated with non-surgical treatment. In this

case, the cyst healed after the non-surgical

treatment using Ca(OH)2(calcium

hydroxide) as intracanal medicament.The

patient was evaluated on the first and fourth

month after the first Ca(OH)2 application

and showed the healing process by radio-

graphic regression of the lesion.

REFERENCES

1. Nainani P, Sidhu GK. Radicular

Cyst -An Update with emphasis on

Pathogenesis. J Adv Med Dent Scie Res.

2014;2(3):97- 101.

2. Caliskan MK. Prognosis of large

cyst-like periapical lesions following

nonsurgical root canal treatment : a clinical

review. Int Endod J. 2004;37:408-16.

3. Tak O, Yilmaz S, Ozel E, Kavak M.

Five Year Clinical Follow Up of a Patient

with Radicular Cyst in the Maxillary Ante-

rior Region. Eur J Prosthodont. 2016;4:17-

21.

4. Khan AU, Qayyum Z, Farooq MU.

Characteristics and Etiology of Radicular

Cyst — A Study. Pakistan Oral Dent J.

27(1):97- 102.

5. Kr H, Vk V, Deepa C. Radicular cyst

: A case report. Int J Appl Dent Sci.

2015;1(4):20-2.

6. Chaudhary S, Tripathi P, Upad-

haya Y, Seth P. Successful non- surgical

management of a large radicular cyst: A

case report with review of literature. Int J

Con- temp Dent Med Rev. 2015;4-7.

7. Domingos P, Jr R, Gon9alves ES,

Neto ES. Surgical Approaches of Extensive

Periapical Cyst : Considerations about

Surgical Technique. Salusvita, Bauru.

2004;23(2):317-28.

8. Azad A, Chourasia HR, Singh D,

Sharma I, Azad A, Pahla- jani V.

Management of a Large Periapical Cyst : A

Case Report. 2014;7(1).

9. Bansal R, Khursheed I, Bansal T.

Review Article Endodontic Management of

a Periapical Cyst- A Review. J Adv Med

Dent Scie Res. 2013;1(1):7-16.

10. Penumatsa NV, Nallanchakra- va S,

Muppa R, Dandem- pally A, Panthula P,

Report






19





C. Conservative Approach in the

Management of Radicular Cyst in a

Child : Case Report.

2013;2013(Figure 1):2—5.

11. Valois CRA, Costa-junior ED.

Periapical Cyst Repair After

Nonsurgical Endodontic Therapy -

Case Report. Braz Dent J.

2005;16(3):254-8.

12. Bansal R, Khursheed I, Bansal

T. Endodontic Management of a

Periapical Cyst - A Review. J Adv

Med Dent Scie. 2013;1(1):7—16.

13. Kim D, Kim E. Antimicrobial Effect of

Calcium Hydroxide as an Intracanal

Medicament in Root Canal

Treatment : a Literature Review -

Part I . In Vitro Studies. Restor Dent

Endod. 2014;7658:1-12.

14. Jr JFS, Lopes HP. Mechanisms of

Antimicrobial Activity of Calcium

Hydroxide : A Critical Review. Int

Endod J. 1999;32:361-

9.

15. Calcio HDE, Baseado E, Evidences

EM. Calcium Hydroxide: Study

Based on Scentific Evidences. J Appl

Oral Sci. 2003;11(4):269-82.

16. Metzger Z, Basrani B, E. Good H.

Cohen’s Pathway of the Pulp 10th

Edition. Instruments, Ma

terials, and Devices. Elsevier

Mosby; 2011. p. 253-4.

17. Lin LM, Rosenberg PA. Repair and

Regeneration in Endodontics. Int

Endod J. 2011;44:889- 906.

18. Polimeni G, Xiropaidis A V., Wikesjo

UME. Biology and Principles of

Periodontal Wound Healing /

Regeneration. Peri- odontol 2000.

2006;41(24):30- 47.

19. M. Lin L, T-J Huang G. Cohen’s

Pathway of the Pulp 10th Edition.

Pathobiology of Periapeks. Elsevier

Mosby; 2011. p. 52954.

20. Lin LM, Huang GT-J, Rosenberg PA.

Proliferation of Epithelial Cell Rests,

Formation of Apical Cysts, and

Regression of Apical Cysts after

Periapical Wound Healing. J Endod.

2007;33(8):908-16.

21. Pagni G, Pellegrini G, Gi-

annobile W V, Rasperini G.

Postextraction Alveolar Ridge

Preservation : Biological Ba

sis and Treatments. Int J Dent.

2012;2012:1-13.

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