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BEDAH PERIODONTAL
drg. Ahmad Syaify, Sp.Perio (K)Spesialis Konsultan Bedah Perio & Estetik
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Materi Kuliah Pengantar Bedah Perio
Kuretase dan ENAP
Gingie!tomy " #ro$n %enghtening &rene!tomy
&lap Surgery
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Periodontal Surgery Salahsatu 'omponen periodontal treatment mumnya dila'u'an seagai therapi fase 'edua Motiasi pasien dan home !are
*arus didahului therapi fase a$al +ida' sering dan tida' radi'al Perdarahan harus minimal *asilnya se!ara morfologis harus ai' *ilangnya aringan harus seminimal mung'in
-ndi'asi harus tepat Prognose ai' Kontrol dan re!all se!ara teratur
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The art and science
of periodontal surgery Purposes and goal of periodontal surgery
-ndi!ations for and methods of surgery
e/ealuation after initial therapy is !omplete Preparation for periodontal pro!edure
0arious standard surgi!al te!hni1ues
(Klaus et.al.1994)
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Purpose and goals of surgi!al
therapy oot !leaning and smoothing (planing) $ith
dire!t ision edu!tion or elimination of pla1ue/retentie
area that promote infe!tion, espe!iallyperiodontal po!'et
Eliminations of inflamation and po!'et a!tiity Enhan!ing the regeneration of periodontal
tissues #reation of physiologi! morphology of the
marginal periodontal and the mu!ogongialorder
(Klaus et.al.1994)
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-ni!ations and methods
ENAP pro!edure, open !urettages Gingie!tomy " gingioplasty &rene!tomy Partial fap refle!tion &ull flap refle!tio $ith ariale flap
repositioning Mu!ogigial surgery
#omined " spe!ial operations
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e/ealuasi -nisal therapy harus optimal #e' proing depth, atta!hment loss,
inflamasi gingia, a'umulasi pla'.
2*- paling tida' 345 +ida' ada leeding (B2P / ) Pertimang'an penya'it sistemi' adiotherapi dan anti/'oagulan
Premedi'asi tentatif %uas area diatasi
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Atlas of surgi!al te!hni1ues
Gingial !urettage
ENAP (open !urettage)
Modified 6idman &lap (M6&) &lap pro!edures
Gingie!tomy (G0)
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Pemilihan teni !edah perio +ergantung tipe " 'eparahan
-nisial terapi harus sempurna
7iagnosa harus !ermat dan a'urat
Pertimangan prognose
Efe'tiitas dan efisiensi
-nformed !onsent
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"IN"I#AL $%RRETA"E
drg& Ahmad 'yaify( 'p&Perio )*+
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7efinisi
Kuretase (!urretage) / s!raping
/ pengeru'an
/ peng'uretan
Memuang dinding po'et yg mengalami
granulasi8firolasti'8angiolasti' dan
inflamasi.
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6hat is Periodontal Po!'et9
7efinition
#lassifi!ation ased on :
/ epithel atta!hment " gingial margin
/ aleolar !rest
/ type of enlargement
/ deep of po!'et
/ area of po!'et
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Mengapa perlu 'uretase9 Mengamil8memuang ar granulasi yang
mengalami inflamasi 'ronis pada dinding
po'et
;aringan granulasi / 'oloni a'teri
/ sugingial 'al'ulus
/ destru'si epit sul'us / destru'si epit atta!h
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-N7-KAS- KE+ASE
Po'et dang'al < moderat (=/> mm)
2edematous, inflamasi, non firoti'
Kontur gingia relatif ai'Ada 'ontra indi'asi edah perio lanut
e!all isit untu' maintenan!e po'et yang
re'uren
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Periodontitisditandai terentu'nyapo'et periodontal, resorsi tulang
aleolar, 'egoyahan gigi
Ne$man d'', 2000. Clinial Periodontolo!"
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K2N+A -N7-KAS-
7inding po'et firoti'
Po'et yang dalam
Keterliatan per!aangan a'ar
7aerah sulit diang'au 8 asesiilitas??
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ELI,INA'I PO*ET D"N *%RET
E&EK PENGKE+AN
NE6 A++A#*MEN+ 8 E/EP-+E%-SAS-
+uuan 'uretase (Naers " Stal'ers, @4)
@. Memersih'an aringan granulasi
. Memersih'an aringan inflamasi
=. Mengurangi 'edalaman po'etC. Mengamil papilla interdental yg rusa'
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Teni uretase Kelanutan s'eling dan root planing
Menghilang'an aringan granulasi
Memuat lu'a aru
#losed method 8 lind method
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Tata lasana uretase
@. -ndi'asi
. S'eling dan root planing 'unungan -
=. Anaestesi lo'al dgn !ytoe!t
C. Masu''an 'uret 88 a'sisi gigi sampai dasar po'et,
sisi taam pada epitel sul'uler@. %a'u'an pengero'an ('uret) rp 'ali
. -rigasi
=. +e'an daerah operasi =/> menit
C. Suturing tentatie
>. Apli'asi periodontal dressing
D. Kontrol @ minggu
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Penyem!uhan pasca uretase Perai'an epitel sul'us / hari
Perai'an epitel !e'at > hari
Peng'erutan gingial margin hari Penyemuhan sempura minggu
Carranza & Newman,1996)
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KE%EMA*AN KE+ASE
@. P2SE7 S%-+ SE#AA +EKN-S
. B+* 6AK+ F %AMA
=. PENEMB*AN *AMP- SAMA 7GN
-NS-S-8BE7A*
C. *AS-%NA +7K +E%A% S-GN-&-KAN
7-BAN7-NGKAN SKE%-NG " 22+ P%AN-NG
SA;A
Lindhe, 1984
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ENAP(EH!isional Ne$ Atta!hment
Pro!edure)
drg& Ahmad 'yaify( 'p&Perio )*+
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ENAP #odi$ikasi kuretase den!an insisi
dindin! poket E%P ' open kuretase
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ENAP
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INDI*A'I ENAP
-ndi'asi umum I 'uretase
;i'a diperlu'an e'sisi
gingia 'eratin ade'uat lo!aliJed regio anterior, papilla
interdental
periodontitis ringan8sedang
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*ontra indiasi ENAP
periodontitis erat po'et dalam po'et infraony gingia 'eratin sempit
'erusa'an tulang aleolar aringan hiperplasti' 'eterliatan fur'asi daerah interpro'simal suli
diang'au
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*E%NT%N"AN ENAP
AKSES-B-%-+AS F KE+ASE PENGAMB-%AN ;A GAN%AS- F 2P+-MA%
7AN +EK2N+2% B-SA N+K P2KE+ G %EB-* 7A%AM
(7-BAN7-NGKAN KE+ASE) E&EK+-& N+K P2KE+ SPAB2N ANG
2E7EMA+S (;GA &-B2S-S -NGAN) SE7-K-+ KESAKAN PA7A ;A-NGAN %NAK MEPAKAN P2SE7 G PE7-#+AB%E
N+K E%-M-NAS- P2KE+
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*ELE,AHAN ENAP +d' untu' po'et 88mu'ogingial un!tion
+ida' untu' defe' tulang
+ida' untu' 'erusa'an daerah api'al
po'et
Menimul'an resesi gingia
Sulit tentu'an daerah epithel atta!hment
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PRO'ED%R ENAP
@. S'eling dan root planing @ minggu slmnya. #e' 'edalaman po'et, Jona er'eratin !u'up
=. Anestasi lo'al
C. -nsisi miring 'e dalam dgn s'alpel sampai dasar
sul'us>. ;aringan granulasi diamil dgn s'aler dan 'uret
D. %a'u'an s'eling dan root planing lagi
. Suturing interupted pada interpro'simal
3. 7ite'an dgn 'apas steril =/> menit
. Periodontal dressing
@4. Medi'amentosa
@@. Kontrol @ minggu
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"IN"I#E*TO,I -
"IN"I#OPLA'TI
drg. Ahmad Syaify, Sp.Perio
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GINGIVEKTOMI
E'sisi gingia yg enlargement
+uuan elimininasi po'et a'iat
enlargement gingia, enis po'et false 0isiilitas " a'sesiilitas FFF
untu' pengamilan 'al'ulus sugingia
dan root planing
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INDI*A'I "IN"I#E*TO,I
ELIMINASI SUPRABONI POCKET
KEDALAMAN > 4 MM
SUPRABONI POKET DENGAN DINDINGPOKET FIBROUS
ELIMINASI ENLARGEMENT GINGIVA
ELIMINASI ABSES PERIODONTAL
INTERDENTAL GINGIVAL CRATER
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*ONTRA INDI*A'I
2*- SE%A% ;E%EK
-N&%AMAS- AK+
;-KA 7-PE%KAN BE7A* +%ANG A%0E2%A
7ASA P2KE+ 7-BA6A* M#2G-NG-0A%;N#+-2N
&EKENS- KA-ES +-NGG-
&EKENS- MA%P2S-S- ANG +-NGG-
K2N+A -N7-KAS- PENAK-+ S-S+EM-K
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PRO'ED%R "IN"I#E*TO,I
-N-+-A% P*ASE +*EAP +EN+KAN KE7A%AMAN P2KE+ 7ENGAN P2BE
PE-272N+A% +EN+KAN B%EE7-NG P2-N+ 7ENGAN P2#KE+
MAKE EKS+ENA% BE0E% -N#-S-2N 7- AP-KA% B%EE7-NG
P2-N+ (oran, 'ir'land 'nies) AMB-% 7-N7-NG P2KE+ ANG S7A* 7- EKS-S- KE+ASE
PE-272N+A% 7ESS-NG
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.RENE*TO,I
Bedah perio untu' 'ore'si perle'atan
frenulum anormal
+uuan : @. Mengatasi mu'ogingial prolem
. 2ptimasi 'eersihan mulut
=. Petimangan esteti'
C. Keperluan pera$atan ortodonti'
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Perle'atan frenulum laialis
@. renulu noral
Perle'atan sampai atas mu'ogingial un!tion
2. renulu sedan! &rene'tomi tentatif. Perle'atan sampai atta!hed gingia, free
gingial grooe
*. renulu tin!!i &rene'tomi mutla'.
Perle'atan sampai free gingia, interdentalpapilla, palatum
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