Laporan Tutorial Bahan Pengisi Saluran Akar

LAPORAN TUTORIAL SKENARIO 7 Bahan pengisi saluran akar

 Diajukan Untuk Memenuhi Salah Satu Tugas Blok Bahan dan Teknologi  Kedokteran Gigi II 

Disusun oleh : KELOMPOK  TUTORIAL

4

Dosen pembimbing : drg Amandia Dewi Permana Sita

FAKULTAS KEDOKTERAN GIGI UNIVERSITAS JEMBER  2011

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Daftar anggota tutorial 4 :

etua K etua

: R izki izki Nuha Aliyah

(091610101019)

Scriber : Aminatus Sakdiyah

(091610101014)

 Notulen : Larasati S.

(091610101006)

Anggota

:

1. Dewi Fitria Anugrahati

(091610101003)

2.

(091610101004)

isca Mufidah R isca

3. Fama Alburuda

(091610101012)

4.

(091610101015)

iclas Yusuf Punta R iclas

5. Veny Alfiani

(091610101016)

6.

Lusy Augustin Margaretha

(091610101026)

7.

Meilisa

(091610101027)

Nitawati

8. Deny R angga angga Gomay

(091610101046)

9. Sufi Azzahro

(091610101049)

hoirunnisa K hoirunnisa

10. M. Martin Widayat

(091610101057)

Anggota

tambahan dari tutorial 8 : 11. Yunda Sis Wulandari

(091610101035)

12. Faridlotul Imaniyah

(091610101054)

13. Alchi R adita adita S

(091610101097)

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KATA PENGANTAR 

Puji

Syukur  K ehadirat ehadirat

Allah

SWT, atas limpahan rahmat dan hidayah-Nya sehingga

kami dapat menyelesaikan laporan tutorial skenario 7 pada Blok  Ilmu Bahan dan Teknologi edokteran K edokteran

Gigi

II

mengenai ³Bahan Pengisi Saluran Akar ´. Banyak sekali hambatan yang

kami alami dalam pembuatan laporan tutorial ini, tetapi berkat dukungan dari berbagai pihak  maka kami bersyukur bersyukur pada akhirnya dapat menyelesaikan laporan laporan tutorial ini dengan baik. Tidak lupa kami mengucapkan banyak terima kasih kepada drg. Permana

Sita,

Amandia

Dewi

selaku tutor pembimbing pembimbing dalam kelompok tutorial 4 yang telah banyak 

memberikan dukungan, bimbingan dan pengarahan dalam menyelesaikan makalah ini di selasela kesibukan beliau. ami K ami Perpustakaan

juga berterimakasih kepada perpustakaan Fakultas K edokteran edokteran Gigi dan juga UPT

Universitas Jember yang telah memberikan banyak bantuan dalam menyediakan

 buku-buku referensi dan kakak tingkat serta teman-teman mahasiswa Fakultas K edokteran edokteran Gigi angkatan 2009 yang telah banyak mendukung. Tiada gading yang tak retak, begitu pula kami sangat menyadari bahwa dalam   pembuatan laporan tutorial ini masih jauh dari kesempurnaan. Oleh karena itu kami sangat mangharapkan kritik dan saran yang membangun demi kesempurnaan makalah ini. Semoga laporan tutorial ini dapat bermanfaat di kemudian hari, khususnya dalam  bidang

edokteran K edokteran

Gigi di kalangan ka langan Universitas Jember.

Jember,10 Maret 2011

Penulis

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BAB I PENDAHULUAN 1.1 Latar Belakang

Dalam bidang

edokteran K edokteran

Gigi, dikenal istilah bahan dan teknologi untuk  K edokteran edokteran

Gigi. Bahan dan teknologi ini nantinya bisa diaplikasikan pada kehidupan di masyarakat. Salah satu contohnya adalah bahan

edokteran K edokteran

Gigi yang digunakan untuk mengisi saluran akar.

Dalam skenario ini, akan dibahas mengenai bahan-bahan untuk mengisi saluran akar. Pada

skenario, dijelaskan bahwa rongga bekas jaringan pulpa yang telah disterilisasikan,

dilakukan pengisian dengan bahan pengisian saluran akar sebagai pengganti pulpa yang telah di ambil.

Pengisian

saluran akar tersebut sampai menutup rapat apeks gigi. Jenis bahan yang

digunakan ada banyak macamnya, pemilihan bahan tersebut tergantung jenis diagnosanya, jenis gigi. Dari pernyataan tersebut, kami diharapkan bisa mengetahui bahan-bahan pengisi saluran akar dari segala aspek agar kami bisa menyeleksi bahan pengisi saluran akar yang paling baik  dan tidak merugikan bagi masyarakat.

1.2 Rumusan Masalah

1.Menjelaskan bahan pengisi saluran akar : a. Jenis bahan pengisi saluran akar   b.

omposisi K omposisi

bahan pengisi saluran akar 

c. Sifat bahan pengisi saluran akar  d.

A plikasi

dan indikasi bahan pengisi saluran akar 

1.3 Tujuan

1. Dapat menjelaskan bahan pengisi saluran akar  a. Dapat menjelaskan jenis bahan pengisi saluran akar   b. Dapat menjelaskan komposisi bahan pengisi saluran akar 

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1.4 Maping

BAHA  N  N PE NG ISIISI BAHA PE NG SAL URA AKAR  SAL U N RA N AKAR 

syarat

SEMI PADAT

PADAT

JE NIS

KOMPOSISI

keuntungan

SIFAT kerugian

APLIKASI

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BAB II TINJAUAN PUSTAKA

Tahap pengisian saluran akar atau obturasi pada perawatan saluran akar selalu mendapat perhatian yang besar.

Menurut

sejarah, pengisian merupakan tahap yang sangat

kritis, dan menjadi penyebab dari hampir seluruh kegagalan perawatan. Suatu laporan kasus lama yang sering dikutip menyatakan bahwa hampir seluruh kegagalan perawatan disebabkan oleh obturasi yang tidak t idak sempurna. Bahan pengisi saluran akar merupakan bahan yang dimasukkan pada saluran akar  setelah gigi dipreparasi dan diirigasi. Bahan ini diberikan untuk memberikan kekuatan  pada gigi, yaitu sebagai bahan pengganti dentin dan jaringan yang diambil saat preparasi, dengan harapan bahan pengisi saluran akar dapat berfungsi sebagai gigi pada umumnya. Fungsi bahan pengisi saluran akar yaitu mengobturasi saluran akar dan menghilangkan semua pintu masuk antara periodonsium dan saluran akar.

Makin

baik 

  penutupnya makin baik prognosis gigi. Namun untuk mendapatkan bahan penutup yang ideal sama rumitnya dengan anatomi system saluran akar itu sendiri.

arena K arena

semua bahan

 pengisi saluran akar harus menutup semua foramina yang menuju ke dalam periodonsium, maka suatu bahan pengisi ideal harus dapat memadat dengan baik, harus sesuai dan melekat pada dinding saluran yang telah diinstrumentasi, dan harus berakhir pada  penyatuan saluran akar dan periodonsium. (Torabinejad, 1998: 264)

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yang dibuat oleh Ingle dan Beveridge, 58% kegagalan endodontic dapat dihubungkan dengan obturasi saluran akar yang tidak sempurna. (Torabinejad, 1998: 264)

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BAB III PEMBAHASAN 3.1 Jenis bahan pengisi saluran akar  a. Bahan Pengisi Padat y

Cone P erak 

euntungan K euntungan

pemakaian cone perak yaitu mudah digunakan dan dapat disesuaikan

dengan panjang kerja.

ekakuan K ekakuan

dan fleksibelitasnya memungkinkan pengisian

saluran akar yang bengkok dan sempit, silver cone fleksibel tetapi tidak resilien sehingga mudah mengadaptasi kurvatur saluran. Silver cone sesuai dengan bagian apical bila saluran dipreparasi ke bentuk standar, tanpa pelebaran servikal saluran dengan aksi reaming. Silver cone sangat populer karena mudah dimasukkan ke saluran yang sempit atau berkelok-kelok karena cone terkecil sekalipun mempunyai kekakuan yang baik, dapat dimasukkan ke saluran pada panjang yang tepat, dapat terlihat pada radiograf. rad iograf.  b. Bahan Pengisi Pasta y

Zinc Oksida -

Zinc

oksida eugenol (tanpa modifikasi)

Oksida

seng dapat dicampur dengan eugenol membentuk campuran murni

(tanpa aditif) yang kental. Formula lain berupa campuran oksida eugenol (OSE) dengan berbagai aditif. Tipe yang umum dikenal adalah N2 atau R C2B.

Jenis ini merupakan derifat dari formula Sargenti dan mengantung

opaker, oksida metalik (timah) atau klorida (mercuri), steroid (sekali-kali),

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y

Toleransi jaringan, bahan tidak boleh menyebabkan kerusakan jaringan maupun kematian sel

y

Memiliki

dimensi yang stabil, tidak mengerut sewaktu pengerasan.

y

Memiliki

waktu pengerasan yang lama agar waktu kerja lama dan hasilnya

 baik.

y

y

Tidak mewarnai gigi dan jaringan sekitarnya. sek itarnya.

y

Tidak larut dalam cairan rongga mulut

y

Bersifat bakteriostati bakter iostatiss

y

Memiliki

daya adhesif yang kuat.

alsium Hidroksida K alsium

alsium K alsium

hidroksida merupakan senyawa kimia dengan rumus Ca(OH)2, berwarna

  bubuk putih atau kristal dan terjadi oleh karena reaksi pencampuran antara kalsium oksida dengan air.

alsium K alsium

hidroksida juga bisa didaptkan dari reaksi

antara larutan kalium dengan sodium hidroksida.

alsium K alsium

hidroksida memiliki

sifat seperti : 

alsium K alsium

hidroksida dapat menetralisir asam fosfor yang terlepas dari semen

fosfat. 

Memiliki

pH 11-12, kebasaan ini dapat menghancurkan daya tahan

mikroorganisme yang terdapat pada gigi yang karies. 

elarutannya K elarutannya

tinggi t inggi..

Penggunaannya

mudah

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c. Bahan pengisi Plastis y

Gutta Percha

Gutta

Percha

adalah lateks koagulasi dari sejumlah pohon tropis. Secara kimia

merupakan transisomer karet. Gutta percha merupakan suatu bahan alami yang terdiri dari eksudat koagulasi yang telah dimurnikan dari pohon Mazer (Isonandra  percha). Gutta percha yang biasa digunakan dalam bidang kedokteran gigi terdiri dari dua bentuk yaitu bentuk  dan bentuk . Bentuk  biasa digunakan untuk    produk-produk yang diinjeksikan karena memiliki sifat aliran yang lebih baik. Sedangkan bentuk  biasa digunakan untuk batangan gutta percha atau gutta   percha cone. Biokompabilitas dari bahan ini relative baik, walaupun sitotoksik  (Monaco,

Miller

dan Uverett, 1978;

Holland

dkk, 1982; Tanzilli, Nevins dan

Borden, 1983). Plastisnya dianggap sangat menguntungkan. Baru-baru ini terbukti   bahwa gutta percha mempunyai aktivitas antibakteri (Moorer dan Genet, 1982). Aktivitas

ini berhubungan dengan komponen zinc okside (Moorer dan Genet,

1982). Gutta percha dapat digunakan untuk cone saluran akar serta berisi gutta   percha (19-22%), zinc oksid(59-75%) dan malam, bahan pewarna, bahan antioksidasi dan bahan opak (2-17%), bervariasi dari merek satu ke yang lain (Friedman dkk, 1975). c. Bahan Pengisi Semen y

Semen Seng Oksida-R esin esin

Sebagian besar semen untuk penggunaan umum mengandung resin seng-oksida sebagai dasar serbuk. Termasuk dalam kelompok ini adalah semen Grossman,

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y

Semen K alsium alsium Hidroksida

Beberapa semen seng-oksida-eugenol telah dimodifikasi dengan memasukkan kalsium hidroksida. Sealapex, suatu produk 

err K err

manufacturing

Company

merupakan sealer saluran akar polimeri po limerik k kalsium hidroksida, noneugeno l.

y

Semen glass-ionomer  Semen glass-ionomer terbukti lebih efektif daripada semen zinc oksida eugenol untuk mencegah kebocoran secara in vitro (Pitt Ford, 1979;

Zidan

dan

ElDeeb,

1985)

y

Semen polikarboksilat Semen polikarboksilat merupakan sealer efektif asalkan ada kontak yang cukup dengan dinding saluran akar(McComb dan Smith, 1976). K ekurangannya ekurangannya adanya  perlunya alat plastic khusus karena sangat adhesive terhadap logam.

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3.2 K omposisi omposisi bahan pengisi saluran akar  a. Guttapercha

Gutta percha dapat digunakan untuk cone saluran akar serta berisi gutta percha (19-22%), zinc oksid(59-75%) dan malam, bahan pewarna, bahan antioksidasi dan bahan opak (2-17%),  bervariasi dari merek satu ke yang lain (Friedman dkk, 1975).

b.Zink

okside eugenol

andungan K andungan

utama bubuk adalah zink oksida dengan bahan tambahan seperti white rosin

untuk mengurangi kerapuhan saat setting, zink state sebagai plasticizer dan zink acetate untuk meningkatkan kekuatan. Larutannya adalah eugenol dengan minyak olive sebagai  plasticizer.

Bubuk : Zink

okside 69%

White rosin 29,3% Zink

state 1%

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d.Semen Paraformaldehida Meskipun

bahan dasar semen paraformaldehida adalah seng oksida, biasanya mengandung

unsur lain, termasuk paraformaldehida, yang dipermasalahkan. Biasanya N2 mengandung tetrosida timah dan kortikosteroid, sedangkan Endomethasone mengandung kortikosteroid. ortikosteroid K ortikosteroid

diperkirakan mengurangi rasa sakit pasca-operasi.

e.Semen Ionomer Kaca

Glass ionomer cement adalah bahan yang dapat digunakan sebagai pengisi saluran akar.   pada pengisian saluran akar dengan glass ionomer cement, sebelum meletakkan cone, sealer glass ionomer cement diaduk sesuai dengan aturan pabrik.

emudian K emudian

sealer 

dimasukkan ke saluran akar dengan menggunakan lentulo supaya dinding saluran akar  terlapisi glass ionomer cement.

Master

cone diletakkan ke saluran akar sesuai dengan

  panjang kerja, kemudian finger spreader dimasukkan ke saluran akar 1-2 mm lebih  pendek dari panjang kerja ker ja dan dikondensasi secara lateral.

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3.3 Sifat bahan pengisi saluran akar  Sifat-sifat a) Kon Perak  euntungan: K euntungan: Mudah

diletakkan dan dikontrol panjangnya. K ekakuan ekakuan dan fleksibilitasnya memungkinkan untuk obturasi saluran akar yang sempit dan bengkok. erugian: K erugian: 1. Adaptasi buruk  Ini

adalah masalah utama. K on on perak kaku dan tidak dapat beradaptasi dengan baik pada dinding saluran akar yang tak teratur.

2. Toksisitas on K on

perak akan berkarat bila berkontak lama dengan cairan jaringan. Produk karat akan menyebar dan merusak jaringa periapeks.

3. Sulit dikeluarkan Pengangkatan

kon perak untuk perawatan ulang atau pemasangan pasak menjadi masalah utama. K o on n perak sering kali terkunci dwengan erat di saluran akar sebelum disemen. Pangkalnya dapat berada di kamar pulpa atau saluran akar bagian servikal sedemikian

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-

Mempunyai

dimensi yang stabil

-

Toleransi jaringan yang baik 

-

Mudah

-

Tidak dapat ditembus oleh cairan

-

Tidak mewarnai struktur gigi

-

Mudah

didapat

-

elatif R elatif

murah

disterilkan

erugian K erugian -

Tidak melekat pada dentin dan sedikit elastis sehingga menjauhi dinding saluran akar 

-

Sulit mengisi salauran akar yang bengkok serta apeks terbuka

-

Mudah

-

Bila terlalu banya ditekan secara vertikal dapat masuk ke jaringan periapikal

1.

Pasta

patah

elebihan: K elebihan: y

Cepat

ekurangan: K ekurangan:

dan mudah karena hanya menggunakan satu macam bahan

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Cairan:

-Eugenol atau minyak daun pimenta

c) Zinc Okside Eugenol Merupakan

bahan porus, relatif rapuh, dan larut dalam cairan jaringan. Bila masuk ke

  jaringan periapikal mudah mengalami pembusukan. Bersifat sitotoksik dan mutagenik, terutama pada dosis tinggi. Semen seng oksida eugenol juga mempunyai waktu pengerasan yang lambat. Bila sudah mengeras, bahan zinc oxide eugenol membentuk porus dan lemah. Bahan dapat mengalami dekomposisi dalam cairan jaringan. Semen ini tidak kuat (hanya 1/5 kekuatan semen zinc fosfat) dan tidak tahan erosi. ZOE

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Bahan pengisi saluran akar harus memiliki persyaratan sebagai berikut :

1.

Memiliki

sifat biokompatibilitas a Bahan tersebut tidak boleh membahayakan pulpa dan jaringan lunak   b Bahan tersebut tidak boleh mengandung substansi kronik yang larut dalam air, yang dapat dilepas dan diserap d iserap kedalam system sirkulasi sehingga menimbulkan respon toksisitas sistemik. c Bahan tersebut harus bebas dari dar i bahan berpotensi menimbulkan sensitivitas yang dapat menyebabkan suatu alergi d Bahan tersebut harus tidak memiliki potensi karsinogenik  2. Mudah dimasukkan kedalam saluran akar  3. R apat apat ke lateral maupun apical 4. Tidak mengerut setelah dimasukkan

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a. Semen Saluran Akar egunaannya K egunaannya

biasanya untuk menyemen bahan pengisi saluran akar, melapisi saluran

akar, mengisi saluran akar tambahan, mengontrol pertumbuhan bakteri yang masih ada dalam saluran akar.

b.

Zinc oksid Eugenol

Komposisi : Bubuk (zinc oksid 69%, white resin 29%, zinc stearate 1%, zinc acetate 0,7%)

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BAB IV KESIMPULAN

1.Jenis-jenis bahan pengisi saluran akar adalah : a. Bahan pengisi padat  b. Bahan pengisi pasta c. Bahan pengisi plastis plast is d. Bahan pengisi semen

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Powder

:

Eugenol Minyak

85% zaitun (olive oil) 15%

c.Semen Seng-Oksida-Resin

Sebagian besar semen untuk penggunaan umum mengandung resin seng-oksida sebagai unsur dasar serbuk. Termasuk dalam kelompok ini adalah semen Grossman, Siller Saluran akar K err*, err*, Tubli ±Seal K err,* err,* Endomethasone. Cairannya

loropeka K loropeka

N-O, N2 normal, Semen Wachs, dan

biasanya terdiri dari hanya eugenol atau dalam kombinasi dengan

cairan lain seperti balsam Canada, eukaliptol, beechwood creosote, creosote, atau minyak amandel

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f. Kalsium Hidroksida

Biasanya hanya mengandung larutan kalsium hidroksida dengan air namun kurang cukup kuat. Selain campuran dengan kalsium hidroksida juga terdapat campuran larutan metal

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ekurangan: K ekurangan: y

Pengendalian

panjang pengisian susah

y

Susah mencegah pengisian yang berlebih

y

erapatan K erapatan

tidak konsisten, kadang sangat baik, kadang sangat buruk, hal ini

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dimasukkan ke saluran akar dengan menggunakan lentulo supaya dinding saluran akar  terlapisi glass ionomer cement.

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BAB V DAFTAR PUSTAKA Harty.

FJ. alih bahasa Lilian Yuwono. Endodontik K linis. linis. Jakarta Hipokrates.