Journal of International Dental and Medical...

ISSN: 1309-100X

Journal of

International

Dental and Medical

Research

2016 - Vol. 9 – Special Issue

Universitas Indonesia 1st International Workshop on Dental Research 2016

http://www.ektodermaldisplazi.com/journal.htm

TABLE OF CONTENTS / 2016; 9 (Special Issue, U.I. 1st International Workshop on Dental Research)

J Int Dent Med Res

Journal of International Dental and Medical Research / ISSN: 1309-100X

DENTISTRY

CLINICAL ARTICLE

1. Validation of Stress Screening Questionnaire in Temporomandibular Disorders Patient

Ira Tanti, Laura S. Himawan, Lindawati Kusdhany, Adang Bachtiar, RadenIrawati Ismail

Pages 272-276

CLINICAL ARTICLE

2. The Behavior Change on Brushing Teeth of Children by Mothers Using a Periodic Dental Health

Evaluation Card

Risqa Rina Darwita, Anton Rahardjo, Peter Andreas, Febriana Setiawati, Melissa Adiatman,

Diah Ayu Maharani

Pages 273-281

CLINICAL ARTICLE

3. Dentocraniofacial Morphology in Unilateral and Bilateral Cleft Lip and Palate Following Labioplasty

and Palatoplasty; Analysis at First and Second Cervical Vertebral Maturation Stage

Devina Yastani, Maria Purbiati, Ida Ayu Astuti, Krisnawati

Pages 282-286

CLINICAL ARTICLE

4. Impact of Using Denture on Cognitive Function in the Elderly

Lindawati S Kusdhany, Michael Nathanael, Ramon Dyas, Muslita Indrasari,Chaidar Masulili,

Tri Budi Rahardjo, Dinni Agustin, Eef Hogervorst

Pages 287-292

CLINICAL ARTICLE

5. Association Between Masticatory Performance and Body Mass Index (BMI)

Muslita Indrasari, Tasya Shakina, Chaidar Masulili

Pages 293-298

CLINICAL ARTICLE

6. Etiology of Temporomandibular Disorders Index

Ira Tanti, Laura Susanti Himawan, Lindawati Kusdhany

Pages 299-305

CLINICAL ARTICLE

7. Oral Findings in Children with Human Immunodeficiency Virus Treated with Highly Active

Antiretroviral Therapy: an Institutional Study in Indonesia

Manuel Dwiyanto H Lugito, Harum Sasanti, Nia Kurniati, Yuniardini Septorini Wimardhani

Pages 306-311

CLINICAL ARTICLE

8. Prediction Index of Total Blood Testosterone Level in Elderly Men

Maria G Ernawati, Lindawati S Kusdhany, Hanna HB Iskandar

Pages 312-316

CLINICAL ARTICLE

9. Relation between Tooth Loss and Denture Wearing toward Nutritional Status

Melia Felicita, Henni Koesmaningati, Ratna Sari Dewi

Pages 317-321

CLINICAL ARTICLE

10. Association of Maxillary Transverse Discrepancies and Impacted Maxillary Canines in Patients 10 – 25

Years Old

Evy Eida Vitria, Iwan Tofani, Endang Winiati Bachtiar, Lindawati Kusdhany

Pages 322-328


J Int Dent Med Res


CLINICAL ARTICLE

11. Gingival Crevicular Fluid Levels of Resistin and Adiponectinin Chronic Periodontitis with Type 2

Diabetes Mellitus

Natalina, Sri Lelyati C Masulili, Nadhia Anindhita Harsas, Imam Subekti, Elza Ibrahim Auerkari

Pages 329-333

CLINICAL ARTICLE

12. Occlusal Vertical Dimension Index to Simplified Vertical Dimension Measurement

Lindawati S Kusdhany, Muslita Indrasari, Henni Koesmaningati, Max B Leepel, Indriani Oktaria

Pages 334-338

CLINICAL ARTICLE

13. Serotype C and E Streptococcus Mutans from Dental Plaque of Child-Mother Pairs With Dental Caries

Amrita Widyagarini, Heriandi Sutadi, Sarworini B. Budiardjo

Pages 339-344

CLINICAL ARTICLE

14. The Duration of Bracket Detachment at Public Health Center Jakarta and Dental Hospital Universitas

Indonesia

Gina Maringka, Ellyza Herda

Pages 345-350

CLINICAL ARTICLE

15. The LEPR Q223R Polymorphismas a Potential Bioindicator of Class II Malocclusion

Fadli Jazaldi, Endah Dwi Handayani, Yossi Nurul Utami Damayanti, Agoeng Tjahajani Sarwono,

Benny Mulyono Soegiharto, Nurtami Soedarsono, Elza Ibrahim Auerkari

Pages 351-355

CLINICAL ARTICLE

16. The Comparison of Space Closure Rate between Conventional and Passive Self-ligating System Using

Elastomeric Chain in Maxilla

Sabrina, Krisnawati, Benny Mulyono Soegiharto

Pages 356-361

EXPERIMENTAL ARTICLE

17. Mangosteen Extract Inhibits LPS-Induced Bone Resorption by Controlling Osteoclast

Erik Idrus, Bramma Kiswanjaya

Pages 362-367


18. Increased Endothelial Cell Growth in Culture Supplemented with Outdated Human Platelet Lysate

Lisa Rinanda Amir, Endang Winiati Bachtiar, Ria Puspitawati, Agnes Henny Puspitasari, Benita Kurniawan

Pages 368-375


19. Low Resonance Frequency Analyzer (Lrfa) as a Potential Tool for Evaluating Dental Implant

Osseointegration

Ratna Sari Dewi, Laura Susanti Himawan, Sri Angky Soekanto, Lindawati S. Kusdhany

Pages 376-381


20. Exposure of Gel Emulsion Zoledronate Bisphosphonateolive Oil Increase Osteoclast Apoptosis

Dini Anggraini, Retno Widayati, Erni H Purwaningsih, Ahmad Aulia Jusuf

Pages 382-386


J Int Dent Med Res


CASE REPORT

21. Oral Mucosal Burn Caused by Topical Application of 36% Policresulen Solution – A Case Series

Indriasti Indah Wardhany, Yuniardini Septorini Wimardhani, AnandinaIrmagita Soegyanto

Pages 387-391

CASE REPORT

22. The Clinical Management of Nd-YAG LASER Combined with Endodontic Treatment in Localized

Severe Periodontitis Patient: Case Evaluation

Benso Sulijaya, Yuniarti Soeroso, Hari Sunarto, Putie Ambun Suri, Kamizar Nazar

Pages 392-397

CASE REPORT

23. Successful Treatment of Persistent Oral Ulcers in Patients with HIV / AIDS

Ellis Eka Ramadian, Siti Aliyah Pradono, Yuniardini Septorini Wimardhani

Pages 398-402

CASE REPORT

24. Oral Manifestations of Hemolytic Anemia: A Case Report

Istiqamah Yusuf, Anandina Irmagita Soegyanto, Harum Sasanti, Hamzah Shatri

Pages 403-407

CASE REPORT

25. A Rare Case of Ranula on Ventral Surface of the Tongue

Nissia Ananda, Arfan Badeges, Pradono

Pages 408-412

CASE REPORT

26. Root Coverage Treatment in Bilateral Miller’s Class I Using Subepithelial Connective Tissue Graft in a

Smoker Patient

Nadhia Anindhita Harsas, Putri Lenggogeny, Robert Lessang, Antonius Irwan

Pages 413-419

REVIEW

27. A Review of Speech Function and Maxillary Growth in Cleft Palate Patients

Dwi Ariawan, Diah Ayu Maharani, Anton Rahardjo, Iwan Tofani

Pages 420-426

REVIEW

28. The Use of Coral Scaffold in Oral and Maxillofacial Surgery: A Review

Vera Julia, Diah Ayu Maharani, Rahmana Emran Kartasasmita, Benny Sjariefsjah Latief

Pages 427-435

REVIEW

29. Genetic Role in Ameloblastoma: A Systematic Review

Fiona Verisqa, Lilies Dwi Sulistyani, Pradono, Iwan Tofani

Pages 436-440

REVIEW

30. Genes Contributing in Cleft Lip and Cleft Palate: A Literature Review

Stella Lesmana, Elza I. Auerkari

Pages 441-448

Journal of International Dental and Medical Research ISSN 1309-100X Nd-YAG LASER Combined with Endodontic Treatment http://www.ektodermaldisplazi.com/journal.htm Benso Sulijaya, and et al

Volume ∙ 9 ∙ Special Issue (U.I. 1st International Workshop on Dental Research) ∙ 2016 Page 392

The Clinical Management of Nd-YAG LASER Combined with Endodontic Treatment in Localized Severe Periodontitis Patient: Case Evaluation

Benso Sulijaya1*, Yuniarti Soeroso2, Hari Sunarto3, Putie Ambun Suri4, Kamizar Nazar5

1. BDS, DDS, Specialist in Periodontology; Lecturer in Department of Periodontology, Faculty of Dentistry, Universitas Indonesia. 2. BDS, DDS, Specialist in Periodontology, PhD; Senior Lecturer in Department of Periodontology, Faculty of Dentistry, Universitas Indonesia. 3. BDS, DDS, Specialist in Periodontology; Senior Lecturer in Department of Periodontology, Faculty of Dentistry, Universitas Indonesia. 4. BDS, DDS, Specialist in Conservative Dentistry. 5. BDS, DDS, Specialist in Conservative Dentistry; Senior Lecturer in Department of Conservative Dentistry, Faculty of Dentistry, Universitas Indonesia.

Abstract

This report is purposed to provide a holistic perception on treating localized severe periodontitis case. Fifty-five years old male, complaining of recession on his lower incisors #42, #41, #31, #32. Tooth mobility was significantly in buccal-lingual aspects (grade III). Clinical attachment loss (CAL) is up to six mm. Radiograph findings, the height of the alveolar bone loss is up to the apical area. It showed a radiolucent area surround the apical tooth #42 and #32. He is refusing of any tooth extraction. Periodontics, endodontic and dental hygienist was elaborated as a team. The oral hygiene procedure, occlusal adjustment and also temporary splint were performed. Patient had root canal treatment. After evaluation phase, pocket debridement and sulcus conditioning were executed using Nd-YAG LASER. There was a significant enhancement in Bone Density (BD) and Bone Gain (BG). Tooth mobility was reduced. Comprehensive treatment plans are needed to achieve a satisfied long-term result. Case selection is important to give a predictable outcome. Adequate oral hygiene procedure, supportive periodontal therapy (SPT) and periodic recall are required to maintain the result.

Case report (J Int Dent Med Res 2016; 9: (Special Issue), pp. 392-397) Keywords: Nd-YAG, laser, severe periodontitis, periodontal, endodontic. Received date: 28 September 2016 Accept date: 29 October 2016

Introduction Severe periodontitis is characterized by massive destruction of the dental supporting tissues and tooth mobility that leading to tooth loss.1,2 It is almost always accompanied by traumatic occlusion as predisposing factor. The prevalence of severe periodontitis in 2010 has been reported reaching 11.2% of adult population worldwide and 13.1% in South East Asia.3 The incidence of periodontal disease (2012) in Indonesia was informed about 157.485 new cases (18.5%).4 Treating severe periodontitis is a challenge. In some situation, some patient refused to get their hopeless tooth

being extracted. Instead of extract the tooth, they prefer to preserve it. Samet et al. (2009) explained the prognosis classification based on periodontal tissue support, remaining tooth’s structure, endodontic condition, occlusal plane and also tooth position.5 Lang et al. (2015) in his meta-analysis report stated that the result of the periodontal therapy may be individual.6 Recently, non-invasive therapy has developed to approach this situation. New perspective of comprehensive teamwork management could be applied. Minimizing trauma, reducing patient’s anxiety and predictable result are gained with this approach. In order to maintain the long term success of hopeless tooth management, supportive periodontal therapy (SPT) is an take an crucial part.7,8 This report is purposed to provide a holistic perception on treating localized severe periodontitis case.

*Corresponding author:

Dr. Benso Sulijaya, BDS, DDS, Specialist in Periodontology; Lecturer in Department of Periodontology, Faculty of Dentistry, Universitas Indonesia. E-mail: [email protected]



Case Report Fifty-five year old male is complaining of recession on his lower incisor. Patient fells difficulty in biting and fear of tooth loss. The mobility of the incisor tooth was significantly buccal-lingual movement (grade III). Periodontal examination reveals clinical attachment loss (CAL) is about 5-6 mm. From the radiograph findings, the height of the alveolar bone loss is on the apical. There is radiolucent surround the apical of tooth #42 and #32. He is refusing of any tooth extraction. This lower incisor was categorized as a hopeless tooth and diagnosed as severe localized periodontitis inducing by traumatic occlusion. Tooth #31 and #32 had a primary periodontal-secondary endodontic lesion.

The vitality tooth #31 and #32 is non-vital with apical blackening as seen in the radiograph (figure.1). His medical history was observed and he was free of systemic diseases.

Figure 1. First clinical appearance and dental radiograph. Case Management: We do comprehensive teamwork, periodontics and endodontic. The

information about the disease condition, treatment’s option, prognosis, risk of failure and complication was given through the inform consent form and signed by the patient. Oral hygiene procedure, occlusal adjustment and also temporary splint are performed initially (figure 2).

No medication was given to this patient. On this phase, patient was told to perform a good oral hygiene procedure at home. Considering about the blackening appearance on the apical #42 and #32, then we referred it to the conservative department. Patient had a root canal treatment (RCT) on tooth #31 and #32 subsequently. The consideration to did RCT is because the vitality of tooth #31 and #32 were non-vital. It might become worse because there might be some infection spread from periodontal tissue into the pulp tissue leads to pulp necrosis. Even though from the radiograph examination, we note the blackening appearance on the apical tooth #42, but the tooth was vital. Therefore, we just evaluate the vitality of tooth #42. After the evaluation phase, pocket debridement and sulcus conditioning are executed using Nd-YAG LASER (figure 3).

Figure 2. Initial periodontal therapy was performed.



Figure 3. Pocket debridement and sulcus conditioning were executed after endodontic treatment using Nd-YAG LASER.

Nine months after, we evaluate the

condition of gingiva and the mobility of the tooth. Patient shows good oral hygiene maintenance. Dental radiograph display a reducing of apical blackening on tooth #31 and #32 (figure 4).

The patient remains motivated to have a periodically recall periodontal visit. This is aimed to maintain good oral hygiene and also to confirm the long term success of severe periodontitis tooth. Two years follow-up, the periodontal pocket is reduced and the inflammation sign was absent.

Tooth mobility is also decreased. Dental radiograph shows a thickening of cortical bone and increasing of trabecular bone density (figure 5).

Figure 4. Clinical and radiograph appearance nine months after initial treatment.

Figure. 5. Clinical and radiograph appearance

two years after initial treatment.



Discussion

Treating a severe periodontitis tooth is still a controversial issue whether to extract or to preserve it. For some patients, they insist to keep their own tooth rather than change with a denture. As a consequence, the patient had to performed adequate oral hygiene maintenance and to have periodically dental visit. Tooth #32, #31, #41, #42 in this case is characterized as severe localized periodontitis with hopeless prognosis. As seen in figure 1, the dental radiograph shows a massive horizontal bone destruction caused by traumatic occlusion. At the first visit, the patient is explained about the condition and the possibility risk on preserving the tooth. On tooth #32, there is almost no bone left surround the apical area. The ideal treatment plan for this patient would have been extraction of the hopeless tooth followed by removable denture, but keeping in mind the preference of the patient about preserving the tooth rather than extraction. Samet et al. (2009) explained the prognosis classification of this similar case. Based on Samet’s classification, this case was classified as a non-salvageable tooth or ―class x‖ due to less than 30% of alveolar bone support available. According to the Samet’s report, its indication therapy for that tooth is extraction.5 Lang et al. (2015) in his meta-analysis report concluded that the immune response to the periodontal therapy outcomes may be individual and vary amongst periodontitis patients.6 From that report, we may assumed that there might be a periodontal tissue improvement if the patient’s host response was positive to the treatment. Therefore, periodic clinical evaluation and supportive periodontal therapy are important to determine the prognosis for disease progression and the long-term maintenance.9-11

In managing this situation, almost similar management has been done by Rajpal et al (2013).12 He reported the therapy of hopeless tooth due to advanced periodontal disease by extracting the tooth, treating the root canal outside mouth and replanting it back to the socket technique by Lu DP13. Three months follow-up showed the replanted tooth was stable, health gingiva with no present of inflammation.12 In contrast with our case management, we did the root canal treatment inside the mouth without any extraction procedure. In our consideration by did the pocket debridement and sulcus

conditioning using Nd-YAG LASER, it will eliminate the bacterial activity and will directly promote the healing process. Seyyed A et. Al (2012) mention some application of LASER Nd-YAG in periodontology field such as soft tissue incision, ablation, sub-gingival curettage, bacterial elimination, sulcular debridement, melanin pigment removal and also treatment of dentine hypersensitivity.14 Tooth #31 and #32 need non-invasive periodontal therapy that could be given by using Nd-YAG LASER. LASER known has its ability as photo-bio-stimulator in promoting regeneration of fibroblast. Even though there is a severe bone loss, but the use of bone graft is not recommended in this kind of situation. Then use of bone graft as a regenerative material or guided tissue regeneration (GTR) was recommended better in three-wall bony defect or infra bony defect. Kanwal et al. (2014) stated that bone graft needs a vascularization to survive and attract undifferentiated mesenchymal cells and osteoblast.15 In our case, one-wall bony defect might be a challenge in the future to raise or develop a periodontal tissue vertically. Without taking a risk of periodontal tissue collapse due to invasive surgery, then we decided to perform in non-invasive way by Nd-YAG LASER.

Figure 6. Shows the significant improvement of bone density (BD) and bone gain (BG). BD in the apical lower incisors (tooth #41, #42, #31, #32) at baseline compared to 9 months and 24 months-after showed significant improvement of radio-opacity. In harmony with BD, BG in all tooth showed an improvement, especially tooth #32 and #31.

A



Figure 6. Radiograph appearance comparison of lower incisors. (A. Baseline) (B. 9 months-after) (C. 24 months-after).

In order to maintain the long term success of hopeless tooth management, supportive periodontal therapy (SPT) is an important element. It has three goals, which is to prevent recurrence or disease progression in periodontitis patients, to prevent the incidence of tooth loss, and to increase the probability of locating and treating other conditions or diseases in timely manner.7,8 The follow-up study by Hirshfeld et al (1978) has revealed that the SPT will minimize the incidence of tooth loss, he found the tooth loss rate among patient who continue SPT is low (0.09 teeth/patient/year).9 Beside 2-3 months, 3-4 months, 6 months recall visit, the interval of SPT is suggested at least four times a year.10 Moreover, Renvert et al. (2004) explained that the SPT should be individualized to meet the needs of each patient.11 In our case, we advise the patient to follow SPT program every 6 months because the disease progression was reduced significantly.

Javed et al (2015) has investigated the Efficacy of non-surgical periodontal therapy with adjunct Nd:YAG laser among type-2 diabetic patients. He found that Nd-YAG LASER is significantly reduce gingival inflammation and could be served as adjunct therapy for medically compromised patients.16 This particular situation also observed by Brown (2013), that conventional surgical technique could often resulting unpleasant effects, pain or aesthetic problems. The application of LASER for periodontal pocket elimination has been clinically proved will effective in avoiding the bad effect.17

Contrary with previous authors, Romanos (2015) found that there was no significant result in bacterial reduction comparing subjects provided with scaling root planning (SRP) only and those who undergo SRP with Nd-YAG LASER.18 Nguyen et al (2015) has also agree with Romanos where LASER Nd-YAG did not showed significant difference compared to the conventional methods.19 Giannopoulou et al (2012) has studied about levels of several cytokines regarding LASER therapy. He concluded that there was no evidence for a specific diode LASER or photodynamic therapy will enhance the expression of inflammatory mediators.20

Conclusions

There was a significant enhancement of bone density (BD) and bone gain (BG) in lower incisors. Tooth mobility was decreased. Even though the aesthetic outcome in not achieved, the patient is quite satisfied with his result. Comprehensive teamwork (periodontics, endodontic and dental hygienist) are needed to achieve a satisfied long-term result. Even though the treatment of localized severe periodontitis tooth is still a challenge, non-invasive therapy could be appropriate for this case. Case selection is important to give a predictable outcome. Besides, an adequate oral hygiene procedure, SPT and periodic recall are required to maintain the result. Declaration of Interest The authors report no conflict of interest and the article is not funded or supported by any research grant.

B

C



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16. Fawad Javed, Mohammad D. Al Amri, Abdulaziz A. Al-Kheraif, Talat Qadri, Asma Ahmed, Alexis Ghanem, José Luis Calvo-Guirado, Georgios E. Romanos. Efficacy of non-surgical periodontal therapy with adjunct Nd:YAG laser therapy in the treatment of periodontal inflammation among patients with and without type 2 diabetes mellitus: A short-term pilot study. Journal of Photochemistry and Photobiology B: Biology. 2015 (149):230–4.

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Norbert Cionca, Andrea Mombelli. Effect of Photodynamic Therapy, Diode Laser, and Deep Scaling on Cytokine and Acute-Phase Protein Levels in Gingival Crevicular Fluid of Residual Periodontal Pockets. Journal of Periodontology. 2012; 83(8): 1018-27.

http://www.ncbi.nlm.nih.gov/pubmed/?term=Romanos%20G%5Bauth%5D

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