Seorang pasien laki-laki, usia 27tahun,

mengeluh gigi depannya menjadi tambah

renggang dan kelihatan memanjang
sebelah. Gigi tersebut tidak sakit, tapi terasa
goyang dan kadang ada darah. Pasien juga
mengeluh adanya bau mulut. Pada
pemeriksaan ekstra oral, tidak ditemukan
adanya kelainan, pemeriksaan intra oral,
tampak diastema antara gigi 11 dan 21,
resesi pada gigi 11, gigi 11 goyah derajat 2.
Probing Depth pada gigi 11, 4 mm.
Diagnosis, etiologi???

Perawatan periodontal
drg. Puspito Ratih H MDSc,
Sp.Perio

Periodontal therapy treatment algorithm. BOP. Bleeding on probing; HMT, host modulatory
therapy; OHI, oral hygiene instruction; SPT, supportive periodontal therapy (reinforce OHI,
scaling, antiseptics).

NONSURGICAL
APPROACH
Mechanical Therapy
Antimicrobial
Antiseptics

NSAIDS
Periostat

Bisphosphonase
Periostat

Osteoclass
Bacterial
Products

Prostaglandins
Host
Cells

Cytokines
(IL-1, IL-6, TNF)
MMP8

Pocket
And
CAL

Bone
Resorption
Connective
Tissue
Breakdown

Tooth
Mobility
and
Loss

Periostat
Bacterial
Component

Host Response Component

= Clinical

Sequelae

Points of intervention for nonsurgical therapy. CAL, clinical attachment loss; IL,
interleukin; NSAID, nonsteroidal anti-inflammatory drugs; TNF, tumor necrosis
factor.

Perawatan non bedah

Kontrolantimikroba
SRP
Terapi
Splinting
oklusal
diet dan DHE

Nevin, Periodontal therapy.,

1998

Kontrol diet dan DHE

Kontrol plak

SRP
Scaling

Terapi oklusal

Intercuspal position (ICP): The position of the

mandible when there is maximal intercuspation
between the maxillary and mandibular teeth
Centric occlusion.
Muscular contact position (MCP): The position of
the mandible when lifted into contact from resting
position.

Excursive movement: Any movement of the

mandible away from ICP.

Laterotrusion: Movement of the mandible laterally

to the right or left from ICP working movement.

Laterotrusive side: The side of either dental

arch corresponding to the side of the mandible
moving away
from the midline working side.
Mediotrusive side: The side of either dental arch
corresponding to the side of the mandible
moving toward
the midline balancing side, nonworking
side.

Protrusion: Movement of the mandible

anteriorly
from ICP.
Retrusion: Movement of the mandible
posteriorly from
ICP
Retruded position: The most cranial position of the
mandible along the retruded path of closure
centric relation.

Interference: Any contact, in ICP or excursions,

that
prevents the remaining occlusal surfaces from
achieving
stable contact. Synonym: supracontact.
Guidance: Pattern of opposing tooth contact
during excursive
movements of the mandible.
The teeth makingsuch contact cause separation
of the other teeth disclusion.

Pemeriksaan oklusi intra

oral
Pemeriksaan area kontak ICP

Hal yang diperhatikan untuk

stabilitas oklusi
ICP

Splinting
Imobilisasi gigi, stabilisasi gigi
distribusi daya oklusal, menbantu
penyembuhan, mencegah trauma
Syarat spint iritasi minimal, mudah
dibersihkan, estetik

Temporary

Temporary

Hal yang perlu diperhatikan

FIXED SPLINT

Survive Right : 5
10th

A Composite restorative
material may be used on
etched enamel to join the
interproximal surfaces of
adjoining teeth.

One of the simplest forms

of temporary splint is the
bite guard.

ekstrakorona

Indikasi
Intrakorona

Deep overbite
Jar perio sehat sedikit
Akar gigi pendek
Root amputation &
mobilitas
Post ortho
Sosial ekonomi

ekstrakorona

Ant dengan mobilitas

moderat
Post ortho tanpa
mobilitas
Stabilitas trauma akut

Terapi antimikroba
Lokal / topikal atau sistemik
Mengkontrol infeksi bakteri
Single atau kombinasi

golongan

Obat

Sifat

Indikasi

PEnicilin

Amoxicilin

Aktivitas
antimikroba,
absorbsi oral
baik, sistemik

LAP, GAP, MRP,

RP

Augmentin

Penilinase mo,
sisitemik

Minosiklin

Spektrum luas,
sistemik dan lokal
(subgingoval)

Doxycycline

Spketrum luas,
sistemik dan
lokal, dosis
koeterapi sbh
host modulasi

Tetrasiklin

Spketrum luas,
lokal dalm bentuk
fiber

Derivative
lincomycin

Clindamycin

Pasien alergi
penicilin,
anaerob, sistemik

Quinolon

Ciprofloxacin

Gram negatif rod,

Tetrasiklin

Perawatan bedah

Tujuan terapi bedah periodontal

Prinsip umum bedah

periodontal
Tissue
Persiapan
Pencegahan
Sedasi
management
dankegawatdaruratan
pasien
anestesia
transmisi infeksi

Periodontal
Hemostasis
SRP
Instruksi
maintenance
pasca
dressing
operasi

Kuretase
Definisi

Mengambil/mengerok dinding lateral

poket mengangkat jaringan
granulasi inflamasi
Jaringan granulasi, inflamasi kronis,
kalkulus, koloni bakteri

Mengeliminasi poket, membentuk

perlekatan baru
Tindakan kuretase diawali SRP

Poket infraboni pada area yg mudah terjangkau

Perbedaan kuret gracey dan

universal

Penyembuhan setelah kuretase

Gingivektomi
Definisi

Eksisi gingiva,
mengangkat dinding
poket
Akses dan visibilitas
pengambilan kalkulus,
penghalusan akar

Poket supraboni, dinding poket fibrous da

Bekuan
New
Fibroblast,
maturasi
epitelisasi
conective
darah
epitel
tissue
berproliferasi
(angioblast)

Bedah flap periodontal

Definisi

Poket infraboni

Teknik flap periodontal

Frenectomy
Frenulum lipatan membran
mukosa disertai serat otot yang
mengikat bibir, pipi ke mukosa
alveolar atau gingiva dan
periosteum.
Frenulum masalah terlalu
dekat dengan margin gingiva

Asepsis
Jepit
remove
Insisi
Jahit
dng
dan
horizontal
dan
tutup
hemostrat
anestesi
dng spons

Sistem rujukan

Faktor-faktor Yang Perlu Diperhatikan Dalam Merujuk

Extent of disease: The deeper the pockets,

the stronger the indication for referral.
Root length: Short roots are more seriously
jeopardized by 5 mm of clinical attachment
loss than long roots.
Hypermobility, which suggests a more
guarded prognosis.
Difficulty of scaling and root planing: The
presence of deep pockets and furcations
make local treatment much more difficult.

 Restorative work: Long-term prognosis of the

tooth is an important consideration in planning
extensive restorative work.
Age of the patient: The younger the patient with
extensive
attachment loss, the more aggressive the
disease process is likely to be.
Resolution by shrinkage: Some tissue such as
thick, fibrotic gingiva do not resolve as well as
thinner, edematous gingiva when edema
subsides, leaving deeperprobing depths.

Apa yang terjadi setelah terapi

periodontal?
Regeneration

Daftar Pustaka
Newman, clinical periodontology
Nevile. Periodontal therapy
Sato, atlas cosmetic perio surgery