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TEHNIK EKSODONSI

METODA TERBUKA
Aries Muharram drg, Sp.BM &
Maksilofasial

Pendahuluan
Pencabutan Gigi pada kasus sulit
diartikan sama dengan pencabutan
gigi dengan metode
terbuka/pembedahan,karena dengan
tehnik simple extraction sulit
berhasil/menimbulkan resiko.
Tehnik pencabutan ini relatif simple &
masih dalam lingkup wewenang
general practisioners jika prinsipprinsip bedah dipatuhi.(Fragiskos,2007)

pendahuluan
Pencabutan dgn open methode akan menjadi
lebih konservatif dan mengurangi morbiditas
dibanding closed methode bila dimungkinkan.
Pencabutan dgn forceps techniques akan
memerlukan kekuatan lebih besarfraktur
gigi/tulang alv/tlng dsr sinus.
Kerusakan tulang bisa dikurangi dgn
pembuatan flap,pengambilan sedikit tulang
dan pemotongan akar menjadi beberapa
bagian.

INDIKASI

(Howe)

1. Retensi pada tindakan pencabutan sederhana


2. Sisa akar yang tidak dapat di keluarkan baik
dengan tang ataupn elevator.
3. Adanya riwayat kegagalan pencabutan
4. Gigi dengan restorasi yang luas
5. Hipersementosis dan ankilosis.
6. Geminasi
7. RO: Arah/disai akar yang tidak searah
dengan keluarnya gigi
8. Kasus immediate denture.

.indikasi
Sisa akar akibat pencabutan gigi yang patah.
Gigi posterior rahang atas dimana akarnya
sangat dekat dengan sinus maxilaris.
Akar gigi yang tertanam dalam tulang
rahang.
Akar gigi dg lesi periapikal yang tak bisa
dikuret.
Gigi molar sulung yg akarnya membungkus
mahkota gigi permanen penggantinya.
Gigi posterior dengan supraeruption.

..Indikasi.
Morfologi Akar yang Abnormal

Teeth with unusual root morphology. Surgical


technique
is indicated for removal.

Indikasi
Hypercementosis Akar

Hypercementosis of root of
mandibular second
premolar

Radiograph showing maxillary


premolar with
hypercementosis at root tip

Indikasi
Ujung Akar Bengkok

Root tips of first and second premolar, with nearly


right-angle curvature compared to long axis of
teeth.

Indikasi.
Dens in Dente

Dens in dente of maxillary left canine

Indikasi
Gigi Impaksi

Semi-impacted mandibular third molar. Surgical


technique is indicated for removal

Indikasi
Gigi Fusi

a Panoramic radiograph, showing fusion of two


mandibular premolars. b The same fused teeth
after

Maxillary second molar for which the surgical


technique is indicated for removal. During the
procedure the third molar would be removed as
well, due to fusion of the two teeth in the apical

Indikasi
Akar Gigi Patah

Radiograph showing root tips of mandibular third


molar,which are close to the mandibular canal.

Indikasi
Akar Gigi Dekat Dengan Sinus

Pneumatization of the maxillary sinus into the


alveolar process of the edentulous area
corresponding to the maxillary first molar.

Indikasi
Akar Gigi Tertanam Dalam
Tulang

Radiograph showing the


mesial root of the mandibular
first molar, entirely covered by
bone

Roots of maxillary and


mandibular molars
completely
covered by bone

Indikasi
Akar Gigi dg Lesi Periapikal yg
Tidak bisa Dikuret.

Radiograph showing roots with large periapical


lesions. Their removal is only possible with the surgical
technique

Indikasi
Akar Gigi Sulung Membungkus
Mahkota Gigi Permanen
Penggantinya.

Deciduous mandibular molar, whose roots embrace the


crown of the succedaneous premolar. Risk of concurrent
luxation with the simple extraction technique

Kontra Indikasi
Fraktur akar yang tidak ada keluhan
dari gigi yang masih vital dan
terletak dalam.
Ada resiko komplikasi lokal
perforasi sinus,kerusakan nervus alv.
Inferior/ n. lingualis/n. mentalis.
Problem kesehatan umum penderita
yang serius.

ASEPSIS
Mengendalikan kontaminasi selama tindakan
bedah
Operator

Pasien

Sterilisasi alat.
Pemakaian Baju
bersih
Cuci tangan
Theathre dress
(Gowning) .

Tindakan asepsis pada


penderita
Drapping

ZONA STERIL DI RUANG


OPERASI
DRAPPING
Tujuan :
mempersempit
lapangan pandang
operasi dengan duk
steril

BAJU
BERSIH

Tutup kepala
Google/shield
Masker
Kemeja bersih
Baju bersih
Alas kaki
tertutup

SURGICAL GOWN(Pada pasien


bedah minor/ Operator R Operasi
mayor)

Tindakan minor
Kasus khusus

Baju operator infeksi


(HIV)C

ARMAMENTARIUM
EKSODONSI METODA
TERBUKA

a. Killner cheek retraktor


b. Minnesota retraktor
c. Tongue depressor/retraltor
d. Fine tip suction.
e. Rubber Bite block/mouth prop
f. Suction tip besar (Yankeur)
g. Nier becken
h. Botol Spooling
i. Syringe
j. Handle scalpel
k. Rasparatorium
l. Duck klem
m.Ronger forcept
n. Chisel
o. Hammer/ O mallet
p. Wire cheeck retractor
q. Pinset anatomis
r. Bone file
s. Gunting
t. Pinset cirurgis
u. Nedle holder
v. Pinset dental
w. Curretage

Mouth Prop / Mouth Gag

Minesota

Rasparatorium

Curretage

Tang Knabel

Bone file

Spuit/Spooling

Suction tip

Arteri Klem

Pinset

Needle Holder

Klem Ellis

Tehnik Pencabutan.
Tehnik Pencabutan gigi akar tunggal
maupun ganda sama.
Pembuatan flap.
Pengambilan tulang
secukupnyaakar kelihatan(1-2 mm).
Pencabutan menggunakan bein atau
dengan tang.
Luka ditutup dengan dijahit.

Steps in the surgical extraction of an intact maxillary first


molar. Reflection of the envelope flap, sectioning of two
buccal roots from the crown (a), removal of the crown
together with the palatal root, and then finally removal of
themesial and distal roots (b)

Tehnik Pencabutan Mahkota


Masih Utuh.
Akar Ganda.
Pembuatan flap.
Pengambilan tulang secukupnya pada bagian
bukal dengan round bur sejauh bifurkasi.
Akar mesial dan distal dipotong dan
dipisahkan dengan menggunakan fissure bur.
Mahkota dan akar palatinal dicabut bersamasama.
Masing-masing akar mesial-distal dikeluarkan
dengan bein/tang sisa akar yang kecil.

Tehnik Pencabutan Akar Dengan Hypercementosis

Diagrammatic illustrations showing the steps in the surgical


extraction of a single-rooted tooth with hypercementosis at
the root tip. An L-shaped incision is made and the flap is
reflected.
The buccal plate covering the surface of the root is
removed, and the tooth is extracted using forceps

Surgical extraction of a mandibular molar


with hypercementosis at the distal root tip. The envelope
flap is reflected, part of the buccal plate is removed, and
the
tooth is sectioned buccolingually at the crown as far as the
intraradicular bone

Extraction of the mesial portion of the tooth,


Which includes the crown and root.

Widening of the alveolus with a round bur, so


that removal of the root is possible without
fracturing the bulbous root tip

a. Extraction of the distal portion of the tooth using


forceps after creating a pathway for removal.
b. Suturing of the flap using interrupted sutures

Pencabutan Gigi Molar Sulung


Yang Memeluk Mahkota Gigi
Permanen Pengantinya.

Deciduous molar, whose roots embrace the crown


of the succedaneous premolar

Envelope flap created and bone removed as far as the


root bifurcation
Roots of themolar sectioned with a perpendicular
groove on the crown, which extends as far as the
intraradicular
Bone.

Removal of the distal portion of the tooth, which


includes the crown and root, using forceps.
Removal of the mesial portion of the tooth, which
includes the crown and root

Suturing of the flap with interrupted


sutures

Pencabutan Gigi Ankylosis


Pada kasus gigi ankylosis, apalagi
juga ditemukan dental
dysplasia(dens in dente).
Pada kasus ini tidak mungkin bisa
simpl. Extr. fraktur tulang bukal.

Tehnik Pencabutan Gigi


Ankylosis.
Buat flap bentuk trapesium .
Tulang bukal sekitar diambil dengan
fissure bur.
Dengan chisel gigi dan bagian tulang
yang ankylosis diambil bersamasama.
Soket ditutup dengan dijahit.

Radiograph (a) and clinical photograph (b)


of a maxillary canine with dens in dente. A
surgical technique is indicated for its removal.
Flap is created, which extends A trapezoidal
from the lateral incisor as far as the distal
aspect of the maxillary first premolar.

Use of a chisel to remove the tooth, together


with the ankylosed portion of the labial plate
Operation site after placement of sutures
Tooth after removal, with a portion of bone
on
the labial surface

EKSODONSI TERBUKA
PADA SISA AKAR

a. Small portion of the buccal plate is removed and


a groove created at the surface of the root, at a
45 angle to the long axis of the tooth.
b. Placement of the double-angled elevator in the
purchase point of the root for luxation.

a. Groove created between the root and


buccal bone for elevator placement.
b. Luxation of the root with angled Seldin
elevator

DENGAN TEHNIK SEPARASI

Radiograph of roots of the mandibular first molar.The


surgical technique is indicated for their removal

Clinical photograph

Diagrammatic illustration (a) and clinical


photograph (b) showing the creation of an
envelope flap to expose the roots

Diagrammatic illustration (a) and clinical photograph (b)


showing the removal of the buccal plate as far as
the root bifurcation. Roots are separated using a fissure bur
in the buccolingual direction

Luxation of roots after sectioning.


a. Diagrammatic illustration. b. Clinical
photograph

PENGAMBILAN UJUNG
AKAR

TEHNIK JENDELA (WINDOW)

Radiograph of the root of a maxillary first premolar. The


open window technique on buccal alveolar bone is indicated
for its extraction

Clinical photograph

Final step in root extraction from the


socket.
Operation site after placement of
sutures

DALAM SINUS

DALAM SINUS

TEKNIK TIDAK DIANJURKAN

a. Removal of the buccal plate along the length of


the root using a round bur. b. The root is exposed
after bone
removal. This technique is employed in caseswhere
ankylosis is present along the entire root surface

TEHNIK PENUTUPAN
LUKA

LAPORAN

Data pasien.
Waktu + lama pembedahan.
Orang yang terlibat.
Diagnosa.
Kegiatan Perioperative.
Gambar/denah (Sebelum/insisi/penutupan)
luka.
Prosedur
(Pra/perioperative/therapy/medikamentosa)
Tanda tangan operator.

PERAWATAN PASKA OPERASI


Evaluasi perdarahan.
Hindari lepasnya
bekuan darah.
Hindari jejas pada luka
Diet lunak tinggi kalori
dan protein.
Jaga OH
Kontrol infeksi
Lepas jahitan hr 5-7
bila tanda keradangan
mereda

SEKEDAR MENGERTI
TIDAKLAH MEMBUAT
SESEORANG SUKSES
HANYA DENGAN
TINDAKANLAH
SESEORANG MULAI
MENGGAPAI KESUKSESAN
DIRI SENDIRI