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Endodontic Care for Patients with Polycythemia: Clinical Considerations and Case Analysis Nugroho, Dian Lestari Putri; Nugraheni, Tunjung; Imandini, Aldila; Rinastiti, Margareta
Majalah Kedokteran Gigi Indonesia Vol 10, No 3 (2024): December
Publisher : Faculty of Dentistry, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/majkedgiind.91425

Polycythemia is a myeloproliferative neoplasm characterized by uncontrolled proliferation of red blood cells due to mutations in early hematopoietic cells, often linked to Janus kinase 2 (JAK2) gene mutations. Polycythemia vera (PV), the primary form of the disease, leads to increased blood viscosity and stasis, raising the risk of thrombotic events such as stroke and myocardial infarction. Secondary polycythemia results from hypoxic conditions, stimulating erythropoietin production. Diagnosis is confirmed through hemoglobin and hematocrit levels, with treatment aimed at reducing thrombosis and hemorrhage risks. Low-risk patients are treated with aspirin and phlebotomy, while high-risk cases may require cytoreductive therapies like hydroxyurea.In our case, a patient presented with necrosis and horizontal bone loss in tooth 36, complicated by polycythemia. Due to the increased risk of bleeding and inflammation, the decision was made to prioritize endodontic treatment, avoiding periodontal surgery. The patient, considered low-risk for PV complications due to the absence of thrombosis history, was managed conservatively. Preoperative coordination with hematologists was essential to optimize hematologic parameters and minimize potential risks.The goal of endodontic treatment was to disinfect and seal the root canal, reducing inflammation in the surrounding periodontal tissues and preventing reinfection. This approach allowed for effective management of the patient's oral condition while minimizing systemic risks. This case highlights the importance of a multidisciplinary approach in managing dental treatment for patients with polycythemia, ensuring both local and systemic complications are effectively addressed.

Fiber reinforced direct composite for endodontic treated tooth in one year follow-up Satrio, Fajar; Mulyawati, Ema; Rinastiti, Margareta
Majalah Kedokteran Gigi Indonesia Vol 11, No 2 (2025): August
Publisher : Faculty of Dentistry, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/majkedgiind.91558

After root canal treatment, tooth will be more fragile due to loss of tooth structure integrity as a result of the caries process, access preparation, reduced water, and or tooth fracture. This is the main consideration for determining the material and restoration technique for endodontic treated tooth (ETT). Fiber reinforcement direct composite can maintain the remaining tooth structure and increase fracture resistance. This case report aims to evaluate the 1-year follow-up of fiber reinforcement direct composite in molar tooth after root canal treatment. The first case was a 28-year-old man, who came to RSGM to maintain his left lower right molar which had been filled for about 10 years. On the radiograph, there was a radiopaque filling to the pulp and apical radiolucency. The results of clinical examination obtained previously initiated therapy, asymptomatic apical periodontitis. The second case, a 27-year-old woman, complained pain on biting in the lower left molar for a week. On the radiograph, there was a radiopaque filling at the occlusal side, a non-hermetic obturation material in the root canals, and apical radiolucency. From the clinical examination, previously treated, symptomatic apical periodontitis was obtained. One-visit endodontic treatment was given followed by a direct restoration with composite resin, short-fiber filler, and fiber ribbond. The endodontic treated tooth restored with fiber reinforcement direct composite obtained good results after 1 year follow-up.

Distal root hemisection of mandibular left first molar with pulp necrosis, bifurcation perforation, and symptomatic apical periodontitis Regina, APrima Vista Okta; Maharani, Cyntia Dewi; Widyastuti, Andina; Rinastiti, Margareta
Majalah Kedokteran Gigi Indonesia Vol 10, No 3 (2024): December
Publisher : Faculty of Dentistry, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/majkedgiind.91794

Hemisection is an endodontic surgery performed by removing one or more roots and existing crown structures to increase the retention of the remaining teeth and to correct defected dental roots that are not possible to maintain. This defect can be caused by pulp tissue or periodontal tissue. Diagnosis of endodontic-periodontal lesions is an essential determinant whether it is due to endodontic or periodontal pathogens. In this case, endodontic treatment needs to be performed in combination with hemisection surgery. The purpose of this case report is to save the tooth with furcation involvement and pulp necrosis, making it perforated on the bifurcation of mandibular first molar. A female patient aged 20 years had a large cavity in tooth 36 with symptomatic apical periodontitis. The tooth was sensitive to percussion test and negative to palpation test, and the mobility was normal. The radiographic feature showed a perforated tooth in the furcation section and furcation involvement. The diagnosis of tooth 36 was pulp necrosis with bifurcation perforation and symptomatic apical periodontitis. The patient received initial treatment, root canal treatment, and obturation on the mesial first molar, then followed by intake of the distal root of the molar. The installation of a prefabricated fiber post in the mesial root of tooth 36 and hemisection surgery were performed on tooth 36. The restoration was done in the form of a full porcelain fused to metal crown on tooth 36 with a splinted crown. Hemisection surgical treatment is a reliable alternative solution and has a good prognosis because it can maintain dental and periodontal tissue as long as possible without tooth extraction.

Management missed canal tooth and broken file using ultrasonic instrument Abiddinda; Agustin, Wandita Swasti; Rinastiti, Margareta; Ratih, Diatri Nari
Dental Journal (Majalah Kedokteran Gigi) Vol. 56 No. 4 (2023): December
Publisher : Faculty of Dental Medicine, Universitas Airlangga https://fkg.unair.ac.id/en

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/j.djmkg.v56.i4.p255-260

Background: Endodontic mishaps, such as missed canal and broken file, are procedural accidents that can affect the prognosis of endodontic treatment. A missed canal can lead to endodontic failure because of bacterial remnants in the root canal. A broken file may cause obstruction of the canal, inhibiting the process of shaping and cleaning. An ultrasonic instrument can be used under a dental microscope to manage a missed canal or broken file fragment. Purpose: This study aimed to show the management of missed canal and instrument separation by endodontic retreatment using an ultrasonic instrument under dental microscope. Case: A 31-year-old female patient presented to Dental Hospital Universitas Gadjah Mada with discomfort from chewing her upper left molar since 2 weeks (January 4, 2022). The tooth was subjected to root canal treatment 2 years ago (November 18, 2019). The percussion test yielded a positive result. The examination of radiographs showed the presence of a broken file in the middle third of the mesiobuccal root canal. Case Management: The first stage of the retreatment was removal of the gutta-percha. This was followed by exploration of the missed canal and retrieval of the broken file using an ultrasonic instrument under a dental microscope. Then, the root canals, including the messiobuccal2 canal, that was missed at the previous treatment, were prepared. The final step was zirconia crown restoration with a fiber post. Conclusion: An ultrasonic device along with a dental microscope can be used to manage a missed canal and instrument separation conservatively.

THE EFFECT SODIUM HYPOCHLORITE 2,5% AND SODIUM THIOSULPHATE AS IRRIGATION ON THE CLEANLINESS OF THE APICAL THIRD ROOT Mahardika, Christina; Kristanti, Yulita; Rinastiti, Margareta
Odonto : Dental Journal Vol 9, No 1 (2022): July 2022
Publisher : Faculty of Dentistry, Universitas Islam Sultan Agung

Background: Sodium hypochlorite produces free oxygen and free radicals that cause damage to dentin collagen. Combination with Sodium thiosulfate with the aim of improving root canal hygiene and restoring the oxidizing effect on the dentin surface.The apical third of the root canal is the most difficult part, due to its narrower anatomy, curvature and frequent branching of the root canal. Method: The study used 30 specimens which were divided into 3 groups, group I was irrigated with 2.5% NaOCl, 5% sodium thiosulfate and saline, group II was irrigated with 2.5% NaOCl, 10% sodium thiosulfate and saline and group III was irrigated with 2.5% NaOCl and saline. The tooth length 14 mm measured from apical to crown. The crown down technique was prepared using the M3 Pro gold file. Observation of the level of cleanliness of the root canal was carried out using a Scanning Electron Microscope (SEM) with 5000x magnification at apical third . The results of micrographic photographs are then given a score of 1-4.Result: Irrigated with 5% and 10% sodium thiosulfate showed no significant difference.Conclusion: The differences is not significant, 2,5% irrigation with sodium thiosulfate resulted in a higher cleanliness apical third of the root canalthan 2,5% NaOCl irigation with saline

Effect of nanofilled self-adhesive protective coating on color changes and surface roughness of composite resin Rinastiti, Margareta; Widyastuti, Andina
Odonto : Dental Journal Vol 10, No 1 (2023): July 2023
Publisher : Faculty of Dentistry, Universitas Islam Sultan Agung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30659/odj.10.1.28-36

Background: Discoloration of composite restorations may affecting aesthetic appearance. The aging-process and surface roughness may influence color changes. A nanofilled self-adhesive protecting coating has been developed for coating tooth restoration and expected to prolong the longevity of restoration. To evaluate the effect of nanofilled self-adhesive protective coating on the surface roughness and color-changes of flowable and packable composite after aging condition. Methods: The total of 40 discs (15x2mm) and 60 boxes (20Ã—10Ã— 2mm) specimens from flowable and packable composite were used. A half of the specimens was coated by using protective-coating. The reflectance chromameter was used to measure the color baseline. Afterward, the specimens were subjected into aging process by immersing in artificial saliva and carbonated drink (37oC,7d). The color changes were calculated based on the [CIE L*a*b*].For surface roughness, box-shaped specimens were measured in fresh condition, after aging conditions. Results: The color change ranged from 0.49 to 2.31. Applying protective-coating was associated with a significant decrease in the color-changes and surface roughness after aging. The changes of three color coordinates resulted in significant differences for both composite, with and without protective coating application. Conclusion: The application of protective-coating decrease the color-changes and surface roughness of flowable and packable composite-resin.

Fiber-reinforced stress reduced direct composites for endodontic treated tooth: a serial case report Erwidawan, Mahar rosa; Satrio, Fajar; Rinastiti, Margareta; Enggardipta, Raras Ajeng
Jurnal Kedokteran Gigi Universitas Padjadjaran Vol 37, No 2 (2025): Agustus 2025
Publisher : Fakultas Kedokteran Gigi Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/jkg.v37i2.58363

Introduction: Endodontically treated teeth (ETT) become more fragile due to the loss of tooth structural integrity as a result of caries, access preparation, decreased moisture content, and/or tooth fracture. These conditions influence the choice of restorative materials and techniques for ETT. Fiber-reinforced, stress-reduced direct composite (FR-SRDC) is a promising approach for restoring ETT because it preserves the remaining tooth structure and enhances fracture resistance. This case report evaluates the use of FR-SRDC in Class II cavities of ETT first maxillary molars with a six-month follow-up. Case Report: Case 1: A 35-year-old woman presented with a complaint of decay under an old filling placed two years ago in the left first maxillary molar, without pain on biting. Radiographic examination revealed a radiopaque filling on the mesio-occlusal surface and leakage marked by radiolucency between the restoration and the tooth structure extending toward the pulp. The diagnosis was pulp necrosis with asymptomatic apical periodontitis. The prognosis was good, considering the absence of pain and asymptomatic presentation. Case 2: A 29-year-old male complaining of decay in the left first maxillary molar and pain on biting for a week. The diagnosis was pulp necrosis with symptomatic apical periodontitis. The prognosis was fairly good, but required attention due to pain. Treatment for both cases consisted of root canal treatment (RCT) followed by restoration with FR-SRDC. The six-month follow-up showed good results for both cases, demonstrating the effectiveness and durability of fiber-reinforced, stress-reduced direct composite restorations. Conclusion: Fiber-reinforced, stress-reduced direct composites appear to be an effective restorative option for class II cavities in endodontically treated first maxillary molars, yielding favorable results over a six-month follow up period.Restorasi direk komposit dengan penguat fiber pada gigi pasca perawatan saluran akar: laporan kasus berserialPendahuluan: Gigi yang telah dirawat endodontik (ETT) menjadi lebih rapuh karena hilangnya integritas struktur gigi akibat karies, preparasi akses, berkurangnya kadar air, dan/atau fraktur gigi. Kondisi ini menentukan pilihan bahan dan teknik restorasi ETT. Komposit direk pengurangan stres yang diperkuat fiber (FR SRDC) adalah pendekatan yang baik untuk ETT karena akan mempertahankan struktur gigi yang tersisa dan meningkatkan ketahanan fraktur. Laporan kasus ini mengevaluasi penggunaan FR SRDC pada kavitas kelas II ETT molar pertama rahang atas dengan tindak lanjut 6 bulan. Laporan Kasus: Kasus 1: Wanita 35 tahun mengeluhkan kerusakan di bawah tambalan lama 2 tahun yang lalu pada molar pertama rahang atas kiri, tanpa rasa sakit saat menggigit. Pemeriksaan radiografi menunjukkan tambalan radiopak pada mesio-oklusal dan kebocoran tambalan yang ditandai dengan radiolusensi antara tambalan dan gigi hingga ke pulpa. Diagnosis: nekrosis pulpa, periodontitis apikal asimptomatik. Prognosis: Baik, mengingat tidak adanya rasa sakit dan kondisi asimptomatik. Kasus 2: Pria 29 tahun mengeluhkan kerusakan pada molar pertama rahang atas kiri dan rasa sakit saat menggigit selama seminggu. Diagnosis nekrosis pulpa, periodontitis apikal simptomatik. Prognosis cukup baik, namun memerlukan perhatian karena adanya rasa sakit. Indikasi perawatan untuk kedua kasus: Perawatan saluran akar (PSA) diikuti dengan FR SRDC. Tindak lanjut 6 bulan menunjukkan hasil yang baik untuk kedua kasus, mendemonstrasikan efektivitas komposit langsung pengurangan stres yang diperkuat serat. Simpulan: Komposit direk pengurangan stres yang diperkuat fiber dapat menjadi pilihan yang efektif pada kavitas kelas II gigi yang telah dirawat endodontik pada molar pertama rahang atas dengan hasil yang baik selama periode 6 bulan

Effect of nanofilled self-adhesive protective coating on color changes and surface roughness of composite resin Rinastiti, Margareta; Widyastuti, Andina
Odonto : Dental Journal Vol 10, No 1 (2023): July 2023
Publisher : Faculty of Dentistry, Universitas Islam Sultan Agung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30659/odj.10.1.28-36

Background: Discoloration of composite restorations may affecting aesthetic appearance. The aging-process and surface roughness may influence color changes. A nanofilled self-adhesive protecting coating has been developed for coating tooth restoration and expected to prolong the longevity of restoration. To evaluate the effect of nanofilled self-adhesive protective coating on the surface roughness and color-changes of flowable and packable composite after aging condition. Methods: The total of 40 discs (15x2mm) and 60 boxes (20Ã—10Ã— 2mm) specimens from flowable and packable composite were used. A half of the specimens was coated by using protective-coating. The reflectance chromameter was used to measure the color baseline. Afterward, the specimens were subjected into aging process by immersing in artificial saliva and carbonated drink (37oC,7d). The color changes were calculated based on the [CIE L*a*b*].For surface roughness, box-shaped specimens were measured in fresh condition, after aging conditions. Results: The color change ranged from 0.49 to 2.31. Applying protective-coating was associated with a significant decrease in the color-changes and surface roughness after aging. The changes of three color coordinates resulted in significant differences for both composite, with and without protective coating application. Conclusion: The application of protective-coating decrease the color-changes and surface roughness of flowable and packable composite-resin.

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