Penatalaksanaan diskolorisasi gigi pasca perawatan endodontik dengan teknik walking bleachManagement of post-endodontic tooth discolouration with the walking bleach technique

Abstract

Pendahuluan: Diskolorisasi gigi setelah perawatan endodontik dapat disebabkan oleh bahan pengisi saluran akar. Bahan endodontik yang tertinggal di dalam kamar pulpa akan menginfiltrasi tubulus dentin sehingga menyebabkan pewarnaan. Diskolorisasi intrinsik akibat bahan pengisi saluran akar seringkali terlihat pada sepertiga servikal gigi yang telah dirawat endodontik. Walking bleach merupakan teknik bleaching internal yang digunakan pada kasus diskolorasi pasca perawatan endodontik. Tujuan laporan kasus ini adalah memaparkan tentang penatalaksanaan diskolorisasi gigi pasca perawatan saluran akar dengan teknik walking bleach. Laporan kasus: Pasien perempuan berusia 20 tahun datang ke RSGM Unpad dengan keluhan gigi depan atas kiri berwarna kecoklatan dan mengganggu penampilan. Pemeriksaan klinis menunjukkan gigi 21 terdapat tumpatan komposit pada mesiobukal disertai diskolorisasi intrinsik dengan warna kecoklatan tampak dominan pada daerah servikal. Hasil tes vitalitas, perkusi dan palpasi negatif. Pemeriksaan radiologis menunjukkan gambaran radiopak menyerupai bahan pengisi saluran akar dari kamar pulpa hingga 2/3 panjang saluran akar. Diagnosis pada kasus ini adalah Previously Treated gigi 21. Perawatan ulang saluran akar dilakukan dan diikuti prosedur bleaching internal dengan teknik walking bleach. Gutta-percha dihilangkan 3 mm di bawah orifice kemudian dibuat barrier semen glass ionomer. Pasta H₂O₂ 35% diletakkan diatas barrier lalu ditutup tumpatan glass ionomer. Setelah 1 minggu didapatkan warna yang sesuai, kalsium hidroksida diaplikasikan pada kamar pulpa. Gigi direstorasi dengan resin komposit 2 minggu kemudian. Aplikasi pasta H₂O₂ 35% dengan teknik walking bleach terbukti dapat mengembalikan warna gigi tersebut. Simpulan: Teknik walking bleach merupakan salah satu pilihan perawatan yang dapat mengatasi diskolorisasi intrinsik pada gigi non vital pasca perawatan endodontik secara efektif.

Kata kunci: Diskolorisasi intrinsik, bleaching internal, teknik walking bleach.

ABSTRACT

Introduction: Tooth discolouration post-endodontic treatment can be caused by root canal filling materials. The endodontic material left in the pulp chamber will infiltrate the dentinal tubules, thus causing staining. Intrinsic discolouration due to root canal filling is frequently seen in an endodontically-treated third cervical. Walking bleach is an internal bleaching technique used in post endodontic discolouration cases. The purpose of this case report was to describe the management of post-endodontic root canal discolouration with the walking bleach technique. Case report: A 20-year-old female patient came to Universitas Padjadjaran Dental Hospital (RSGM Unpad) with complaints that her maxillary anterior left teeth were brownish and disturbing her appearance. Clinical examination showed that tooth 21 had a mesiobuccal composite fill with intrinsic discolouration, in which the brownish colour was appearing predominantly in the cervical area. Vitality, percussion and palpation test results were negative. Radiological examination showed a radiopaque image resembling a root canal filling material from the pulp chamber to two-thirds of the root canal length. The diagnosis was previously treated tooth. Root canal re-treatment was carried out and followed by an internal bleaching procedure using the walking bleach technique. The gutta-percha was removed 3 mm below the orifice, and a glass ionomer cement barrier was made. 35% H2O2 paste was placed above the barrier and then covered with a glass ionomer spill. After one week of obtaining the appropriate colour, calcium hydroxide was applied to the pulp chamber. The tooth was restored with composite resin two weeks after. The application of 35% H2O2 paste using the walking bleach technique was proven to be able to restore the teeth colour. Conclusion: The walking bleach technique is one treatment option that can effectively treat intrinsic discolouration of non-vital teeth post-endodontic treatment.

Keywords: Intrinsic discolouration, internal bleaching, walking bleach technique.