Successful regenerative approach with direct pulp capping using mineral trioxide aggregate after pulpal injury 2 years follow-up: Case report
Abstract
ASBTRAK
Introduction: A complete excavation of dental caries can accidentally expose the pulp. Pulp exposure should be sealed immediately to maintain pulp vitality and heal after injury, called direct pulp capping. Direct pulp capping can stimulate the formation of dentinal bridgess to maintain pulp vitality after injury using biomaterial agents The objective of this case report is to demonstrate the efficacy of regenerative endodontic approach, specifically direct pulp-capping therapy using mineral trioxide aggregate, in treating the injury with a six-month follow up. Case report: A 19-year-old female complained of slight discomfort while drinking cold water on her right second incisor. Clinical examination revealed proximal dentin caries. Vitality and percussion tests were negative. Radiograph examination showed a radiolucent area on the mesial proximal part that affected both enamel and dentin. The tooth was diagnosed with reversible pulpitis. The area was isolated with a rubber dam. Dentin caries was removed using the rotary instrument. In the process, the pulp cavity was exposed iatrogenically at one site with minor bleeding, so direct pulp capping was applied to maintain pulp vitality. The cavity was disinfected with chlorhexidine 2%. Mineral Trioxide Aggregate (MTA) was selected as the material for direct pulp capping. Initially, it was administered to the exposed pulp, succeeded by the application of glass ionomer cement and temporary restoration. Two years follow-up, positive vitality and negative percussion test results were observed. X-rays showed the formation of hard tissue, and there were no pathological findings in the apical on tooth #12. Conclusion: When pulp is exposed due to deep caries, endodontic regenerative methods involving biomaterial agents can be employed. MTA has the capacity to encourage the formation of dentinal bridges and promote pulpal regeneration following an injury.
Kata kunci
dental caries, direct pulp capping, mineral trioxide aggregate, pulpal injury, pulp regeneration
Keberhasilan kaping pulpa direk menggunakan mineral trioxide aggregate paska injuri 2 tahun follow-up: laporan kasus
ABSTRACT
Pendahuluan: Ekskavasi lesi karies dentin yang dalam secara tidak sengaja dapat menyebabkan eksposur pada pulpa. Jika eksposur pulpa terjadi, pulpa perlu dilapisi dengan segera untuk menjaga vitalitas pulpa dan regenerasi kembali setelah terjadi injuri yang disebut dengan kaping pulpa direk. Kaping pulpa direk dapat menstimulasi formasi jembatan dentin untuk menjaga vitalitas pulpa pasca injuri dengan suatu bahan biomaterial. Tujuan laporan kasus ini menunjukkan keberhasilan pendekatan regeneratif endodontik dengan perawatan kaping pulpa direk menggunakan mineral trioxide aggregate pasca injuri dengan 6 bulan follow-up. Laporan kasus: Pasien perempuan berusia 19 tahun mempunyai keluhan ada rasa ngilu yang ringan saat minum air dingin pada gigi depan kedua sebelah kanannya. Pemeriksaan klinis terdapat karies dentin pada bagian proximal. Tes vitalitas dan perkusi negatif. Pemeriksaan radiografi menunjukkan daerah radiolusen pada proksimal bagian mesial yang mengenai enamel dan dentin. Gigi tersebut didiagnosa dengan pulpitis reversibel. Daerah kerja diisolasi dengan rubber dam. Saat melakukan ekskavasi karies secara iatrogenik pulpa terbuka dengan titik perdarahan kecil dalam kavitas, perawatan kaping pulpa direk dipilih dalam mengatasi masalah tersebut. Kavitas di desinfeksi dengan larutan chlorhexidine 2%. Mineral Trioxide Aggregate (MTA) dipilih sebagai bahan biomaterial kaping pulpa direk. Setelah dua minggu pasca perawatan, restorasi akhir dilanjutkan dengan restorasi resin komposit. Pemeriksaan berkala 2 tahun paska perawatan, tes vitalitas dan perkusi negatif. Pemeriksaan radiografi terlihat formasi jaringan keras dan tidak terlihat adanya kelainan periapikal pada gigi #12. Simpulan: Pendekatan regeneratif endodontik dengan kaping pulpa direk, dapat diterapkan dalam perawatan pulpa yang terkena injuri saat ekskavasi karies dentin yang dalam. Penggunaan MTA dapat menstimulasi formasi jembatan dentin dan regenerasi pulpa setelah injuri
Key words
injuri pulpa, kaping pulpa direk, karies dentin, mineral trioxide aggregate, regenerasi pulpa
Keywords
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DOI: https://doi.org/10.24198/jkg.v36i4.49194
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