• 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).
Perawatan non bedah
Kontrol diet Terapi
SRP
dan DHE oklusal

Terapi
Splinting
antimikroba
 NONSURGICAL APPROACH
Bisphosphonase
Mechanical Therapy NSAIDS Periostat
Antimicrobial Periostat
Antiseptics
Pocket
Osteoclass And
CAL
Prostaglandins
Bacterial Bone
Products Host Cytokines Resorption
Cells (IL-1, IL-6, TNF) Tooth
Connective Mobility
MMP8 Tissue and
Breakdown Loss

Periostat

Bacterial = Clinical
+ Host Response Component Sequelae
Component

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

Menghilangka
evaluasi n kalkulus

Penyesuain Menghilangkan
oklusi mikroba plak

Koreksi
restorasidan
karies
Nevin, Periodontal therapy., 1998
 Kontrol diet dan DHE
Kontrol plak
• Menghilangkan plak dental
• Mencegah akumulasinya
Edukasi
• Mencegah keparahan penyakit
• Tanggung jawab os
 SRP
Scaling
• Hilangkan plak dan kalkulus
supra dan subgingiva
Root planing
• Penghalusan permukaan akar
dari kalkulus dan sementum
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

Pedoman saat pergerakan mandibula (excursive

movement)

Mobilitas gigi

Atrisi
Hal yang diperhatikan untuk stabilitas
oklusi
ICP

Smooth excursive movements

without interferences

Favorable subjective response to occlusal

form and function

No trauma from occlusion

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

Permanen

Semi Permanen
 • Short term
• Stabilize teeth
Temporary • Periodonta th or traumatic

• Bbrp bulan-tahun
• Observasi respon th
provisional • stabilisasi

• Permanen
• Jar perio yang berkurang
permanent
Hal yang perlu diperhatikan

Etiologi Kontur gigi Morfologi

koronal
mobilotas dan posis embrasure
Lepasan

Fixed / cekat
Survive Right : 5 – 10th
 Temporary splint

A Composite restorative material One of the simplest forms of

may be used on etched enamel to temporary splint is the bite guard.
join the interproximal surfaces of
adjoining teeth.
ekstrakorona
• Bersifat temporary
• Tdk ada preparasi

Intrakorona
• Preparasi kavitas
• Meningkatkan kekuatan dan retensi
 Indikasi
Intrakorona ekstrakorona
• Deep overbite • Ant dengan mobilitas
• Jar perio sehat sedikit moderat
• Akar gigi pendek • Post ortho tanpa mobilitas
• Root amputation & • Stabilitas trauma akut
mobilitas
• Post ortho
• Sosial ekonomi
 Terapi antimikroba
• Lokal / topikal atau sistemik
• Mengkontrol infeksi bakteri
• Single atau kombinasi
golongan Obat Sifat Indikasi
Penicilin Amoxicilin Aktivitas antimikroba, LAP, GAP, MRP, RP
absorbsi oral baik,
sistemik
Augmentin Penilinase mo,
sisitemik
Tetrasiklin Minosiklin Spektrum luas,
sistemik dan lokal
(subgingoval)
Doxycycline Spektrum luas,
sistemik dan lokal,
dosis koeterapi sbh
host modulasi

Tetrasiklin Spektrum luas, lokal

dalm bentuk fiber

Derivative lincomycin Clindamycin Pasien alergi penicilin,

anaerob, sistemik
Quinolon Ciprofloxacin Gram negatif rod,
Nitroimidazole Metronidazole Anaerob, sistemik dan LAP, GAP, MRP, RP, AP,
subgingival (gel) NUG
Perawatan bedah
Tujuan terapi bedah periodontal

Eliminasi
Regenerasi
perubahan Estetis dan
jaringan
patologis fungsional
periodontal
poket
 Prinsip umum bedah periodontal

Persiapan Pencegahan
Persiapan pasien
kegawatdaruratan transmisi infeksi

Sedasi dan Tissue

anestesia management
 Periodontal
SRP Hemostasis
dressing

Instruksi
maintenance
pasca operasi
 Kuretase
Definisi

Indikasi

Prosedur

Proses penyembuhan
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

Pasien immunocopmrimised

Maintenance dan mencegah rekurensi poket

Perbedaan kuret gracey dan universal
 Penyembuhan setelah kuretase

Proliferasi jar Epitelisasi (2-7

Bekuan darah
granulasi hari)

Pembentukan
Serat kolagen
epitel
(21 hari)
junctional
 Gingivektomi
Definisi

Indikasi

Prosedur

Proses penyembuhan
 Eksisi gingiva, mengangkat
dinding poket

Akses dan visibilitas pengambilan

kalkulus, penghalusan akar
Poket supraboni, dinding poket
fibrous dan kenyal

Pembesaran gingiva
 Asepsis dan Penandaan dng
anestesi poket marker

Pembersihan
jaringa granulasi,
Eksisi gingiva
kalkulus,
sementum nekrotik

Penutupan dng
Gingivopasty
dressing
 New conective Fibroblast,
Bekuan darah tissue epitel
(angioblast) berproliferasi

epitelisasi maturasi
 Bedah flap periodontal
Definisi

Indikasi

Prosedur

Proses penyembuhan
Poket infraboni

Poket supraboni yang tidak dapat

terjangkau oleh alat

Bone graft
Teknik flap periodontal

Apically
Modifikasi Undisplaced
displaced
Widman fap
flap
 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
 resesi

Masalah
Jejas gigi Central
pada lidah pada diastema
frenulum

ankyloglossia
Asepsis dan Jepit dng
Insisi
anestesi hemostrat

Insisi Jahit dan tutup

remove
horizontal 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

Repair

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