Terapi LSTR Suatu Paradigma Baru

Dalam Perawatan Pulpa Infeksi:

Drg. Anton Rahardjo, MKM, PhD

(Departemen Ilmu Kesehatan Gigi Masyarakat & Kedokteran Gigi Pencegahan
Fakultas Kedokteran Gigi-Universitas Indonesia)

DEPOK DONTIA 2007

PENDAHULUAN

Wah ,
cabut
saja ya

Masalah
Kesehatan Gigi
Masyarakat
Masalah tenaga
kesehatan gigi yg
terbatas
Masalah teknologi
kedokteran gigi
Anton Rahardjo, 2007

Harapan
Target WHO thn 2000 separuh dari anak
usia 5-6 tahun bebas caries.
60 s/d 90% murid SD menderita karies?
Angka pencabutan menurun, ratio tambalcabut meningkat (Target nasional 1:1)
20% lansia umur 80 tahun mempunyai 20
gigi yg berfungsi baik.
Kualitas hidup tinggi shg produktifitas
meningkat.
Anton Rahardjo, 2007

Kenyataan
Angka kehilangan gigi
karena karies cendrung
meningkat
Tenaga kesehatan gigi jauh dari memadai
Pelayanan yang diberikan tidak memenuhi
kebutuhan masyarakat banyak
Pencabutan

>

Penambalan
Anton Rahardjo, 2007

Anton Rahardjo, 2007

Anton Rahardjo, 2007

Ekstraksi gigi pilihan utama

Pasien datang ke Puskesmas pd umumnya dg
karies yg sudah lanjut.
Pasien tdk percaya giginya akan sembuh kecuali
di cabut.
Perawatan endodontik cakupannya terbatas dan
hanya utk org mampu di perkotaan. Tdk tepat
guna utk pelayanan di PKM karena multiple visit.
Prevalensi kehilangan gigi meningkat, yg pd
gilirannya mempengaruhi keadaan umum pasien.

Anton Rahardjo, 2007

Kegiatan Balai Pengobatan

Gigi di PUSKESMAS ?

PUSKESMAS
KELILING ???

A missing tooth/teeth will affect:

Your dental health: Teeth that are around the missing tooth area will
"drift" into this empty space resulting in chewing, biting and joint
problems
Your nutritional well-being: leading to poor nutritional health
Your physical health: with jaw and joint problems and pain
Your speech: Your teeth help you speech clearly and distinctly
Your bite: by increasing the risk of fracturing a tooth/teeth due to their
misalignment
Oral hygiene: The drifting teeth become crooked and misaligned making
them more prone to decay because they are harder to keep clean
Your budget. It is more affordable to treat the tooth in need than to
replace the tooth/teeth with a bridge, implant or denture
Time. It can be more time consuming to replace a tooth/teeth than to
repair them
Once a tooth is taken out the bone becomes less dense and begins to shrink
making it harder to put in any type of a replacement.
Your appearance will also change: Shrinkage in the jaw bones will cause
your facial structure to change leading to hollow checks thus aging and
wrinkling your face
Anton Rahardjo, 2007

SAVE YOUR TEETH,

CHANGE YOUR LIFE
Good dental function is significantly associated with ...
better brain function,
better vision,
better hearing,
better lung volume,
better heart volume,
better muscle strength,
better bone mineral content,
less heart attacks,
and longer life.
(SOURCE: British Medical Journal--1989)
(Community Dental Oral Epidemiology--1990)
Your Jaws ~ Your Life (page 30)
Anton Rahardjo, 2006

Changing levels of dental caries experience (DMFT) among 12year-olds in developed and developing countries

Anton Rahardjo, 2006

Lesion Sterilization and Tissue

Repair Theraphy*
Biocompatible sterilization Eradikasi bakteri utk
sterilisasi optimal dg AB.
Soft and hard Tissue repair No inflammation
(soft tissue) & Reminarilzation (hard tissue)
Preserve the natural teeth < Preparasi minimal >
Adhesive restorative material
Patient Friendly options
*Dikembangkan oleh Cariology Reserch Unit di Niigata University,

Anton Rahardjo, 2006

Sterilisasi Vs Obturasi

Kesulitan Lain dalam obturasi

saluran akar

Gigi dengan infeksi pulpa

Terapi : Endodontik

Terapi : Lesion Sterilization & Tissue

Repair 3Mix-MP

Research

Research

? ? ? ? ? ? ?Research ? ? ? ? ? ? ?

Development of LSTR 3Mix-MP

Evident Based
RCTs, Meta-analysis
Identifikasi
Bakteri
oral.

Pemilihan dan
Uji drug
vehicle
delivery

Cohort
studies, etc

Cases
reported

Hipotesis
Kerangka
Konsep
Uji sensitifitas AB
thp ber-macam2
bakteri oral.

Macrogol

Clinical
study

3Mix-MP
1970

Expert
opinion

Review
article

------------------------------------------------------------------------- 1987 -------2006-- -------------------------------Anton Rahardjo, 2006

Lesion Sterilization and Tissue

Repair Theraphy*
3 Antibiotik

3Mix-MP: Pasta Antibiotik sbg bahan

sterilisasi yg terdiri dari:
Mortal &
Pastel

Set 3Mix-MP

Metronidazol, Minocycline dan Ciprofloxacine

dg perbandingan 1:1:1 dicampur dg Macrogol
dan Propylene Glycol.

Restorasi: Persyaratan utama adalah yi: Tidak

ada microleakage/kebocoran micro.
Bonding Amalgam atau Direct Inlay dg
komposit Resin.

Peralatan lain

BAHAN MP
MACROGOL
SB

PROPYLENE
GLYCOL

Anton Rahardjo, 2006

Disinfection of Immature Teeth with a Triple Antibiotic

Paste.
Journal of Endodontics. 31(6):439-443, June 2005.
Windley, William III DDS, MS; Teixeira, Fabricio DDS, MSc, PhD; Levin,
Linda DDS, PhD; Sigurdsson, Asgeir DDS, MS; Trope, Martin DMD

Abstract:
This study assessed the efficacy of a triple antibiotic paste in the
disinfection of immature dog teeth with apical periodontitis. The
canals were sampled before (S1) and after (S2) irrigation with 1.25%
NaOCL and after dressing with a triple antibiotic paste (S3), consisting
of metronidazole, ciprofloxacin, and minocycline. At S1, 100% of the
samples cultured positive for bacteria with a mean CFU count of 1.7 x
108. At S2, 10% of the samples cultured bacteria-free with a mean
CFU count of 1.4 x 104. At S3, 70% of the samples cultured bacteriafree with a mean CFU count of only 26. Reductions in mean CFU
counts between S1 and S2 (p < 0.0001) as well as between S2 and S3 (p
< 0.0001) were statistically significant. These results indicate the
effectiveness of a triple antibiotic paste in the disinfection of immature
teeth with apical periodontitis.

Disinfection of Immature Teeth with a Triple Antibiotic

Paste.
Journal of Endodontics. 31(6):439-443, June 2005.
Windley, William III DDS, MS; Teixeira, Fabricio DDS, MSc, PhD; Levin,
Linda DDS, PhD; Sigurdsson, Asgeir DDS, MS; Trope, Martin DMD

Abstract:
This study assessed the efficacy of a triple antibiotic paste in the
disinfection of immature dog teeth with apical periodontitis. The
canals were sampled before (S1) and after (S2) irrigation with 1.25%
NaOCL and after dressing with a triple antibiotic paste (S3), consisting
of metronidazole, ciprofloxacin, and minocycline. At S1, 100% of the
samples cultured positive for bacteria with a mean CFU count of 1.7 x
108. At S2, 10% of the samples cultured bacteria-free with a mean
CFU count of 1.4 x 104. At S3, 70% of the samples cultured bacteriafree with a mean CFU count of only 26. Reductions in mean CFU
counts between S1 and S2 (p < 0.0001) as well as between S2 and S3 (p
< 0.0001) were statistically significant. These results indicate the
effectiveness of a triple antibiotic paste in the disinfection of immature
teeth with apical periodontitis.

Kemampuan Propylene Glycol dalam penetrasi keseluruh jaringan

dentin dalam detik

Restorasi
z Syarat:

Tight sealing, non microleakage dan

merangsang remineralisasi.
z Jenis Restorasi
z
z
z

ART atau MRT

Bonding Amalgam
Direct Inlay

z Tehnik:

Press finger, sandwich, baldwin dan

full-press.
Anton Rahardjo, 2006

Untuk UKGS atau Puskesmas

dg peralatan terbatas
z ART

= Atraumatic Restorative Treatment

Dengan Glass Ionomer Filling

z MRT

= Manually Restorative Treatment

(Bela Monse dkk)
Dengan Amalgam Filling

Keberhasilan Pendekatan
LSTR Pada perawatan gigi
sulung
(Angraeni. R dkk. 2003)1
z 100% (Takushige.T dkk. 2004)2
z 100%

1Angraeni.

R et al 2003. Evaluasi klinis dari terapi lesi sterilisasi dan perbaikan

jaringan (LSTR) 3Mix-Mp. JKGUI(Ed. Khusus)527-530.

2Takushige.

T et al 2004. Endodontic treatment of Primary teeth using combination

of antibacterial drug. Int.Endodontic Journal, 37. 132-138.
Anton
Anton Rahardjo,
Rahardjo, 2006
2006

Int Endod J, 2004 Feb, 37(2), 132 - 8

Endodontic treatment of primary teeth using a
combination of antibacterial drugs; Takushige T et al.;
RESULTS:
In all cases, clinical symptoms such as gingival swelling (52 cases),
sinus tracts (22 cases), induced dull pain (3 cases), spontaneous dull
pain (26 cases), and pain on biting (46 cases) disappeared after
treatment, although in four cases clinical signs and symptoms were
finally resolved only after retreatment using the same procedures .
Thus, gingival abscesses and fistulae, if present, disappeared after a
few days . Successor permanent teeth erupted without any disorders,
or were found radiographically to be normal and in the process of
eruption . All the cases were evaluated as successful . The mean
function time of the primary teeth was 680 days (range: 68-2390 days),
except for one case in which the successor permanent tooth was
congenitally missing .
CONCLUSION:
Primary teeth with periradicular lesions with or without physiologic
root resorption were treated successfully by the LSTR endodontic
therapy.
Anton Rahardjo, 2006

Clinical Evaluation of LSTR 3Mix-MP

Endodontic Treatment
H.Nakahara, T. Takushige, and E. Hoshino.
z

Results:
Almost all cases (969, 97.8%) were successful because of
disappearance of acute or chronic clinical symptoms, such
as fistulae, abscess formation, purulent exudates, swelling
or bite pain, and partial or full recovery of radiolucent
periradicular lesions, if any at the first visit. The
successfully treated teeth did not felt pain or discomfort on
biting. Clinical success obtained regardless of root canal
filling conditions. Of 602 cases followed up more than 7
years, 595 (98.8%) were evaluated as successful. In NIET,
including cases in which previous root canal filling
material was intentionally remained, 187 cases (98.4%)
were also clinically successful.
Conclusion:
These indicate that 3Mix-MP endodontic treatment,
including NIET, results in excellent clinical outcomes.
Anton Rahardjo, 2006

2044 LSTR 3Mix-MP NIET in Area Oral Health

Program :
E.Hoshino, M.A. Asgor M, M. Yagi, E.V. Cruz, M.C.G. Garcia,
H. Oyanagi, T. Takushigei, K. Kota, and R. Anggraeni.
z

Results:
Caries prevalence in Shibuchar was 51% and 26% for 5-13 year olds
in the primary and permanent dentitions, and 66% and 19% for the 67 year olds in Alfonso, respectively. DMF and dmf were 0.55 and 1.96
in Shibuchar and 0.41 and 3.85 in Alfonso. In Shibuchar, of the 26 first
molars and 5 primary molars, 19 resin-inlay cases were successful, 12
GI filling were lost 3 months after the treatment, but there was no
reported discomfort or pain before and after the loss. Of 9 first molars
and 6 primary molars in Alfonso, all the 10 CR cases were successful,
while GIs were lost in 3 cases.
z Conclusion:
These results indicate that the one-time LSTR 3Mix-MP NIET may be
useful in dentistry in under-resourced settings.

Anton Rahardjo, 2006

Clinical Evaluation of LSTR 3Mix-MP Endodontic

Treatment H. NAKAHARA, Miyagi National Hospital, Japan, T. TAKUSHIGE, Takushige D.C,
Sendai, Japan, and E. HOSHINO, Niigata University, Japan

991 dirawat PSA (701, 80.8% ) dan NIET (LSTR) (190,

19.2%),
Rata2 kunjungan 2,3 kali utk PSA, NIET 1 kali kunjungan.
Restorasi: resin inlay, metal inlay or metal crown
Hasil:
(969, 97.8%) sukses dg tidak adanya gejala klinik dan
keluhan ps.
602 kasus yg dapat diikuti selama 7 tahun sebanyak 595
(98.8%) berhasil sukses secara klinis.
Yg dirawat dg LSTR 3Mix-MP 187 kasus (98.4%) berhasil
baik tanpa keluhan dan tidak ditemukan gejla klinik.
Kesimpulan: Perawatan LSTR dg 3Mix-MP berhasil dg
memuaskan berdasarkan keluhan ps dan gejala klinik.
Anton
Anton Rahardjo,
Rahardjo, 2006
2006

Tissue Repair

Tissue Repair
GIC
3Mix-MP

Kelainan
periapical
Perbaikan jaringan periapikal dan
jaringan sekitarnya setelah 18 bulan

Pulp capping dengan 3Mix-Mp

Gigi sulung dengan
perawatan LSTR,
mengalami resorbsi
akar

Gigi premolar pra-erupsi

Anton Rahardjo, 2006

3 bulan

8 bulan

16 bulan
Terbentuk
dentinal bridge

LESION STERILIZATION AND TISSUE REPAIR

LAPORAN
KASUS

Kegiatan Bakti Sosial FKG UI

di Lombok

Anton Rahardjo, 2006

Kegiatan Bakti Sosial FKG UI

di Lombok

Anton Rahardjo, 2006

Kegiatan Bakti Sosial FKG UI

di Lombok

Anton Rahardjo, 2006

Kegiatan Bakti Sosial FKG UI

di Lombok

Anton Rahardjo 2006

Anton Rahardjo 2006

Karies luas pada gigi sulung

Anton Rahardjo, 2006

Pulpitis kronis eksaserbasi

akut

Kasus pulpa
nekrosis dg
Fistula

Anton Rahardjo, 2006

Anton Rahardjo, 2006

Anton Rahardjo, 2006

Kondensasi
amalgam dengan
matrik metal.
Pro: pembersihan
sisa2 amalgam,
Ro. Foto.
Kemudian
janjikan untuk
poles 24 jam
berikutnya.
Anton Rahardjo, 2006

Cek apakah ada tambalan overhanging, dan sisa-sisa bahan

amalgam. Bila ada koreksi dan bersihkan

3Mix-MP

Anton Rahardjo, 2006

Kasus Pulpa Polip

Tumpatan
dengan Fuji
IXCapsul-fast

Anton Rahardjo, 2006

 Kasus pulpa
nekrosis dg
Fistula

Anton
Anton Rahardjo,
Rahardjo, 2006
2006

Kegagalan;
z 3Mix

sudah rusak atau kadaluarsa, MP

banyak menyerap air.
z Restorasi bocor, ada invasi bakteri.
z Terlalu banyak manipulasi pd pulpa yg vital
z Nekrosis pulpa tdk di openbur
z Tambalan ketinggian

Anton
Anton Rahardjo,
Rahardjo, 2006
2006

Operational Research
*Dikti (FKGUI) dan JSPS** (Niigata University)

The New Paradigm in Preventive Dentistry:

Tissue Repair Strategy Using LSTR Method
in Public Health centers.

*Direktorat Pendidikan Tinggi

**Japan Society for the Promotion of Science

Penutup
LSTR dapat dipakai sebagai perawatan gg vital
dg pulpa terinfeksi atau gigi nonvital yang
dapat memenuhi keinginan sesuai dg keadaan
secara umum pelayanan kesehatan gigi di
Indonesia (Fasilitas terbatas).
Keuntungan, non toxic/ non carcinogenic,
preserve the natural teeth, tissue repair,
terjangkau, mudah dan patient friendly (1
visit). Walaupun demikian perlu diperhatikan
keterbatasan perawatan ini terutama dalam
restorasi yg dipilih dan seleksi kasus.

Catatan ..
z

LSTR 3Mix-MP bukan penganti perawatan

endodontik, tetapi sebagai perawatan alternatif pd
pelayanan kesehatan gigi dg tenaga dan peralatan
terbatas.
Kegagalan bisa terjadi berdasarkan pengamatan
disebabkan: bahan palsu, kadaluarsa atau salah
penanganan dan restorasi tdk tepat atau timbul
kebocoran atau pecah.

Anton Rahardjo, 2006

No more..

Anton Rahardjo, 2006

Terima kasih atas perhatiannya

Silahkan bergabung untuk berdiskusi di:

http://groups.yahoo.com/group/LSTRIndonesia/

Anton Rahardjo, 2006

Terima
Kasih
Silahkan bergabung untuk berdiskusi di:

http://groups.yahoo.com/group/LSTRIndonesia/

Anton Rahardjo, 2006