RE-TREATMENT OF MISMANAGED BILATERAL CONDYLAR FRACTURE AND POST-SURGICAL COMPLICATION

Introduction: Improper management of condyle fractures can lead to changes in the structure of the temporomandibular joint, which can impact the patient's oral function. Corrective surgery is necessary to restore the patient's function and quality of life. This case report aims to discuss the procedure of bilateral condylectomy in neglected condylar fracture, as well as the risks and post-operative complication management. Case: A 26-year-old female patient presented with mandibular hypomobility and occasional temporomandibular pain. The patient had history of a traffic accident around four months ago, and was managed in a public hospital but symptoms persisted. Case Treatment: After thorough examinations, the patient was diagnosed with neglected complete bilateral condylar fracture with displacement and managed via bilateral condylectomy. Post-operative, the patient presented with anterior open-bite and facial paralysis on the right side, and was treated accordingly. During 4-month follow-up, complications and chief complaints had all subsided. Discussions: Mismanagement of condylar fracture could result in malunion of fragments, which is difficult to reposition due to the changes that have already occurred in the temporomandibular structure. Condylectomy is often necessary to relieve symptoms, although bilateral condylectomy poses certain neurological risks. Prompt recognition and intervention of nerve injury is important to prevent permanent complication. Conclusion and Suggestions: Condylectomy could properly treat neglected bilateral condylar fracture in adult patients. Operators must know the associated risk and management of post-operative complications

EFFECT OF 4 wt% HYDROXYAPATITE PASTA ON DENTAL EMAIL HARDNESS

Introduction: Dental erosion can affect the dental demineralization due to the pH level that is below the critical pH of 5,5 resulting a decrease in dental enamel hardness. Remineralization is needed to bring back the mineral loss. Hydroxyapatite is similar to inorganic components in dental enamel dan have biocompatible properties. Hydroxyapatite with 4 wt% concentration has a Ca/P molar ratio close to 1,67, which is similar to the human enamel and can regenerate enamel. This study is aimed to analyze the effects of 4 wt% hydroxyapatite paste on dental enamel hardness for 7 and 14 days. Material and Methods: 20 maxillary premolars were divided into 4 groups. Group A1 were applied with 4 wt% hydroxyapatite paste for 30 minutes each day for 7 days, group A2 were applied with 4 wt% hydroxyapatite paste for 30 minutes each day for 14 days, group B1 were immersed with artificial saliva for 7 days, and group B2 were immersed with artificial saliva for 14 days. All groups were immersed with artificial saliva and was incubated for 24 hours at 37°C. Hardness measurements were carried out at the start, after erosion, and at the end of the experiment. Dental enamel hardness was measured with Vickers Hardness Tester (Shimadzu HMV G-21 Series). Dental enamel hardness data were analysed with GLM Repeated Measure ANOVA test (p<0,05) and One-way ANOVA test (p<0,05). Results and Discussions: The result showed dental enamel hardness number after 4 wt% hydroxyapatite paste application showed significant difference than untreated group, which was immersed in artificial saliva. Dental enamel hardness number after 4 wt% hydroxyapatite paste application for 14 days showed significant difference than 7 days. Conclusion: It can be concluded that 4 wt% hydroxyapatite paste application for 14 days resulted in an increase of dental enamel hardness as in normal condition of dental enamel before erosio

THE EFFECTIVENESS OF PLATELET RICH FIBRIN, CONNECTIVE TISSUE GRAFT AND THEIR COMBINATION IN THE CLOSURE OF GINGIVAL RECESSION: A SYSTEMATIC REVIEW

Introduction: Connective Tissue Graft (CTG) is one of the techniques in gingival recession treatment, but considering the morbidity of using CTG, biomaterials such as Platelet Rich Fibrin (PRF) can be an alternative in gingival recession closure treatment. This systematic review aims to compare and evaluate the use of PRF, CTG and their combination in gingival recession closure. Review: An electronic literature search in Medline (PubMed), Google Scholar, and Elsevier (Sciencedirect) was conducted to identify Randomized Clinical Trial (RCT) reporting on the treatment of gingival recession using PRF, CTG or a combination of both from 2018 to 2023 in English. This systematic review was conducted following the Preferred Reporting Items for Systematic review (PRISMA) guidelines. The parameters assessed in the RCTs were: recession depth (RD), clinical attachment level (CAL), keratinized gingival width and height (KTW, KTH), probing depth (PD), gingival thickness (GT) and patient discomfort after surgery assessed by VAS (Visual Analog Scale). Based on the 1,152 articles retrieved, there were only five RCTs eligible for systematic review. Four articles compared the use of PRF with CTG, and one article compared the use of CTG with the combination of CTG + PRF in gingival recession closure. Conclusion: The use of PRF, CTG, and a combination of both were effective in closing gingival recession. The use of CTG gave better results in increasing gingival thickness and keratinized gingival width compared to the use of PRF, but the combination of CTG and PRF gave significant results in keratinized gingival height and decreasing recession depth compared to the use of CTG alone. Thus, the combination of CTG and PRF may be a more promising gingival recession closure treatment option

TEST OF RESISTANCE OF ALPUKAT (Persea americana mill) FRUIT EXTRACT ON THE GROWTH OF THE Streptococcus mutans

Introduction: Streptococcus mutans  is one of the normal flora living in the oral cavity, but in excessive amounts is the main causative agent of dental caries. The active compounds of alkaloids, saponins and quinones in avocado pulp extract is an antibacterial alternative that can inhibit the growth of Streptococcus mutans  in the oral cavity. The aim of this research was to determine the inhibitory power that contain in avocado pulp against Streptococcus mutans . Materials and Methods: This study used 4 concentrations namely 25%, 50%, 75% and 100% with each repetition 4 times. Avocado pulp extraction was carried out by maceration method using 96% ethanol solvent. Inhibition zone testing was carried out using the Kirby baurer method. Results and Discussions: The zone of inhibition was determined using the Kruskal wallis test, which showed that there were significant differences in various concentrations against the growth of Streptococcus mutans  bacteria. Avocado fruit pulp extract is able to inhibit the growth of Streptococcus mutans  bacteria because avocado fruit pulp extract has active compounds that cause antibacterial activity. Active compounds of avocado fruit flesh that are efficacious as antibacterials are alkaloids, saponins and quinones. Conclusion: Avocado pulp extract has been proven to have an antibacterial effect against Streptococcus mutans  with an effective concentration level of 100%. Increasing the concentration of avocado pulp extract was also shown to affect the diameter of Streptococcus mutans  inhibition zon

CHITOSAN COLLAGEN HYDROGEL: A POTENTIAL SCAFFOLD BIOMATERIAL FOR PERIODONTAL REGENERATIVE TREATMENT

Introduction: Hydrogels are considered a promising scaffold biomaterial for regenerative periodontal treatment. The development of collagen and chitosan based hydrogels can improve the final characteristics of the hydrogel. Review: Collagen and chitosan are the two main materials used to design scaffolds for tissue engineering. Collagen is a material that is often used to develop hydrogels because it has the advantage of high biocompatibility. In the biomedical field, collagen is often used as a drug delivery system. Collagen has weak mechanical strength so other biomaterials are needed for its use. Chitosan material has high biocompatibility and a slow degradation rate. So the combination of these two materials is a strategic choice for making promising biomaterial scaffolds in periodontal regenerative treatment. Conclusion: Chitosan collagen hydrogel is a potential scaffold biomaterial for periodontal regenerative treatment

FUNCTIONAL CROWN LENGTHENING AS A PRE-RESTORATIVE PROCEDURE IN THE AESTHETIC ZONE

Introduction: Crown lengthening is a surgical procedure to increase the height of the clinical crown for aesthetic and restorative purposes, or combination. The indications include treatment of subgingival caries and altered passive eruption. Functional crown lengthening for restorative purposes in the esthetic zone should consider the concept of biologic width and the ideal proportion of the dentogingival complex. Case: A 39-year-old male patient was referred from the Department of Conservative Dentistry, RSGM UGM Prof. Soedomo to expose the maxillary anterior teeth crowns for full crown and veneer restorations. Clinical examination showed 11, 12, and 12 post root canal treatment with 3-4 mm remaining crowns. Teeth 13, 21, 22, and 23 appear short, excessive gingival display of 3 mm, with a diagnosis of altered passive eruption type 1B. Treatment: Functional crown lengthening was performed by gingivectomy followed by flap elevation, ostectomy, and osteoplasty. A fenestration was found at the apical of 22 and treated with regenerative procedure. Full crowns and veneers insertion was done 3 months after surgery. Crown lengthening as a pre-restorative procedure is a multidisciplinary treatment that considers the need for restoration by re-establishing the biologic width, to prevent inflammation and bone loss. In addition, adequate post- surgical tissue healing time prior to restoration is necessary to avoid gingival margin rebound and to assure long-term success of the restoration. Conclusionn : Functional crown lengthening as a pre-restorative procedure in the esthetic zone can gives satisfactory and stable results, with careful examination and correct surgical procedure

EFFECTIVENESS OF SOCKET PRESERVATION IN MAINTAINING ALVEOLAR BONE VOLUME: A SYSTEMATIC REVIEW

Introduction: Alveolar bone undergoes dimensional changes due to resorption after tooth extraction, which can make it difficult to place a denture or implant. Preservation socket procedures are performed at the time of tooth extraction with the aim of minimizing alveolar bone resorption. The purpose of this systematic review is to analyze the effectiveness of socket preservation in preserving alveolar bone. Review: This systematic review was conducted through an electronic literature search in PubMed, Wiley, and Sciencedirect, which was used to obtain a number of Randomized Clinical Trial (RCT) articles on the effectiveness of socket preservation with graft material versus no socket preservation. This systematic review was conducted following the Preferred Reporting Items for Systematic reviews (PRISMA) guidelines. Based on the 417 articles screened, there were 24 duplicates, and after the articles were included by the criteria of: RCT, human study, publication in English, within the last five years and focusing on the methods and outcomes of socket preservation, 5 articles were found to be relevant. Conclusion: Of the five studies reviewed, one study using allograft material and four studies using xenograft material, the results were that socket preservation can reduce alveolar bone resorption and can maintain the horizontal and vertical dimensions of alveolar bone compared to no socket preservatio

REGENERATIVE PERIODONTAL TREATMENT AS MANAGEMENT OF CHRONIC PERIODONTITIS: A CASE REPORT

Introduction: Chronic periodontitis is a chronic inflammatory disease induced by microbes beginning with inflammation of the gingiva and progressing to progressive damage to the tooth supporting structures. Various approaches have been made to treat chronic periodontitis, one of which is regenerative periodontal treatment using bone grafts and platelet-rich fibrin (PRF). History and Clinical Findings: A 32-year-old man came to the Periodontology Department of the Dental and Oral Education Hospital with chief complaints mobility of upper and lower teeth. Clinical examination showed that patient did not have a history of systemic diseases and the patient did not smoke. Intraoral examination showed that the maxillary front teeth grade 1 mobility and the average pocket depth in the maxillary and mandibular anterior teeth was 5 mm. Case Management: Case management includes initial therapy followed by surgical treatment which includes open flap, placement of bone graft and PRF, followed by frenectomy, then suturing and application of a periodontal pack. At 1 month after treatment, the surgical flap phase was continued for the mandibular anterior teeth using a combination of bone graft and membrane placement. Discussion: Bone graft and PRF are used to regenerate furcation defects and their ability to regenerate hard and soft tissue is due to the release of various growth factors. Conclusion: Regenerative surgical treatment in chronic periodontitis patients provides effective results in alveolar bone regeneration and decrease pocket depth

EFFECT OF BROWN ALGAE (Sargassum Sp) GEL ON ALKALINE PHOSPHATASE LEVELS IN PERIODONTITIS RATS INDUCED BY SILK LIGATION MODEL

Introduction: Periodontitis is a chronic inflammatory disease caused by colonies of dysbiotic bacteria that form biofilms and cause destruction of the periodontal tissues. This damage can be induced by silk ligation on Sprague Dawley teeth and results in an increase in Alkaline Phosphate levels in the gingival sulcus. The purpose of this study was to determine the effect of brown algae extract gel (Sargassum sp) on reducing alkaline phosphatase levels in gingival sulcus fluid in Sprague Dawley periodontitis induced by silk ligation Material and Methods: This research is True Experimental with the Pre test - Post test Control Group Design. The research sample consisted of 36 male Wistar rats which were ligated with silk to periodontitis. Rats were divided into two groups (n=18), the control group was treated with Tie-es metronidazole gel plus and brown algae extract (Sargassum sp) gel treatment with a concentration of 75%. Sampling of gingival sulcus fluid (CSG) on days 0 and 5, ALP levels were measured using a UV/V is spectrophotometer with an absorbance of 450 nm. Results and Discussions: This study showed a decrease in ALP levels after being treated with metronidazole and 75% brown algae extract gel, the normal amount of ALP levels in the reference was 53-57 U/L and increased when inflammation occurred to 8283 U / L then a significant difference was obtained. The average reduction in ALP levels from pre test to post test for each group was 39-41  /L, and there was a significant relationship between giving brown algae extract and a decrease in ALP levels (p <0.05). Conclusion: Brown algae gel extract (Sargassum sp) concentration of 75% has a lowering effect on alkaline phosphatase levels of gingival sulcus fluid in periodontitis induced by silk ligatio

COMBINATION OF REGENERATIVE THERAPY AND FREE GINGIVAL GRAFT IN STAGE IV PERIODONTITIS: CASE REPORT

Introduction: Periodontal regenerative therapy can be used to repair damaged periodontal tissues caused by periodontitis. The combination of regenerative periodontal surgery and FGG (Free Gingival Graft) is expected to accelerate the regeneration of periodontal tissue. Case : A 37-year-old woman came with complaints of loose lower front teeth, frequent bleeding and pain when eating and drinking. The complaint was felt since 1 year ago. Clinical examination obtained an average pocket depth of 6 mm and an average second degree of tooth mobility. On radiographic examination found bone damage horizontally. Case Management: The patient received root planing scaling and occlusion adjustment, followed by dental periodontal surgery 42,41,31,32. Stage II surgery for recession closure therapy with FGG was carried out three months after stage 1 surgery was performed. Discussion: Regenerative periodontal surgery is performed to produce new periodontal tissue growth and restore connective tissue attachment to the teeth. Free Gingival Graft is performed to increase gingival keratinization and improve patient esthetics. Conclusion and Suggestions: The combination of regenerative periodontal surgery and FGG for the treatment of periodontitis cases involving severe bone destruction gives good results of periodontal tissue healing by alveolar bone healing and regeneration and quite good aesthetics