Pendahuluan: Pulpitis ireversibel simtomatik ditandai dengan hipersensitivitas terhadap stimulus termal, yang menyebabkan nyeri spontan atau rasa sakit yang bertahan 30 detik atau lebih setelah stimulus dihilangkan, nyeri yang parah, persisten, dan sulit dilokalisir, dapat menjalar ke telinga, pelipis, mata atau leher. Kondisi pulpa yang terinflamasi tidak dapat kembali pulih dan perawatan saluran akar merupakan pilihan perawatan. Tujuan laporan kasus ini membahas mengenai perawatan saluran akar dengan pulpitis ireversibel simtomatik untuk menghentikan inflamasi pulpa dan mempertahan gigi. Laporan kasus: Pasien laki-laki berusia 35 tahun datang ke klinik dengan keluhan gigi belakang kanan bawah terasa sakit berdenyut sejak 1 minggu yang lalu. Gigi tersebut pernah dilakukan penambalan sementara 4 bulan sebelumnya dan tambalan tersebut patah serta nyeri spontan. Pemeriksaan radiologis gigi 46 menunjukkan gambaran radiolusen pada bagian mahkota hingga mencapai tanduk pulpa, terdapat 2 akar, dengan akar mesial dilaserasi ke arah distal dan akar distal lurus, serta saluran akar yang menghilang pada 2/3 dan 1/3 saluran akar distal dan mesial, tidak terdapat pelebaran membran periodontal, lamina dura normal dan tidak terdapat kelainan periapikal. Gigi 46 dilakukan anestesi lokal, dilanjutkan pembukaan akses dan ekstirpasi pulpa, kemudian preparasi saluran akar menggunakan nikel titanium rotary ProTaper Next® (Maillefer, Switzerland) dengan teknik crown down dan pengisian saluran akar. Restorasi follow up overlay komposit indirek pada gigi 46. Simpulan: Pulpitis ireversibel simtomatik pada gigi molar dengan akar dilaserasi terbukti dapat ditangani dengan perawatan saluran akar yang adekuat, ditandai dengan hilangnya keluhan pada pasien dalam kasus ini.Kata kunci: Pulpitis ireversibel simtomatik, perawatan saluran akar, teknik crown down. ABSTRACTIntroduction: Symptomatic irreversible pulpitis is characterised by hypersensitivity to the thermal stimuli, which causes spontaneous pain that lasts 30 seconds or more after the stimulus removed, severe, persistent and difficult to localise, can radiate to the ears, temples, eyes, or neck. The inflamed pulp does not recover; thus, root canal treatment is the treatment option. This case report was aimed to discuss the root canal treatment for symptomatic irreversible pulpitis to stop the pulp inflammation and preserve the teeth. Case report: A 35-year-old male patient came to the clinic with complaints of pulsating pain in the mandibular right molar since one week prior. The tooth had a temporary filling four months earlier, and the filling was fractured, and the pain was spontaneous. Radiological examination of tooth 46 showed radiolucent images on the crown until the pulp horn, there were found two roots, with mesial roots dilated distally and straight distal roots, and root canals that disappeared in the two-third and one-third of the distal and mesial root canals, no dilation of the periodontal membrane, normal lamina dura and no periapical abnormalities. Tooth 46 was subjected to local anaesthesia, followed by access opening and pulp extirpation, then the root canal preparation was performed using the ProTaper Next® rotary nickel-titanium (Maillefer, Switzerland) with the crown-down technique and root canal filling. Indirect composite overlay follow-up restoration was conducted of tooth 46. Conclusion: Symptomatic irreversible pulpitis in molars with dilacerated roots proved to be manageable with adequate root canal treatment, marked by the loss of the patients’ complaints.Keywords: Symptomatic irreversible pulpitis, root canal treatment, crown-down technique.
The root canal treatment in maxillary and mandibular molars with five root canals: Two case reports with two years follow up
