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Cemento-ossifying fibroma of the jaw David B. Kamadjaja
Dental Journal (Majalah Kedokteran Gigi) Vol. 42 No. 4 (2009): December 2009
Publisher : Faculty of Dental Medicine, Universitas Airlangga https://fkg.unair.ac.id/en

Background: Cemento-ossifying fibroma is a benign neoplasm characterized by replacement of normal bone by fibrous tissue and varying amounts of newly formed bone or cementum-like material, or both. The cemento-ossifying fibroma has caused considerable controversy because of confusion regarding terminology and the criteria for its diagnosis. In addition, the cemento-ossifying fibroma often shows variations in clinical, radiographic, and histopathologic features, hence require different treatment options. Purpose: This paper attempts to elaborate the classification and terminology of cemento-ossifying fibroma of the jaw, the clinical characteristic, radiographic, and histopathologic features, the different tumor behaviors, and the surgical treatment modalities required. Case: Two patients diagnosed with cementifying fibroma and two patients with ossifying fibroma were reported, presenting their clinical presentation, diagnostic imaging, and histopathology reports, as well as their surgical treatments. Classifications of fibro-osseous lesion of the jaws and characteristics as well as variations in several aspects of cemento-ossifying fibroma of the jaws are discussed. Conclusion: The diagnosis of cemento-ossifying fibroma of the jaw can be established quite consistently based on clinical, radiographic, and microscopic features. However, these tumors may exhibit variations in their neoplastic behaviors. It is therefore important to take into account the individual tumor behavior when one is planning a proper surgical treatment. The behavior of the tumor governs the required surgical treatment which may range from simple curettage of the tumor to radical resection of the jaw.

Fibrous epulis associated with impacted lower right third molar Ni Putu Mira Sumarta; David B Kamadjaja
Dental Journal (Majalah Kedokteran Gigi) Vol. 42 No. 4 (2009): December 2009
Publisher : Faculty of Dental Medicine, Universitas Airlangga https://fkg.unair.ac.id/en

Background: Epulis or epulides are lesions associated with gingival tissues. Fibrous epulis is a type of hyperplastic fibrous tissue mass located at the gingival which is slow growing, painless, having same color as the oral mucosa and firm on palpation. Anterior regions of the oral cavity are the frequently affected sites as these areas are more prone to be affected by calculus deposition and poor plaque control due to frequent teeth malposition. Removal of any irritating factors and excision of the lesion are the usual treatments. Purpose: This case report presents a rare case of fibrous epulis which occurred in the posterior region of the oral cavity and associated with impacted lower third molar. Case: A case of fibrous epulis at the lower right third molar area of three months duration is presented. The mass was slow growing, painless and on examination it was a pedunculated mass overlying the unerupted lower right third molar, having same color with the oral mucosa and firm on palpation. Clinically, the lesion was diagnosed as fibrous epulis associated with impacted lower right third molar. Case management: The treatment were surgical excision of the epulis and removal of the lower right third molar. The histopathology result showed tissue with squamous epithelial lining, achanthotic fibrous connective tissue, mononuclear inflammatory cells and few capillaries without signs of malignancy. This is consistent with the diagnosis of fibrous epulis. Conclusion: Fibrous epulis, although frequently occurred at the anterior region of the oral cavity, may rarely grow at the area of lower third molar. This phenomenon supports the theory that epulis can grow on any surface of oral mucous membrane as long as local irritants are present.

Simple replantation protocol to avoid ankylosis in teeth intended for orthodontic treatment Yuli Nugraeni; David Buntoro Kamadjaja; Haryono Utomo
Dental Journal (Majalah Kedokteran Gigi) Vol. 42 No. 1 (2009): March 2009
Publisher : Faculty of Dental Medicine, Universitas Airlangga https://fkg.unair.ac.id/en

Background: Dento-alveolar trauma resulted from accidents involving the oral regions mostly affect the upper central incisors. Overjet that is beyond 5 mm and incompetent lip also contribute to increase the risk. Several literatures had already discussed different methods of replantation of avulsed teeth. However, it was not meant for further orthodontic treatment. Purpose: The objective of this review is to propose a simple replantation protocol of avulsed teeth which also prevent from ankylosis. Reviews: Protruded teeth usually need orthodontic treatment; therefore, an appropriate management should be done to avoid the development of ankylosis. Ankylosis of the periodontal ligament (PDL) becomes a problem in orthodontic tooth movement in repositioned or replanted teeth. In addition, ankylosed teeth also more susceptible to root resorption. Actually, it was caused by the endodontic treatment. In particular, severely protruded or unoccluded teeth are hypofunctional, therefore have narrow PDL, thus it may facilitate to ankylosis development. Ideal management protocol such as the use of root canal sealer i.e. mineral trioxide aggregate (MTA); the using of Emdogain, and resilient wiring or semi-rigid fixation with brackets has become a solution in avulsed teeth arranged for orthodontic treatment. Nevertheless, the presence of oral surgeon, endodontist and orthodontist in the same time, and also ideal preparations after an accident was difficult to achieve. Conclusion: Considering that reducing the ongoing PDL inflammation with intracanal medicaments and maintaining the functional force during mastication is possible; it is concluded that this simple replantation protocol is likely.

The role of proper treatment of maxillary sinusitis in the healing of persistent oroantral fistula David B. Kamadjaja
Dental Journal (Majalah Kedokteran Gigi) Vol. 41 No. 3 (2008): September 2008
Publisher : Faculty of Dental Medicine, Universitas Airlangga https://fkg.unair.ac.id/en

Background: Oroantral communication (OAC) is one of the possible complications after extraction of the upper teeth. If not identified and treated properly, a large OAC may develop into oroantral fistula (OAF) which means that there is a permanent epithelium-lined communication between antrum and oral cavity. Such fistulas may cause ingress of microorganism from oral cavity into the antrum leading to maxillary sinusitis. Oroantral fistula usually persists if the infection in the maxillary antrum is not eliminated. Therefore, treatment of oroantral fistula should include management of maxillary sinusitis in which surgical closure of oroantral fistula should be done only when the sinusitis has been cured. Purpose: This case report emphasizes on the importance of proper management of maxillary sinusitis in the healing of oroantral fistula. Case: A case of an oroantral fistula following removal of upper left third molar is presented. As the maxillary sinusitis was not identified pre-operatively, two surgical procedures to close the fistula had ended up in dehiscence. Case management: The diagnosis of maxillary sinusitis was finally made and the sinusitis subsequently treated with combination of trans-alveolar sinus wash out, insertion of an acrylic splint, and two series of nasal and sinus physiotherapy procedures. The size of the defect decreased gradually during the treatment of the sinusitis and finally closed up without any further surgical intervention. Conclusion: This case report points out that it is important to detect intraoperatively an antral perforation after any surgery of the maxillary teeth and to close any oroantral communication as early as possible and that it is important to treat properly any pre-existing maxillary sinusitis before any surgical method is done to close the fistula.

Management of zygomatic-maxillary fracture (The principles of diagnosis and surgical treatment with a case illustration) David B. Kamadjaja; Coen Pramono D
Dental Journal (Majalah Kedokteran Gigi) Vol. 41 No. 2 (2008): June 2008
Publisher : Faculty of Dental Medicine, Universitas Airlangga https://fkg.unair.ac.id/en

Mechanical trauma to the face may cause complex fracture of the zygoma and the maxilla. The characteristic clinical signs of zygomatic bone fracture include flattening of the cheek, infraorbital nerve paraesthesia, diplopia, and trismus, whereas maxillary fracture may typically cause flattening of the midface and malocclusion. The diagnosis of zygomatic and maxillary fracture should be established with thorough clinical examination and careful radiologic evaluation so that a three-dimensional view of the fractured bones can be obtained. This is essential in order to plan a proper surgical treatment to reconstruct the face in terms of functions and aesthetic. A standard surgical protocol should also be followed in performing the surgical reconstruction of the zygoma and the maxilla. A case of delayed bilateral fracture of zygoma and maxilla is presented here to give illustration on how the principle of diagnosis and surgical treatment of complex zygomatico-maxillary fracture are applied.

Jaw locking after maxillofacial trauma David B. Kamadjaja; R. Soesanto
Dental Journal (Majalah Kedokteran Gigi) Vol. 40 No. 3 (2007): September 2007
Publisher : Faculty of Dental Medicine, Universitas Airlangga https://fkg.unair.ac.id/en

The purpose of this report is to present two cases of jaw locking with two different etiologies. In case #1, jaw locking occured 5.5 months after a surgical reduction and internal fixation on the fractured maxilla and mandible. Some plain radiographic x-ray were made but failed to give adequate information in establishing the cause of trismus. The three dimensional computed tomography (3D-CT) was finally made and able to help guide the pre-operative diagnosis and treatment. Two-steps gap arthroplasty were done comprising a gap arthroplasty leading to acceptable outcome. An adult patient in case #2 with a history of trauma at his childhood and bird-like face apprearance clinically, was unable to open the mouth since the time of accident. The patient was diagnosed with bilateral ankylosis of temporomandibular joints. One side (right) gap arthroplasty was done and resulted in normal mouth opening.

Closure of oroantral fistula with rotational palatal flap technique David B. Kamadjaja
Dental Journal (Majalah Kedokteran Gigi) Vol. 40 No. 1 (2007): March 2007
Publisher : Faculty of Dental Medicine, Universitas Airlangga https://fkg.unair.ac.id/en

Oroantral fistula is one of the common complications following dentoalveolar surgeries in the maxilla. Closure of oroantral fistula should be done as early as possible to eliminate the risk of infection of the antrum. Palatal flap is one of the commonly used methods in the closure of oroantral fistula. A case is reported of a male patient who had two oroantral communication after having his two dental implants removed. Buccal flap was used to close the defects, but one of them remained open and resulted in oroantral fistula. Second correction was performed to close the defect using buccal fat pad, but the fistula still persisted. Finally, palatal rotational flap was used to close up the fistula. The result was good, as the defect was successfully closed and the donor site healed uneventfully.

Autogenous tooth transplantation: an alternative to replace extracted tooth David B. Kamadjaja
Dental Journal (Majalah Kedokteran Gigi) Vol. 48 No. 3 (2015): September 2015
Publisher : Faculty of Dental Medicine, Universitas Airlangga https://fkg.unair.ac.id/en

Background: The gold standard treatment to replace missing tooth is dental implants, however, in certain cases, such as in young patients its placement is contraindicated. Autogenous tooth transplantation, which has been widely done in Scandinavian countries for many years, may become a good alternative to overcome this problem. Purpose: This article attempted to provide information about the indication, treatment planning, surgical technique and the successful result of autogenous tooth transplantation. Case: A fifteen year old male patient presented with large caries and periapical disease of his lower left first molar, which was partially erupted and the roots was not fully formed in radiograph. Case management: Autogenous tooth transplantation procedure was performed consisting of extraction of #36, odontectomy of #38 followed by its implantation to socket #36 and fixation of the transplanted tooth to the adjacent teeth. Post operative evaluation was done on regular basis within 18 months period. There was no complaint, the tooth was clinically stable and no evidence of periodontal problem. Serial radiographs showed healing of alveolar bone and periodontal tissue, and the complete root formation was evident by 18 months post operatively. Conclusion: Autogenous tooth transplantation is a potential alternative to replace extracted tooth. Provided that the case be properly planned and operation carefully performed, successful result of this treatment can be achieved.

The correlation between Rood and Shehab’s radiographic features and the incidence of inferior alveolar nerve paraesthesia following odontectomy of lower third molars David Buntoro Kamadjaja; Djodi Asmara; Gita Khairana
Dental Journal (Majalah Kedokteran Gigi) Vol. 49 No. 2 (2016): June 2016
Publisher : Faculty of Dental Medicine, Universitas Airlangga https://fkg.unair.ac.id/en

Background: Odontectomy of lower third molar has a potential risk for inferior alveolar nerve impairment. Paresthesia of inferior alveolar nerve has often been associated with close relationship between the apex of lower third molar and mandibular canal. Rood and Shehab’s category has been commonly used for radiological prediction of inferior alveolar nerve injury following third molar surgery. Purpose: This study aimed to determine whether there was correlation between Rood and Shehab’s radiographic features and the incidence of inferior alveolar nerve paraesthesia following odontectomy of lower third molar. Method: This was a retrospective cross-sectional study, using data obtained from the dental record of patients who had undergone odontectomy of lower third molars in Dental hospital of Universitas Airlangga during 2 years period. Samples were cases that, from presurgical radiograph, showed close relationship between lower third molar roots and mandibular canal. The case and non-case groups were assigned based on the presence of paraesthesia and non-paraesthesia of inferior alveolar nerves, respectively. Based on Rood and Shehab’s category, the samples collected were then classified into two groups which were those whose relationship matched and did not match with the category, respectively. Data were analyzed using Chi-square correlation test. Result: Of 975 odontectomy cases included in this study, 80 cases were taken as study samples consisting of 15 and 65 cases assigned, respectively, as case and non-case. The 32 cases matched with the criteria of Rood and Shehab's category while the remainder of 48 cases did not. Of 32 cases which met the criteria of Rood and Shehab’s relationship, only 5 cases showed paraesthesia, whereas out of 48 cases which did not met the criteria 10 cases showed paraesthesia. Statistical analysis showed significance value of 0.770 (p>0.05) indicating that there was no significant correlation between relations of third molar root and mandibular canal, based on Rood and Shehab’s category, and the incidence of inferior alveolar nerve paraesthesia. Conclusion: There was no correlation between Rood and Shehab’s radiographic features and the incidence of paraesthesia of inferior alveolar nerve following odontectomy of lower third molars.

The effects of breadfruit leaf (Artocarpus Altilis) extract on fibroblast proliferation in the tooth extraction sockets of Wistar rat Darin Hulwani Rinaldi; David B. Kamadjaja; Ni Putu Mira Sumarta
Dental Journal (Majalah Kedokteran Gigi) Vol. 51 No. 3 (2018): September 2018
Publisher : Faculty of Dental Medicine, Universitas Airlangga https://fkg.unair.ac.id/en

Background: A prolonged tooth extraction socket healing process can affect the well-being of the patient and increase the risk of infection. Fibroblast proliferation in the proliferation phase is an important stage in the healing process. Fibroblast formed from extracellular matrix and collagen fibers support bone formation in the socket. Breadfruit leaves, extremely common in Indonesia, contain polyphenol, flavonoid, tannin and alkaloid substances which accelerate the wound healing process because of their anti-inflammatory, anti-bacterial and anti-oxidant properties. A previous study showed that 16% breadfruit leaf gel extract administered to Wistar rats produced an encouraging anti-inflammatory effect, but its capacity for increasing fibroblast proliferation remains to be fully understood. Purpose: The aim of this study was to observe the effect of applying breadfruit leaf extract on fibroblast proliferation on the healing process in tooth extraction sockets. A preliminary phytochemical study was undertaken. Methods: 24 Wistar rats were divided into four groups: two control groups and two experimental groups. 16% breadfruit leaf gel extract was applied to the experimental groups, while none was applied to the control groups. The number of fibroblasts was counted on both the third and fifth days post-extraction. Data was analyzed statistically using an independent T-test. Results: There were significant differences in the number of post-extraction fibroblasts in Wistar rat tooth sockets on day 3 (p=0.000; p < α=0.05) and day 5 (p=0.000; p < α=0.05). Conclusion: Breadfruit leaf gel extract application increases fibroblast proliferation during the healing process in the tooth extraction sockets of Wistar rats.

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