Catherine Marcia Irawan*, Ovy Damara Prima*, Margareta Rinastiti**, Yulita Kristanti**

Background: Previously initiated therapy with symptomatic apical periodontitis in an open apex in anterior teeth with a shortened root presents challenges in achieving both functional and aesthetic outcomes. In these conditions, especially teeth with limited height, can be addresed using a composite splinter jacket crown accompanied by a post that specifically designed to provide stability. Objective: To highlights the use of a splinter jacket crown as a solution for restoring a shortened anterior tooth after apexification. Case Report: A 23-year-old female presented with tooth 21, diagnosed with previously treated and symptomatic apical periodontitis on the maxillary left central incisor. Clinical and radiographic examinations revealed an open apex, apical radiolucency, with a history of trauma at age 11. The treatment carried out is apexification using Biodentine as an apical plug, conventional root canal preparation, placement of a laboratory composite resin post, and final restoration with a composite splinter jacket crown. Follow-up evaluations at 1 and 3 months showed favorable clinical and radiographic outcomes, including resolution of symptoms and periapical healing. Discussion: The combination of Biodentine for apexification, laboratory post, and laboratory composite resin crowns as a splinter is an efficient solution for managing complex cases that needs root canal treatment in anterior teeth with open apex and shortened roots. Conclusion: Composite splinter jacket crown as a final restoration accompanied by laboratory post after apexification with Biodentine is an effective strategy for managing teeth with an open apex. Composite splinter jacket crown enhanced retention, making it practical for shortened teeth. read more

Creating a lifelike appearance and function, face prosthesis made of various materials and retention techniques can be used to replace facial abnormalities brought on by neoplasms, congenital malformations, or trauma. Due the nose is a relatively immovable structure, a nasal prosthesis may often restore mid-facial abnormalities’ aesthetic form and anatomic features more successfully than surgical repair. Numerous elements, including harmony, texture, colour matching, and melding of the tissue contact with the prosthetic, are critical for effective outcomes. The purpose of the case study is to describe the non-surgical rehabilitation of a patient who underwent total rhinectomy due to squamous cell carcinoma of the nose using a nasal prosthesis made of silicone. A 50 years old man came to the RSUD Sardjito for nasal prosthesis. Patient was operated for squamous cell carcinoma of nose 8 months ago. Sqamous cell carcinoma of the nose was treated through a rhinectomy. The bridge of the nose, including the nasal bones was included in the resection. Using a spectacle glass frame and a mechanical retaining design, the prosthesis was created to restore the patient’s aesthetic look without the need for craniofacial implants. The goal of the nasal prosthesis using mechanical retention was to improve the patient’s function and appearance in order to raise patient’s standard of living. read more

Blofoma Mohentaeses Veransa*, Margareta Rinastiti**

Reintervention presents unique challenges, which become even more complex in hypertensive patients. Hemodynamic control and material selection are critical to minimizing risks and ensuring treatment success. Hypertension can influence the choice of materials and the overall procedural approach. This case report aim to highlights the endodontic reintervention of a maxillary right central incisor in a hypertensive patient, emphasizing strategic planning, material selection, and restorative techniques for long-term success. A 54-year-old hypertensive female patient presented to the Conservative Clinic, RSGM UGM with complaints of discomfort and pain in tooth 11. The patient had undergone root canal treatment several months ago, but no restoration had been placed on the tooth. Radiographic examinations revealed inadequate root canal obturation with extrusion of obturation material beyond the apex and the presence of a periapical radiolucency. Endodontic retreatment was performed with careful hemodynamic monitoring. The previous gutta-percha and sealer were removed, followed by thorough irrigation and disinfection. Obturation was achieved using a resin sealer and a lateral condensation technique to ensure a hermetic seal. The prefabricated fiber post was placed and the final restoration involved a porcelain-fused-to-metal crown. In conclusion, reintervention combined with a porcelain-fused-to-metal crown and a prefabricated fiber post is an effective solution for managing overfilling cases, ensuring both functional and aesthetic rehabilitation. This case report demonstrates the management of a root canal reintervention case involving extruded obturation material without the need for surgical intervention. Precise non-surgical retreatment techniques can effectively resolve periapical pathology while preserving the tooth and restoring its function. read more

Ratna Kartika^1*, Wina Meiana¹, Sri Budi Barunawati², Endang Wahyuningtyas², Titik Ismiyati ²

The eye is vital for vision and integral to facial structure. Eye loss from trauma, congenital anomalies, or pathology impacts both function and aesthetics, affecting the patient’s psychological well-being. Maxillofacial prosthetics aim to restore aesthetics and support psychological health by replacing missing facial structures, including the eye. This case report aims to describe the fabrication of a custom ocular prosthesis for a male patient with a left ocular defect following enucleation. A 26-year-old male patient presented to Prof. Soedomo Dental Hospital, Universitas Gadjah Mada, seeking a new left ocular prosthesis to improve his appearance, as he expressed dissatisfaction and feeling uncomfortable with his previous prosthesis. The patient’s condition was stable with no complaints of pain or discomfort. Subjective and objective examinations were conducted, followed by the fabrication of a custom acrylic resin tray. An initial impression was taken with hydrocolloid material and cast with type-3 gypsum to create a working model. The eye socket was re-impressed with rubber base material, and a wax scleral model was modified to match the patient’s anatomy. The sclera color was matched using a shade guide and photographs of the contralateral eye, then sent to the lab for acrylic sclera fabrication. After trial fitting, the sclera was inserted and evaluated for aesthetics, retention, and stability. At the final follow-up, the patient was satisfied with the result and the eye socket tissues were healthy. The fabrication of a custom ocular prosthesis using acrylic resin successfully enhanced the patient’s aesthetics, comfort, and confidence by ensuring a proper fit to the eye socket. read more

Anastasia Purnama Agustina*^🖂, Evi Rusmawati*, Murti Indrastuti**, Titik Ismiyati**, Intan Ruspita**

A smile makeover enhances both the aesthetics and functionality of a person’s smile, promoting facial harmony, self-esteem, and overall well-being. Digital tools enable the creation of a personalized treatment plan to improve tooth shape, size, and alignment. Common issues such as median diastema, and peg-shaped teeth can be treated using orthodontic treatment, periodontal surgery, veneers, or crowns, depending on the underlying cause and desired outcome. The aim of this study is to emphasizes the importance of a comprehensive digital smile makeover plan, which allows patients to visualize the result before treatment, helping them make informed decisions. This case report presents a 23 year-old female with median diastema, gummy smile, and peg-shaped maxillary lateral incisors. An interdisciplinary approach was performed, combining periodontal surgery and prosthodontic restoration for immediate aesthetic solution. The digital smile design facilitated clear communication of treatment goals, ensuring that the patient had a clear vision of the result. Preprosthetic surgery, including maxillary frenectomy and crown lengthening with ostectomy, was performed to prevent relapse and achieve a proportionate crown ratio. A minimally invasive preparation techniques with a butt joint preparation for the maxillary central incisors, maxillary lateral incisors and maxillary canine were performed to preserve tooth structure while providing adequate thickness for veneers and crowns. High-strength lithium disilicate ceramic (Emax) was chosen for its durability and aesthetic properties. Emax veneers and crowns are an excellent option to provide immediate aesthetic solution for patient with diastema and peg-shaped teeth. The patient was satisfied with the result, and no periodontal or occlusal issues were noted. read more

Tiara Oktavia Saputri*🖂, Luthfir Rahman Nugraha Putra*, Bramasto Purbo Sejati**, Poerwati Soetji Rahajoe**

The accuracy of the curve and the proper adaptation of the reconstruction plate in place of the lost mandibular bone are key factors for successful reconstruction. Improper placement of the reconstruction plate can cause postoperative complications, as the difficulty of bending and positioning the plate during surgery prolongs the procedure, increases surgeon fatigue, and raises the risk of patient morbidity. The use of a plate positioning guide (PPG) and preoperative plate bending addresses these challenges, making the surgery more effective and efficient. The PPG facilitates the placement of reconstruction plates with the correct arch by serving as a transfer method for the reconstruction plate. This case report highlights the efficiency of mandibular reconstruction following resection with the aid of a PPG and preoperative plate bending. Two patients underwent mandibular resection and reconstruction surgery. One patient was treated using a PPG and preoperative plate bending, while the other underwent surgery with intraoperative plate bending. Clinical and radiological evaluations were performed at 1 month and 6 months postoperatively. The patient who underwent surgery using the PPG and preoperative plate bending showed better surgical outcomes, improved facial symmetry, and a shorter operating time. These findings align with existing studies comparing soft tissue symmetry in the lower facial third, the symmetrical width of the mandibular arches, and the consistency in the height of the reconstruction plate post-reconstruction. The use of a plate positioning guide (PPG) and preoperative plate bending can enhance the efficiency of mandibular reconstruction following resection. read more

Agatha Rufina Putriyanti*, Pingky Krisna Arindra**🖂 , Poerwati Soetji Rahajoe**

Maxillary impacted canines associated dentigerous cysts can lead to bone defects. Autotransplantation with autograft offers a viable treatment. Postoperative evaluation of bone density changes is crucial for assessing the success of the bone graft. This analysis examines the use of ImageJ software for assessing relative bone density from Orthopantomograms (OPGs). It emphasizes the role of ImageJ software in evaluating relative bone density changes in the recipient site after autotransplantation of an impacted maxillary canine associated a dentigerous cyst, using autograft. This case report presents an 11 years old girl with a maxillary left impacted canine associated dentigerous cyst. The canine was autotransplanted to the prepared site after cyst enucleation, and the defect was augmented with an autograft harvested from the mandibular symphisis. Postoperative OPGs were taken pre operative, 3, and 6 months. ImageJ software was used to analyse the grey values in the region of interest (ROI), representing bone density at the transplant site. ImageJ analysis allowed for a quantitative assessment of relative bone density changes over time. The grey values in the ROI progressively increased, indicating improved bone density at the recipient site. This method provided an objective measurement that complemented clinical and radiographic evaluation. ImageJ provides a readily available and user-friendly tool for analysing bone density from OPGs. ImageJ analysis of OPGs is a valuable tool for evaluating relative bone density changes following autotransplantation of impacted canines associated cysts with autograft. It allows for objective assessment of bone healing and graft integration, aiding in treatment outcome evaluation. read more

Wisna Darmastuti*, Tunjung Nugraheni**

Broken instrument is common mistakes could have been found in root canal treatment. The successful of every case depends on the diverse of instrument, the location, and length of instrument. Radiographic pre-operative has the important role to decide whether the instrument has to be retrieved of left inside canal. The instrument which is not remove may interfere with thorough cleaning the root canals causing chronic apical abscess as seen in patient. The instrument which left in the middle of canals would cause obturation not hermetically, as result potentially cause failure on root canal treatment. The purpose of this paper is to describe the management of broken instrument retrieval on mesiolingual canal of first right molar mandibular. Some of the possible causes of file fractures are small diameter of canal and complicated root canal anatomy, in addition to that, files which are used excessively for several times have torsional fracture. The retrieval of broken instrument uses conventional techniques and Satelec ultrasonic scaler. It was operated under an endodontic microscope and had three stages in retrieving. The prognosis of this case was ad bonam since location of broken instrument was coronal third which has high successful to retrieve. As the instrument retrieved, the periapical lesion improving and the fistula was gone. Endocrown which is an indirect monoblock restoration that use the pulp chamber as it retention, was chose to be the final restoration since it has ability to cover all cups of molar and would improve the longevity of restoration. read more

Nirwansyah Kalista Ramlie*, Deni Herdiyanto**

Jaw cysts are common benign disease of the maxillofacial region, and odontogenic cysts represent the majority of cases. The most common types of cystic lesions include radicular cysts, dentigerous cysts (follicular cysts), and keratocystic odontogenic tumors (keratocysts), collectively accounting for more than 80% of odontogenic cysts. Radicular cysts are more commonly diagnosed in maxilla, occurring nearly ten times more frequently than in the mandible. The free iliac crest bone graft is still considered as a simple and effective method for oro-facial reconstructions, widely used in maxillofacial surgery and dental implantology. The objective of this case report is to demonstrate the management of a radicular cyst enucleation, followed by a bone graft from the iliac crest. A 52-year-old man was referred to the oral and maxillofacial surgery department at the RSUD dr. H. Jusuf SK (Tarakan, Indonesia) with chief complaints of swelling in the oral cavity, causing changes in facial shape, and pain while chewing food. Panoramic radiographs revealed a well-defined unilocular cystic lesion in the maxilla extending from teeth 15 to 23, crossing the midline of the maxilla. On the basis of the clinical and radiographic findings, the differential diagnosis were radicular cyst, ameloblastoma and keratocystic odontogenic tumor (KOT) were made. Follow-up after one month after enucleation surgery showed a reduction in pain and swelling. The determination of an accurate diagnosis and appropriate management of a radicular cyst can significantly improve the patient’s quality of life. read more

Juan Gabriel Fong*, Intan Ruspita**, Murti Indrastuti** ^(Co-Author)

This case report details the comprehensive treatment of a 16-year-old female patient presenting with fractured maxillary central (#21) and lateral (#11) incisors. Tooth #21 required extraction due to extensive fracture. Following endodontic treatment of #11, a crown lengthening procedure was performed to establish sufficient clinical crown height for restorative purposes. This surgical procedure involved precise soft tissue management to achieve optimal gingival architecture and ensure adequate ferrule preparation on #11. read more