Saran KESIMPULAN DAN SARAN

BAB 5 KESIMPULAN DAN SARAN

5.1. Kesimpulan Dari pembahasan hasil-hasil penelitian di atas dapat diambil kesimpulan sebagai berikut : 1. Latihan fisik berenang dibarengi dengan pemberian asupan kalsium dapat meningkatkan kadar kalsium dalam mandibula, sehingga meningkatkan kualitas mandibula . 2. Latihan fisik berenang saja tanpa pemberian asupan suplemen kalsium, dan pemberian asupan kalsium saja tanpa latihan fisik berenang tampaknya tidak cukup untuk meningkatkan kandungan kalsium dan kualitas mandibula pada mencit. 3. Latihan fisik berenang dan pemberian asupan suplemen kalsium merupakan cara yang efektif untuk meningkatkan kualitas mandibula pada mencit.

5.2. Saran

1. Berdasarkan kesimpulan penelitian ini disarankan agar dilakukan penelitian lanjutan mengenai pengaruh latihan fisik dengan pemberian suplemen kalsium untuk meningkatkan kualitas mandibula yang dilaksanakan lebih intensif, misalnya dengan berbagai variasi intensitas waktu latihan fisik berenang dan dengan pemberian suplemen kalsium yang berbeda baik dosisnya maupun persenyawaan kimianya. 2. Disarankan juga agar hasil penelitian ini dijadikan sebagai penunjang pada penelitian peningkatan kualitas mandibula pada manusia, khususnya dalam bidang Kedokteran Gigi. Universitas Sumatera Utara DAFTAR PUSTAKA Ahola R, korpelainen R, Vainionpaa A, Leppaluoto J, jamsa T, 2009. Time-Course of Exercise and Its Association With 12-Month Bone Changes. BMC Musculoskeletal Disorders. 10: 1-38. Anderson JB, 1996. Calcium, Phosphorus and Human Bone Development. J.Nutr. 126 : 1153S-1158S. Anwar SA, 2009. Pengaruh Kalsium dan Vitamin D3 terhadap stabilitas tulang Alveolar. Study pada tikus jantan putih Ratus-norvegicus. Media medika indonesia 43 5. Semarang. Bouassida A, Latiri I, Bouassida S, Zalleg D, Zaoualli M, Feki Y, Gharbi N, Zbidi A, Tabka Z, 2006. Parathyroid Hormone and Physical Exercise : A Brief Review. Journal of Sports Science and Medicine. 5: 367-374. Carter MA, Alih Bahasa Dr. Peter Anugrah, 1992. Anatomi dan Fisiologi Tulang dan Sendi dalam Patofisiologi Konsep Klinis Proses-Proses Penyakit. Edisi IV. 1175- 1178. Casaburi R, 1992. Principles of Exercise Training. Chest Journal. 1015 : 263S-266S. Charoenphandhu N, 2007. Physical Activity and Exercise Affect Intestinal Calcium Absorption: A Perspective Review. J.Sports Sci. Tecnol. 71 : 171-181. Corwin EJ, 2008. Buku Saku Patofisiologi. Jakarta : EGC. 327-331. Dahlan SM, 2004. Statistika Untuk Kedokteran dan Kesehatan. PT. Arkans. Jakarta. 89- 111. Deborah A, Straub MS, RD, 2007. Calcium Supplementation in Clinical Practice : A Review of Form, Doses, and Indication. 22 : 286-296. Duhe SA, 2003. Swimming Versus Voluntary Running Exercise on Bone Health in Ovariectomized Retired Breeder Rats. Thesis in School of Human Ecology B.S. Lousiana State University. 4-16. Gafni RI, Baron J, 2007. Childhood Bone Mass Acquisition and Peak Bone Mass May Not Be Important Determinants of Bone Mass in Late Adulthood. Pediatrics. 119: S131- 136. Guyton AC, 2000. Alih Bahasa Irawati. Buku Ajar Fisiologi Kedokteran. Jakarta. EGC. 11: 1029-1041. Hart KJ, Shaw JM, Vajda E, Hegsted M, Miller SC, 2001. Swim-Trained Rats Have Greater Bone Mass, Density, Strength, and Dynamics. J appl Physiol. 91: 1663- 1668. Horner K, Devlin H, Alsop CW, Hodjekimson M, and Adams JE, 1996. Mandibular bone mineral density as a predictor of skeletal osteoporosis. The British Journal oh Radiology 69. 1019-1025. Huang TH, Lin SC, Chang FL, Hsieh SS, Liu SH, Yang RS, 2003. Effects of Different Exercise Modes on Mineralization, Structure, and Biomechanical Properties of Growing Bone. J Appl Physiol. 95: 300-307. Huang Z, Cheng SL, Slatopolsky E, 2001. Sustained activation of the extracellular signal- regulated kinase parthway is required for extracellular calcium stimulation of human osteoblast proliferation. J.Biol.Chem, 10. Universitas Sumatera Utara Iwamoto J, Shimamura C, Takeda T, abe H, Ichimura S, Sato Y, Toyama T, 2004. Effects of Treadmill Exercise on Bone Metabolism, and calciotropic Hormones in Young Growing Rats. J Bone Miner Metab. 22: 26-31. Iwamoto J, Takeda T, Sato Y, 2005. Effect of Treadmill Exercise on Bone Mass in Female Rats. Exp. Anim 54 : 1-6. Johnston CC, Slamenda W, 1993. Determinants of Peak Bone Mass. Osteoporosis Int Suppl. 1: S54-55. Karatosun H, Erdogan A, Yildiz M, Akgun C, Cetin C, 2006. Effects of Swimming Training and Free Mobilization on Bone Mineral Densities of Rats With The Immobilization-Induced Osteopenia. Saudi Med J. 273 : 312-316. Karlina IR, Atmajaya L, 2009. Ekstrak Gelatin dari Tulang Rawan Ikan Pari Himantura gerarrdi pada Variasi Larutan asam untuk Perendaman. Skripsi FMIPA ITS, Surabaya. Karlsson MK, Nordvist A, Karlsson C, 2008. Physical Activity Increases Bone Mass During Growth. Review. Food and Nutrition Research. 1-10. Kochanowski BA. 1990. Effect of Calcium Citrate-Malate on Skeletal Development in Young, Growing Rats. Journal of Nutrition. 876-881. Kosnayani AS. 2007. Hubungan Asupan Kalsium, Aktivitas Fisik, Paritas, Indeks Massa Tubuh Dan Kepadatan Tulang Pada Wanita Pascamenopause. Thesis S2. Program Pascasarjana Universitas Diponegoro. Semarang. Lindawati SM, Ismail I, soenawan, 2006. Pengaruh Asupan Kalsium Terhadap Kepadatan Tulang Mandibula Perempuan Pasca Menopause. Indonesian Journal of Dentistry IJD Edisi Khusus KPPIKG XIV. 329-332. Masyitha D, 2006. Struktur Mikroskopik Tulang Mandibula pada Tikus Ovarektomi dan Pemberian Pakan Rasio FosfatKalsium Tinggi. Media Kedokteran Hewan. 22: 112- 116. Mc Veigh J, Kingsley S, grey D, and loram LC. 2010. Swimming Enhances bone Mass acquisition in Growing Female Rats. Journal of Sport and Medicine 9, 612-619. Menteri Kesehatan Republik Indonesia, 2008. Keputusan Menteri Kesehatan Republik Indonesia No 1142MENKESSKXII2008 Tentang Pedoman Pengendalian Osteoporosis. Miles TS, 2004. Bone and Calcium Metabolism in Clinical Oral Physiology. 281-292. Morawati S, 2009. Kadar ß-Cross-Link Telopeptoda Pada Wanita Postmenopause dengan Osteoporosis atau Osteopoeni. Tesis. Patologi Klinik Universitas Sumatera Utara. Nordin BEC, 1997. Calcium in Health and Disease. FNA: 13-21. Nurcahyo, H. 2008, Ilmu Kesehatan Jilid 1 untuk SMK, Jakarta : Pusat Perbukuan Departemen Pendidikan Nasional, h. 169 – 186. Peterson KS, 2005. Calcium- Fortified Beverage Supplementation Effects on Bone Mineral Density and Body Composition in Healthy Young Women. Thesis Department of Human Nutrition Collage of Human Ecology Kansas State University : 1-10. Pudyani PS, 2005. Reversibilitas Kalsifikasi Tulang akibat Kekurangan Protein Pre dan Post Natal. Dental J. 38: 115-119. Rahnama M, Bloniarz J, 2004. Changes of The Calcium Metabolism in Mineralized Tissues of Rats During Experimental Postmenopausal Osteoporosis. Bull Vet Inst Pulawy. 48: 467-470. Rasjad C, 2007. Pengantar Ilmu Bedah Ortopedi. Jakarta: Penerbit PT Yarsif Watampone. 6-11. Universitas Sumatera Utara Stear SJ, Prentice A, Jones SC, Cole TJ, 2003. Effect of a Calcium and exercise Intervention on The Bone Mineral Status of 16-18-Y-Old Adolescent Girls. Am J Clin Nutr. 77: 985-992. Suherman SK, 2007. Farmakologi dan Terapi edisi 5. Jakarta. FK UI. 448-449. Sukandar EY, andrajati R, Sigit JI, Adnyana IK, Setiadi AP, Kusnandar, 2008. Iso Farmakoterapi. Jakarta : Penerbit PT ISFI. 614-615. Teerapornpuntakit J, Dorkkam N, Wongdee K, Krishnamra N, Charoenphandhu N, 2009. Endurance Swimming Stimulates Transpithelial Calcium Transport and Alters the Expression of Genes Related to Calcium Absorption inthe Intestine of Rats. Am J Phisiol Endocrinol Metab. 296: E775-786. Tordoff MG, Bachmanov AA, Reed DR, 2007. Forty Mouse Strain Survey of Voluntary Calcium Intake, Blood Calcium, and Bone Mineral Content. Physiol Behav. 915: 632-643. Turner CH, 2007. Molecular Mechanism of Exercise in Bone and Muscle : The Search For an Exercise Pill. Department of Biomedical Engineering IUPUI Indianapolis. 1-2. Walter F., PhD. and Boron 2003. Medical Physiology: A Cellular And Molecular Approaoch. ElsevierSaunders. pp. 1300. ISBN 1-4160-2328-3 . WebMD. 2011. Calcium Ca in Blood. Diakses tanggal 11-1-2011, http:www.webmd.coma-to-z-guidescalcium-ca-in-blood. Wu J, Wang XX, Higuchi M, yamada K, Ishimi Y, 2004. High Bone Mass Gain by Exercise in Growing Male Mice is Increased by Subsequent Reduced Exercise. J Appl Physiol. 97: 806-810. Yuliati, Sari GM, Setyawan S, Hendromartana S, 2007. Pemberian Tambahan Kalsium Pada Masa Pertumbuhan Terhadap Tebal Tulang kortikal dan Trabekula. Majalah Ilmu Faal. 63: 169-172. Zorbas YG, charapakhin KP, Kuznetsov NA, Kakurin VJ, 1999. Calcium Metabolism in Bone and Teeth of Rats During Exposure to Restriction of Motor Activity and to Swimming Exercise. J Physiol Biochem. 552 : 73-78. Universitas Sumatera Utara Lampiran 1. Data berbagai parameter hasil penelitian Tabel 1. Kandungan kalsium dalam darah mgdL Ulangan P1 P2 P3 P4 M1 10,0 8,4 10,5 10,9 M2 9,5 8,7 9,7 10,2 M3 8,3 8,7 9,5 9,9 M4 9,6 9,1 9,7 10,1 M5 10,3 8,8 9,5 9,5 M6 10,3 8,7 9,5 9,7 Rata 2 ± SD 9,7 ± 0,8 8,7 ± 0,2 9,7 ± 0,4 10,1 ± 0,5 Tabel 2. Kadar kalsium dalam mandibula ppb Ulangan P1 P2 P3 P4 M1 0,0050 0,0065 0,0063 0,0061 M2 0,0065 0,0067 0,0059 0,0070 M3 0,0061 0,0062 0,0057 0,0060 M4 0,0050 0,0059 0,0061 0,0061 M5 0,0065 0,0066 0,0061 0,0072 M6 0,0043 0,0057 0,0062 0,0061 Rata 2 ± SD 0,0056 ± 0,0009 0,0063 ± 0,0004 0,0061 ± 0,0002 0,0064 ± 0,0005 Tabel 3. Kadar kalsium dalam tibia ppb Ulangan P1 P2 P3 P4 M1 0,0028 0,0065 0,0054 0,0080 M2 0,0063 0,0059 0,0065 0,0072 M3 0,0059 0,0063 0,0054 0,0069 M4 0,0061 0,0067 0,0073 0,0076 M5 0,0063 0,0052 0,0069 0,0074 M6 0,0059 0,0065 0,0050 0,0070 Rata 2 ± SD 0,0056 ± 0,0014 0,0062 ± 0,0006 0,0061 ± 0,0009 0,0074 ± 0,0004 Universitas Sumatera Utara Lampiran 2. Analisis distribusi data Tabel 4. Distribusi data masih-masing kelompok perlakuan Tests of Normality .245 6 .200 .849 6 .156 .274 6 .177 .902 6 .389 .368 6 .011 .682 6 .004 .213 6 .200 .937 6 .635 .245 6 .200 .849 6 .156 .274 6 .177 .902 6 .389 .368 6 .011 .682 6 .004 .213 6 .200 .937 6 .635 .230 6 .200 .874 6 .243 .219 6 .200 .922 6 .520 .258 6 .200 .940 6 .659 .390 6 .005 .734 6 .014 .435 6 .001 .614 6 .001 .250 6 .200 .866 6 .211 .266 6 .200 .901 6 .377 .143 6 .200 .956 6 .787 .174 6 .200 .937 6 .638 .202 6 .200 .890 6 .317 .396 6 .004 .765 6 .028 .284 6 .142 .880 6 .268 .182 6 .200 .903 6 .393 .171 6 .200 .966 6 .863 .167 6 .200 .910 6 .435 .141 6 .200 .973 6 .913 .299 6 .100 .758 6 .024 .159 6 .200 .964 6 .849 .226 6 .200 .894 6 .342 .142 6 .200 .968 6 .877 Kelompok P1 P2 P3 P4 P1 P2 P3 P4 P1 P2 P3 P4 P1 P2 P3 P4 P1 P2 P3 P4 P1 P2 P3 P4 P1 P2 P3 P4 Ca_darah Ca_tl_mandibula Ca_tl_tibia BB_tl_Mandibula BK_tl_Mandibula BB_tl_Tibia BK_tl_Tibia Statistic df Sig. Statistic df Sig. Kolmogorov-Smirnov a Shapiro-Wilk This is a lower bound of the true significance. . Lilliefors Significance Correction a. Universitas Sumatera Utara Lampiran 3. Analisis variansi atau homogenitas data Tabel 5. Uji variansi data uji homogenitas distribusi data tiap kelompok perlakuan Test of Homogeneity of Variance 1.583 3 20 .225 1.491 3 20 .247 1.491 3 14.061 .260 1.584 3 20 .224 1.583 3 20 .225 1.491 3 20 .247 1.491 3 14.061 .260 1.584 3 20 .224 10.388 3 20 .000 4.508 3 20 .014 4.508 3 10.795 .028 9.885 3 20 .000 1.941 3 20 .155 .731 3 20 .545 .731 3 7.334 .564 1.421 3 20 .266 2.011 3 20 .145 .955 3 20 .433 .955 3 7.157 .464 1.613 3 20 .218 .409 3 20 .749 .402 3 20 .753 .402 3 13.844 .754 .446 3 20 .723 4.126 3 20 .020 3.247 3 20 .044 3.247 3 14.523 .053 4.004 3 20 .022 Based on Mean Based on Median Based on Median and with adjusted df Based on trimmed mean Based on Mean Based on Median Based on Median and with adjusted df Based on trimmed mean Based on Mean Based on Median Based on Median and with adjusted df Based on trimmed mean Based on Mean Based on Median Based on Median and with adjusted df Based on trimmed mean Based on Mean Based on Median Based on Median and with adjusted df Based on trimmed mean Based on Mean Based on Median Based on Median and with adjusted df Based on trimmed mean Based on Mean Based on Median Based on Median and with adjusted df Based on trimmed mean Ca_darah Ca_tl_mandibula Ca_tl_tibia BB_tl_Mandibula BK_tl_Mandibula BB_tl_Tibia BK_tl_Tibia Levene Statistic df1 df2 Sig. Universitas Sumatera Utara Lampiran 4. Hasil analisis distribusi dan homogenitas data Tabel 6. Hasil analisis distribusi data dan variansi homogenitas data semua parameter uji. Parameter Uji Distribusi data Variansi homogenitas data Ca darah Tidak normal Homogen Ca mandibula Tidak normal Homogeny Ca tibia Tidak normal Tidak homogeny Transformasi data Ca darah 2.31 2.28 2.25 2.22 2.19 2.16 Level 0.0 -0.5 -1.0 Spread Slope = 8.909 Power for transformation = -7.909 Plot of LN of Spread vs LN of Level Spread vs. Level Plot of Ca_darah by Kelompok Universitas Sumatera Utara Transformasi data Ca Mandibula -5.08 -5.10 -5.12 -5.14 -5.16 -5.18 -5.20 Level -6.5 -7.0 -7.5 -8.0 Spread Slope = -9.787 Power for transformation = 10.787 Plot of LN of Spread vs LN of Level Spread vs. Level Plot of Ca_tl_mandibula by Kelompok Transformasi data Ca Tibia -5.050 -5.075 -5.100 -5.125 -5.150 -5.175 -5.200 Level -6.5 -7.0 -7.5 -8.0 Spr ead Slope = -7.048 Power for transformation = 8.048 Plot of LN of Spread vs LN of Level Spread vs. Level Plot of Ca_tl_tibia by Kelompok Lampiran 5. Bentuk transformasi data Universitas Sumatera Utara Tabel 7. Bentuk transformasi data Parameter Uji Distribusi data Variansi homogenitas data Slope Power transformation Betuk Transformasi data Ca Darah Tidak normal homogen 8,909 -7,909 1n Ca Mandibula Tidak normal homogen -9,787 10,787 Kuadrat Ca Tibia Tidak normal Tidak homogen -1,64 2,64 Kuadrat Tabel 8. Hasil uji distribusi data Tests of Normality .277 6 .168 .815 6 .079 .283 6 .146 .905 6 .403 .356 6 .017 .695 6 .006 .196 6 .200 .956 6 .788 .230 6 .200 .865 6 .206 .271 6 .194 .901 6 .378 .373 6 .009 .675 6 .003 .222 6 .200 .926 6 .552 .245 6 .200 .869 6 .221 .215 6 .200 .925 6 .541 .253 6 .200 .945 6 .699 .391 6 .005 .733 6 .013 .466 6 .000 .551 6 .000 .270 6 .196 .828 6 .104 .252 6 .200 .900 6 .377 .141 6 .200 .966 6 .864 .175 6 .200 .939 6 .653 .198 6 .200 .895 6 .346 .367 6 .011 .822 6 .092 .265 6 .200 .905 6 .406 .314 6 .066 .738 6 .015 .163 6 .200 .960 6 .824 .225 6 .200 .903 6 .395 .152 6 .200 .957 6 .797 Kelompok P1 P2 P3 P4 P1 P2 P3 P4 P1 P2 P3 P4 P1 P2 P3 P4 P1 P2 P3 P4 P1 P2 P3 P4 trans_Ca_darah trans_Ca_Mandibula trans_Ca_Tl_Tibia trans_BB_tl_Mandibu trans_BK_tl_Mandibu trans_BK_tl_Tibia Statistic df Sig. Statistic df Sig. Kolmogorov-Smirnov a Shapiro-Wilk This is a lower bound of the true significance. . Lilliefors Significance Correction a. Lampiran 6. Hasil uji variansi homogenitas data Universitas Sumatera Utara Tabel 9. Hasil uji variansi homogenitas data Test of Homogeneity of Variance 1.416 3 20 .267 1.317 3 20 .297 1.317 3 11.414 .316 1.425 3 20 .265 1.670 3 20 .205 1.572 3 20 .227 1.572 3 15.235 .237 1.662 3 20 .207 9.366 3 20 .000 3.272 3 20 .043 3.272 3 9.186 .072 8.740 3 20 .001 3.685 3 20 .029 .717 3 20 .553 .717 3 5.438 .580 2.466 3 20 .092 1.320 3 20 .296 .855 3 20 .480 .855 3 7.702 .504 1.111 3 20 .368 3.162 3 20 .047 2.357 3 20 .102 2.357 3 13.394 .118 3.040 3 20 .053 Based on Mean Based on Median Based on Median and with adjusted df Based on trimmed mean Based on Mean Based on Median Based on Median and with adjusted df Based on trimmed mean Based on Mean Based on Median Based on Median and with adjusted df Based on trimmed mean Based on Mean Based on Median Based on Median and with adjusted df Based on trimmed mean Based on Mean Based on Median Based on Median and with adjusted df Based on trimmed mean Based on Mean Based on Median Based on Median and with adjusted df Based on trimmed mean trans_Ca_darah trans_Ca_Mandibula trans_Ca_Tl_Tibia trans_BB_tl_Mandibula trans_BK_tl_Mandibula trans_BK_tl_Tibia Levene Statistic df1 df2 Sig. Tabel 10. Bentuk Uji lanjut setelah uji distribusi dan variansi homogenitas data Parameter Uji Distribusi data Variansi data Tipe Uji Uji Uji lanjut Ca darah Tidak normal homogen Nonparametrik Kruskal Wallis Mann Whitney Ca mandibula Tidak normal homogen Nonparametrik Kruskal Wallis Mann Whitney Ca tibia Tidak normal Tidak homogen Nonparametrik Kruskal Wallis Mann Whitney Lampiran 7. Uji nonparametrik kruskall wallis untuk beberapa parameter uji Universitas Sumatera Utara NPar Tests Kruskal-Wallis Test Ranks 6 14.17 6 4.50 6 13.83 6 17.50 24 6 14.17 6 4.50 6 13.83 6 17.50 24 6 9.25 6 14.75 6 11.08 6 14.92 24 6 7.67 6 10.83 6 10.58 6 20.92 24 6 3.92 6 9.58 6 16.00 6 20.50 24 6 4.33 6 13.75 6 15.42 6 16.50 24 Kelompok P1 P2 P3 P4 Total P1 P2 P3 P4 Total P1 P2 P3 P4 Total P1 P2 P3 P4 Total P1 P2 P3 P4 Total P1 P2 P3 P4 Total Ca_darah Ca_tl_mandibula