EFEKTIVITAS EKSTRAK BUAH BELIMBING WULUH TERHADAP ANGIOGENESIS PENYEMBUHAN LUKA PENCABUTAN GIGI MARMUT
EFEKTIVITAS EKSTRAK BUAH BELIMBING WULUH TERHADAP ANGIOGENESIS PENYEMBUHAN LUKA PENCABUTAN GIGI MARMUT SKRIPSI
Oleh:
ANGELINA PUTRI LESTARI 021211131019 FAKULTAS KEDOKTERAN GIGI UNIVERSITAS AIRLANGGA SURABAYA 2015
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EFEKTIVITAS EKSTRAK BUAH BELIMBING WULUH TERHADAP ANGIOGENESIS PENYEMBUHAN LUKA PENCABUTAN GIGI MARMUT SKRIPSI Oleh : ANGELINA PUTRI LESTARI 021211131019 FAKULTAS KEDOKTERAN GIGI UNIVERSITAS AIRLANGGA SURABAYA 2015
ADLN - PERPUSTAKAAN UNIVERSITAS AIRLANGGA
ADLN - PERPUSTAKAAN UNIVERSITAS AIRLANGGA
PENETAPAN PANITIA PENGUJI SKRIPSI Skripsi ini telah diuji pada tanggal 22Desember 2015 PANITIA PENGUJI SKRIPSI 1. Dr. David B. Kamadjaja, drg., MDS., Sp.BM (ketua penguji) 2. R. Soesanto, drg, M.Kes., Sp.BM(K) (pembimbing utama/anggota) 3. Djodi Asmara, drg., SU., Sp.BM (pembimbing serta/anggota) 4. Herdi Eko Pranjoto, drg., SU., Sp.BM (penguji) 5. Andra Rizqiawan, drg., PhD., Sp.BM (penguji)
UCAPAN TERIMA KASIH
Segala puji bagi Allah SWT, atas rahmat dan karunia-Nya sehingga skripsi saya yang berjudul “Efektivitas Ekstrak Buah Belimbing Wuluh terhadap Angiogenesis Penyembuhan Luka Pencabutan Gigi Marmut” dapat selesai, sebagai salah satu syarat menyelesaikan pendidikan dokter gigi di Fakultas Kedokteran Gigi Universitas Airlangga.
Perkenankanlah saya mengucapkan terima kasih yang sebesar-besarnya kepada :
1. Dr. R. Darmawan Setijanto, drg., M.Kes selaku dekan Fakultas Kedokteran Gigi Universitas Airlangga 2015-2020 yang telah memberi kesempatan untuk menempuh pendidikan di Fakultas Kedokteran Gigi Universitas Airlangga.
2. Prof. R. M. Coen Pramono D, drg., SU., Sp.BM(K)., selaku dekan Fakultas Kedokteran Gigi Universitas Airlangga periode 2010-2015 yang telah memberi kesempatan untuk menempuh pendidikan di Fakultas Kedokteran Gigi Universitas Airlangga.
3. Herdi Eko Pranjoto, drg., SU., Sp.BM selaku Ketua Departemen Bedah Mulut dan Maksilofasial yang telah memberikan ijin dalam pembuatan skripsi.
4. R. Soesanto, drg, M.Kes., Sp.BM(K) selaku dosen pembimbing utama yang selalu memberikan bimbingan, masukan, arahan, serta meluangkan waktu selama penyusunan skripsi.
5. Djodi Asmara, drg., SU., Sp.BM selaku dosen pembimbing serta yang turut memberikan masukan, evaluasi, koreksi, serta meluangkan waktu selama penyusunan skripsi. ADLN - PERPUSTAKAAN UNIVERSITAS AIRLANGGA
6. Tim penguji yang telah banyak memberikan kritik dan saran dalam penyusunan skripsi ini.
7. Seluruh dosen dan staf Departemen Bedah Mulut dan Maksilofasial Fakultas Kedokteran Gigi Universitas Airlangga.
8. Terima kasih tak terhingga kepada kedua orang tua saya Bapak Restu Harianto dan Ibu Endah Basuki Prihariani yang tersayang, serta adek-adek saya Belinda Harianti Putri dan Chikita Hariani Putri yang telah memberikan doa, semangat, dan dukungan yang tiada henti.
9. Teman-teman seperjuangan yang telah melalui hari-hari pembuatan skripsi bersama dan memberikan dukungan satu sama lain.
10. Semua pihak yang tidak dapat disebutkan satu persatu yang terkait dan telah mendukung saya dalam pembuatan skripsi ini.
Penulis menyadari bahwa penyusunan skripsi ini tidak lepas dari kekurangan. Oleh karena itu, penulis terbuka atas kritik dan saran yang membangun dan semoga penulisan ini dapat bermanfaat bagi pembaca
Surabaya, Desember 2015 Penulis ADLN - PERPUSTAKAAN UNIVERSITAS AIRLANGGA ADLN - PERPUSTAKAAN UNIVERSITAS AIRLANGGA
ABSTRACT EFEKTIVITAS EKSTRAK BUAH BELIMBING WULUH TERHADAP ANGIOGENESIS PENYEMBUHAN LUKA PENCABUTAN GIGI MARMUT EFFECTIVITY OF Averrhoa bilimbii EXTRACT OF ANGIOGENESIS WOUND HEALING MARMOT TOOTH EXTRACTION Background.
The prevalence of tooth extraction in dentistry is 54,3%. Tissue damage that occurs after tooth extraction can cause release growth factor of platelet, namely PDGF and VEGF. Both of growth factor, PDGF and VEGF, simultaneous triggering angiogenesis and mediates blood vessel growth. VEGF plays a role in the increased permeability of blood vessels, and PDGF plays a role in facilitating vascular maturation. This research to find alternatif materials that have increased angiogenesis and by utilizing natural ingredients that can later be used as a gel topical for increased wound healing.Averrhoa bilimbii extract contains flavonoids, saponins and tannins. Flavonoids, saponins and tannins have antioxidant and anti-inflammatory effects. Flavonoids also increase growth factor and wound healing post tooth extraction. Purpose. The aim of this study was to determine Averrhoa bilimbii extract against angiogenesis in socket of marmot post tooth extraction. Method. This research is a laboratory experimental with post test only group design, using 32 marmots, which divided into 8 groups, 4 groups was observed angiogenesis on the third day and 4 groups was observed angiogenesis on the fifth day. 1 of 4 groups as a control group was given CMC-Na and three others as an intervention groups was given Averrhoa bilimbii extract with concentration 10%, 20%, and 40%. Observations were made by calculating the lumens of blood vessels and using histopatological samplings. Finally, the data were analysed using One-Way ANOVA. Result. At the concentration 10%, 20%, and 40% of Averrhoa bilimbii extract showed that affects the increased angiogenesis in socket of marmot post tooth extraction on the third day and fifth day. Conclusion. The Averrhoa bilimbii extract can increased angiogenesis effect in socket of marmot post tooth extraction on the third day and fifth day Keyword : Averrhoa bilimbii extract, Angiogenesis, Tooth extraction.
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DAFTAR ISI Sampul Depan Sampul Dalam ................................................................................................................. i Prasyarat Gelar/Persetujuan ......................................................................................... ii Penetapan Panitia Penguji.............................................................................................. iii Ucapan Terima Kasih ..................................................................................................... iv Abstract............................................................................................................................. v Daftar Isi .......................................................................................................................... vi Daftar Gambar ................................................................................................................ x Daftar Tabel .................................................................................................................... xi Daftar Lampiran ............................................................................................................. xii
BAB 1 PENDAHULUAN .............................................................................................. 1
1.1 Latar Belakang .................................................................................................... 1
1.2 Rumusan Masalah ............................................................................................... 4
1.3 Tujuan Penelitian ............................................................................................... 4
1.3.1 Tujuan Umum ........................................................................................... 4
1.3.2 Tujuan Khusus .......................................................................................... 4
1.4 Manfaat .............................................................................................................. 4
BAB 2 TINJAUAN PUSTAKA ...................................................................................... 6
2.1 Pencabutan Gigi ................................................................................................. 6
2.2 Penyembuhan Luka ............................................................................................ 7
2.2.1 Pengertian Luka ........................................................................................ 7
2.2.2 Fase Penyembuhan Luka .......................................................................... 7
2.2.2.1 Fase Inflamasi .............................................................................. 8
2.2.2.2 Fase Proliferasi ............................................................................ 9
2.2.2.3 Fase Remodeling .......................................................................... 9
2.3 Penyembuhan Luka Pasca Pencabutan Gigi ....................................................... 9
2.8 CMC Na ............................................................................................................. 23
4.3.1 Variabel Bebas .......................................................................................... 30
4.3 Variabel Penelitian .............................................................................................. 30
4.2.3 Besar Sampel ............................................................................................ 29
4.2.2 Kriteria Sampel ......................................................................................... 29
4.2.1 Jenis Sampel ............................................................................................. 29
4.2 Sampel Penelitian ................................................................................................ 29
4.1 Jenis Penelitian .................................................................................................... 27
BAB 4 METODE PENELITIAN ................................................................................... 27
3.2 Hipotesis Penelitian ............................................................................................. 26
3.1 Kerangka Konsep Penelitian ............................................................................... 24
BAB 3 KERANGKA KONSEP ...................................................................................... 24
2.7.5 Manfaat Belimbing Wuluh ........................................................................ 23
2.4 Angiogenesis ....................................................................................................... 10
2.7.4.3 Tanin ............................................................................................ 21
2.7.4.2 Flavonoid ..................................................................................... 19
2.7.4.1 Saponin ........................................................................................ 18
2.7.4 Fitokimia Belimbing Wuluh ..................................................................... 18
2.7.3 Morfologi Tumbuhan Belimbing Wuluh ................................................... 17
2.7.2 Karakteristik Tumbuhan Belimbing Wuluh .............................................. 16
2.7.1 Taksonomi Belimbing Wuluh ................................................................... 15
2.7 Belimbing Wuluh ............................................................................................... 15
2.6 Antioksidan ........................................................................................................ 15
2.5 Radikal Bebas .................................................................................................... 14
2.4.1 VEGF (Vascular Endothelial Growth Factor) .......................................... 12
4.3.2 Variabel Terikat ........................................................................................ 30 ADLN - PERPUSTAKAAN UNIVERSITAS AIRLANGGA
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4.3.3 Variabel Terkontrol ................................................................................... 30
4.4 Definisi Operasional............................................................................................ 31
4.5 Instrument Penelitian .......................................................................................... 31
4.6 Lokasi Penelitian ................................................................................................. 32
4.7 Waktu Penelitian ................................................................................................. 32
4.8 Obyek Penelitian ................................................................................................. 32
4.9 Alat dan Bahan .................................................................................................... 33
4.10 Jalannya Penelitian .............................................................................................. 34
4.10.1 Tahap Persiapan ...................................................................................... 34
4.10.2 Tahap Eksperimen .................................................................................. 37
4.10.3 Tahap Observasi...................................................................................... 39
4.11 Pengolahan dan Analisis Data ............................................................................ 39
4.12 Alur Penelitian .................................................................................................... 41
BAB 5 HASIL PENELITIAN DAN ANALISIS DATA ............................................... 42
5.1 Data Penelitian .................................................................................................... 42
5.2 Analisis Data ....................................................................................................... 43
5.3 Data Gambar Preparat HPA ................................................................................ 46
BAB 6 PEMBAHASAN .................................................................................................. 48 BAB 7 KESIMPULAN DAN SARAN ........................................................................... 53
7.1 Kesimpulan ......................................................................................................... 53
7.2 Saran ................................................................................................................... 53
DAFTAR PUSTAKA ...................................................................................................... 54 LAMPIRAN
DAFTAR GAMBAR Gambar 2.1
Fase Penyembuhan Luka .............................................................. 8
Gambar 2.2 Struktur Protein Faktor Angiogenik ............................................. 13Gambar 2.3 Buah Belimbing Wuluh ................................................................ 17 Gambar 2.4Struktur Kimia Senyawa Saponin ................................................. 19
Gambar 2.5 Struktur Kimia Senyawa Flavonoid .............................................. 20Gambar 2.6 Struktur Kimia Senyawa Tanin .................................................... 22 Gambar 4.1Skema Rancangan Penelitian ....................................................... 27
Gambar 5.1
Angiogenesis ............................................................................... 47 ADLN - PERPUSTAKAAN UNIVERSITAS AIRLANGGA
DAFTAR TABEL Tabel 2.1
Taksonomi Belimbing Wuluh ........................................................... 16
Tabel 5.1 Jumlah endotel yang teramati ............................................................ 42Tabel 5.2 Grafik rata-rata endotel yang teramati ............................................... 43 Tabel 5.3Hasil uji normalitas data ................................................................... 44
Tabel 5.4 Hasil uji homogenitas Variance Levine ............................................. 44Tabel 5.5 Hasil uji One-Way ANOVA ............................................................... 45 Tabel 5.6Uji Tukey HSD .................................................................................. 46 ADLN - PERPUSTAKAAN UNIVERSITAS AIRLANGGA
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DAFTAR LAMPIRAN Lampiran 1.
Keterangan Laik Etik Lampiran 2. Analisis Fitokimia Ekstrak Daun Belimbing Wuluh Lampiran 3. Gambar Alat dan Bahan Lampiran 4.
Tabel Hasil Penelitian Lampiran 5. Hasil Uji Statistik