Implant Placement after Closure of Oroantral Communication by Sinus Bone Graft Using a Collagen Barrier Membrane in the Shape of a Pouch: A Case Report and Review of the Literature.

Jae-Ha Baek,Byung-Ock Kim,Won-Pyo Lee

doi:10.3390/medicina57060626

Abstract

Oro-antral communication (OAC) acts as a pathway for bacteria between the maxillary sinus and oral cavity, and is a common complication after the removal of a dental implant or extraction of a tooth from the maxillary posterior area. In the case of an untreated OAC, oro-antral fistula develops and becomes epithelialized. We aimed to introduce a treatment for OAC closure via a sinus bone grafting procedure using bone tacks and a collagen membrane with an allograft. The procedure was performed by applying an absorbable membrane made in pouch form. This membrane acted as a barrier for closing the large sinus membrane perforation. Bone tacks were used to fix the membranes. Subsequently, the maxillary sinus was filled with the allograft, and the absorbable membrane was reapplied. Primary closure was achieved by performing a periosteum-releasing incision for a tension-free suture. After 6 months, sufficient bone dimensions were gained without any occurrence of maxillary sinusitis or recurrence of OAC. Additional bone grafts and implantation could be performed to rehabilitate the maxillary posterior area. We conclude that this technique might be a useful treatment for reconstructing the maxillary posterior area with simultaneous sinus bone graft and OAC closure.

Highlights

Implant removal or extraction of a tooth from the maxillary posterior region leads to maxillary sinus perforation and oro-antral communication (OAC)
It progresses to epithelial patency, known as an oroantral fistula (OAF) [1,2]
Several procedures describing the closure of OAC have been introduced, including the use of soft tissue flap, sinus elevation accompanied by bone grafting, and the use of platelet-rich fibrin [1,2,3,4]

Summary

Introduction

Implant removal or extraction of a tooth from the maxillary posterior region leads to maxillary sinus perforation and oro-antral communication (OAC). OAC indicates a pathological condition in which the maxillary sinus and oral cavity are connected. This acts as a pathological path for bacteria and can cause maxillary sinusitis. If this condition persists, it progresses to epithelial patency, known as an oroantral fistula (OAF) [1,2]. If OAC and OAF remain unclosed, the oral bacterial infection persists and the continuous communication of food and foreign substances occurs, invoking chronic maxillary sinusitis without healing of the maxillary sinus membrane. There is a delay in maxillary posterior bone reconstruction for implant placement, and eventually a prolongation of the patient’s treatment period [3,4]

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Discussion

Conclusion