Closure Of Oroantral Communication Research Articles

Oroantral communication closure with Bichat adipose body: etiology, clinical and radiographics features

Objective: This study aims to clarify to the dentist about the possible etiological factors responsible for such complication, to identify its clinical and radiographic signs and to describe the surgical technique adopted in these cases. Case Report: For this purpose, the authors present the clinical case of a patient with post-exodontia oroantral fistula of the right permanent maxillary first molar. The proposed treatment was the closure of the fistula under local anesthesia using the Bichat adipose body, with advantages of being a simple procedure, easy to perform, that does not require specific material, minimal complications, low morbidity and can be performed in the own dental practice and with high success rates proven by several studies. Discussion: The oroantral fistula is a common pathological occurrence in the dental clinic, characterized by communication of the maxillary sinus with the oral cavity when the maxillary sinus is pneumatic or during dental extractions of upper posterior elements whose roots are closely related to the maxillary sinus. Conclusion: Communications should be treated immediately, if there are signs of inflammation it should be treated first, so that surgical correction can be performed later.

Management of Oroantral Communication Using Double Layered Closure with Buccal Fat Pad and Buccal Advancement Flap: Prospective Randomized Clinical Study

Introduction: Although many techniques are available for management of oroantral communication, they
 utilize single layer tissue for closure of defect which is composite in nature. There is limited evidence in
 literature regarding efficacy of double layered closure using combination of flaps. This study was designed
 to assess utility of double layer closure of oroantral communication using buccal fat pad and buccal mucosa
 advancement flap.
 Material and Method: Patients with oroantral communication were randomly allocated to two groups;
 group A were treated with two layered closure (buccal fat pad and buccal mucosa) and group B were treated
 with single layer closure (buccal fat pad). Same protocol of perioperative management was used for both
 groups. The postoperative parameters evaluated included success of surgery (complete closure without any
 nasal regurgitation), duration of surgery, pain, swelling and mouth opening.
 Results: Total of 27 patients were divided into group A (n=13) and group B (n=14). The mean size of the
 defect was 28.23 mm in study group and 24.57 mm in the control group. The surgical procedure took more
 time (42.23 minutes) in group A, as compared to group B (26.21 minutes). Post-operative evaluation of pain
 and mouth opening showed no statistically significant between the two groups at 7th and 30th postoperative
 days respectively. However, swelling was relatively more when combination of buccal fat pad and buccal
 advancement flap was used.
 Conclusion: Double layered closure is efficient in management of OAC. No dehiscence of flap was seen in
 study group. Comparatively 3 dehiscence was observed in control group, especially with large size defect.
 The postoperative sequel in both groups was similar.

Study Of The Efficacy Of Pedicled Buccal Fat Pad Graft Technique In The Management Of Oro-Antral Communications

Background of the study: Oro-antral communication is a complication associated with extraction of maxillary posterior teeth, surgeries of the maxillary sinus or pathologies associated with the sinus or the posterior maxilla. Such abnormal communications need to be repaired at the earliest, to maintain oral and nasal complex harmony and to prevent undue complications thereafter. These communications can be repaired by various methods, one of those being buccal fat pad pedicled graft technique which will be clinically evaluated and critically discussed in this paper. The pre-operative, immediate and post-operative measures followed, the eligibility criteria chosen and the duration of follow up period will formulate the outline for the study. A careful assessment of the criteria, clinical signs and healing is noted, to establish the outcome of the technique. Aim: The aim of this clinical study is to evaluate the effectiveness of buccal fat pad pedicled graft technique for closure of Oro-antral communications. The purpose of choosing this method is easy availability of the graft near to the recipient site, ease of technique for the surgeon, reliable technique and predictable outcome of the treatment. The effectiveness of the procedure and its predictability, in comparison to other methods is dealt in detail below. Methods: An observational study to evaluate the effectiveness of a surgical technique to repair oro-antral communications wherein the pedicled buccal fat pad is used as a graft material. 20 patients with OAC, who were presented to the department of Oral & Maxillofacial surgery, VS Dental College & Hospital, Bangalore were recruited for the study. The clinical study was conducted in accordance with the protocol and the results were evaluated on the basis of patient’s comfort towards the procedure, ease of the technique, healing time, post-operative complications and recurrence rate of the communication. The details of the technique and a review of the previous studies published were discussed in detail, to form a relevant summary. Results: The technique was found to be more effective and convenient to both the patient and operator, owing to its ease of performing, minimal risk of complications from the grafted site and the harvest site and predictable healing. Conclusions: The technique is easiest among the various methods recommended so far, pertaining to the procedure and predictability. Although, the training and experience of a skilled operator is equally important in achieving the best results.

Clinical and Radiographic Assessment of cyanoacrylates Opposing Buccal sliding flap for the immediate repair of Oroantral communication

Introduction: Oroantral communication is an uncommon, inadvertent incident resulting from various causes the most commonof which is the extraction of upper molars. Immediate closure of the communication is highly recommended to avoid infectionand subsequent fistulous tract formation. Cyanoacrylate tissue glue was introduced as a reliable method for flapless sealing of thecommunication without any of the complications associated with the surgical maneuvers. One of the oldest surgical proceduresused for closure of the Oroantral communication is the buccal advancement flap which proved efficiency in complete closureof the defect with minimal related complications.Aim of the study: The study aims evaluate the immediate flapless closure of Oroantral communication using cyanoacrylatesversus the buccal sliding advancement flap.Patients and Methods: Twenty patients suffering from instant oroantral communication were included in the study. CBCTwas performed to each of them to confirm the diagnosis, patients were divided into two groups where Group I (Study group)patients were treated by sealing of the defect using periacry l90 HV while Group II (control group) patients performed Buccalsliding advancement flap. Clinical follow up including pain, facial swelling, recurrence of the defect and sulcular depth up wereperformed at day 1, 3, 7, 15 and 1 month. CBCTs were done at 3 and 6 months postoperative to assess healing of the defectregarding size and density.Results: Clinically Group I showed minimal pain and swelling with no change of sulcular depth. In contrast, Group II showedhigh pain level and increase in facial swelling together with a significant decrease in sulcular depth. None of the patients inboth groups showed any recurrence of the condition. CBCTs showed decrease in defect size and formation of bone within thedefect in both groups.Conclusion: Both maneuvers are good modalities for treating OAC, however cyanoacrylate is associated with minimalcomplications.

The use of Buccal Pad of Fat Versus Leukocyte-Platelet Rich Fibrin for Closure of Oroantral Communication

Introduction: extraction of maxillary posterior teeth is considered one of the main cause of Oroantral communication (OAC) due to the close proximity of the roots to the maxillary sinus. Aim of study: Evaluation of Buccal Pad of Fat versus Leukocyte Platelet Rich Fibrin (L-PRF) in the management of oroantral communication. Materials and Methods: This study was carried out on twelve patients with oroantral communication. They were divided into two equal groups, six patients in each. In Group I, the patients were treated with buccal fat pad technique. While in group II, the patients were managed with L-PRF technique for OAC closure. Patients were followed up for 1,3,5,7 days post-operative then weekly for 4 weeks. Results: There was significant difference between the two groups regarding pain, and swelling however, no significant difference between both groups regarding infection during different follow up periods. No recurrence for the oroantral communication was observed in all patients of both groups after 4 weeks postoperatively. Conclusion: The goal of closing an oroantral communications was to prevent infection of the maxillary sinus through separating the oral cavity from maxillary sinus .

USE OF BUCCAL ADVANCEMENT FLAP FOR REPAIR OF OROANTRAL FISTULA: A CASE SERIES STUDY

Objective: To evaluate the success rate of Buccal advancement Flap (BAF) in closure of Oroantral communication (OAC) and Fistula. Materials and Methods: In this case-series study, buccal advancement flap (BAF) was used in 45 consecutive patients at Oral and Maxillofacial Surgery Department of Fatima Memorial Hospital Lahore for period of one year (May 2018-May2019). Male to female ratio was 2:1 and mean age=26 years. Right maxillary OAF of first and second molars presented more than left side (n=35, 77%). All defects were not more than 5mm. After application of flap, patients were evaluated for sign and symptoms of infection, wound dehiscence, loss of flap whether partial or complete and recurrence of oroantral fistula (OAF). Data was analyzed using SPSS version 20, INC, Chicago USA with descriptive analysis to derive percentages and frequencies for all variables. Results: Thirty nine patients (86%) had successful healing of flap. Partial loss occurred in one patient (2.25%). Wound dehiscence was seen in two patients (4.45%). Complete loss of flap was also noted in two patients (4.45%). Recurrent OAF has occurred in one patient (2.25%). Conclusion: BAF is a flap of choice for immediate closure of OAC and OAF of ≤5mm in the region of maxillary first and second molar. The technique is simple and vascular supply ensures the proper healing of flap. More work needs to be done to evaluate the causes for the partial or complete loss of the flap.

Rose-trellis periosteal release in oral mucosal advancement flaps in pigs.

The aims of this study were to find out whether scoring in a rose-trellis pattern improved the stretch of mucoperiosteal flaps more than conventional scoring in the horizontal plane, and to consider its application in the closure of oroantral communications. Sixteen sections of cadaveric porcine buccal mucoperiosteum were removed from the molar region of the maxilla and mandible. A three-sided flap was raised in the subperiosteal plane, excised, and pinned to a cork board with the periosteal side facing upwards. Eight samples were scored in the horizontal plane (control) using lines perpendicular to the line of simulated advancement, and eight in a rose-trellis or criss-cross pattern. Scoring using a rose-trellis pattern yielded a mean increase in stretch of 24.3% (p=0.0003) when compared with the conventional method. Buccal advancement flaps are widely used to close oroantral communications, and scoring of the mucoperiosteum facilitates the stretching of the tissue over the defect. To be successful, defects should be fully closed to prevent contamination, and closure should be tension-free. In this study, scoring in a rose-trellis pattern increased the stretch of the tissue sample more than scoring in the horizontal plane. The rose-trellis technique therefore could aid the effective closure of oroantral communications.

Use of autogenous bone graft of the anterior wall of the maxillary sinus in the management of oroantral fistula

Introduction: The oroantral fistula consists of a persistent communication between the maxillary sinus and the buccal cavity, being a complication resulting from traumas, pathologies or dental extractions. Objective: To present a clinical case of oroantral fistula closure using autogenous bone graft from the anterior sinus wall as a treatment option. Materials and Methods: Patient with a history of traumatic extraction of the upper left molars about 4 months ago. During the clinical examination, there was an orifice in the left maxillary alveolar crest, suggestive of oroantral fistula, responding positively to the Valsalva maneuver. Panoramic radiographic examination evidenced continuity between the oral cavity and the left maxillary sinus, which presented with opacification, suggestive of acute maxillary sinusitis on the left side. Sinusitis was treated within 15 days. After treatment, we evaluated the patient who was asymptomatic and, at that moment, the surgical procedure for the oroantral fistula closure was planned, removing a bone block from the anterior wall of the left maxillary sinus presenting the sinus membrane and grafting with fixation using System 1.5 mm with an "L" plate and four bolts. Conclusion: This surgical technique is useful for the closure of chronic oroantral fistulas in patients with oroantral fistulas.Descriptors: Oroantral Fistula; Bone Transplantation; Maxillary Sinus.ReferencesMartín-Granizo R, Naval L, Costas A, Goizueta C, Rodriguez F, Monje F, Muñoz M, Diaz F. Use of buccal fat pad to repair intraoral defects: review of 30 cases. Br J Oral Maxillofac Surg. 1997;35(2):81-4.Yilmaz T, Suslu AE, Gursel B. Treatment of oroantral fistula:experience with 27 cases. Am J Otolaryngol. 2003;24(4):221-23.Anavi Y, Gal G, Silfen R, Calderon S. Palatal rotation-advancement flap for delayed repair of oroantral fistula: a retrospective evaluation of 63 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96(5):527-34.Haas R, Watzak G, Baron M. A preliminary study of monocortical bone grafts for oroantral fistula closure. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96(3):263-66Zide MF, Karas ND. Hydroxylapatite block closure of oroantral fistulas: report of cases. J Oral Maxillofac Surg. 1992;50(1):71-5.Poeschl PW, Baumann A, Russmueller G, Poeschl E, Klug C, Ewers R. Closure of oroantral communications with Bichat's buccal fat pad. J Oral Maxillofac Surg. 2009;67(7):1460-6.Jain MK, Ramesh C, Sankar K, Lokesh Babu KT. Pedicled buccal fat pad in the management of oroantral fistula: a clinical study of 15 cases. Int J Oral Maxillofac Surg. 2012;41(8):1025-29.Amaratunga NA. Oro-antral fistulae--a study of clinical, radiological and treatment aspects. Br J Oral Maxillofac Surg. 1986;24(6):433-37.Proctor B. Bone graft closure of large or persistent oromaxillary fistula. Laryngoscope 1969;79(5):822-26.Visscher SH, van Minnen B, Bos RR. Closure of oroantral communications: a review of the literature. J Oral Maxillofac Surg. 2010;68(6):1384-91.Visscher SH, van Roon MR, Sluiter WJ, van Minnen B, Bos RR. Retrospective study on the treatment outcome of surgical closure of oroantral communications. J Oral Maxillofac Surg. 2011;69(12):2956-61.Hanazawa Y, Itoh K, Mabashi T, Sato K. Closure of oroantral communications using a pedicled buccal fat pad graft. J Oral Maxillofac Surg. 1995;53(7):771-75.

Inferior-based Nasolabial Flap for the Surgical Treatment of Stage 3 Medication-Related Osteonecrosis of the Maxilla: A Technical Note

Stage 3 medication-related osteonecrosis of the jaw (MRONJ) requires surgical treatment for resolution of the pathology. In the maxilla, removal of the necrotic bone and infected soft tissue leads to large defects with oroantral communications. It is essential to cover the exposed bone and close the communications by using well-vascularized soft tissue for good long-term results without a relapse of the osteonecrosis. Here, we evaluated the technical usefulness of the inferior-based nasolabial flap (IBNF) for covering the exposed bone and closing the oroantral communications in maxillary stage 3 MRONJ after complete decortication and sinusotomy. No problems were noted in the treated areas in four patients at 12 months postoperatively. Despite the limited number of cases, the IBNF may be a reliable and simple method for the reconstruction of relatively large defects and the closure of oroantral communications in maxillary stage 3 MRONJ without complications.

An Unexpected Complication after Use of Pedicled Buccal Fat Pad for Closure of Oroantral Fistulae: Emphysema

Oro-antral communication (OAC) may develop as a complication of dental extraction, trauma, infection or neoplasm. Buccal fat pad (BFP) has been increasingly used for the closure of OAC. However, some complications can be seen for pedicled buccal fad pad flap (PBFPF), such as infection, limitation in mouth opening, hematoma, and swelling. Nevertheless, there are no previousreports of subcutaneous emphysema after PBFPF. In this paper; a complication developed in the early period after use of PBFPF for closure of OAF was illustrated with special emphasis showing the strength of BFP against tension forces.

M34 EMPLOYING A SYSTEMS BIOLOGY APPROACH ON GWAS RESULTS OF DEPRESSION AND LIFETIME TRAUMA

The incidence of oro-antral communication during removal of maxillary posterior teeth, especially the molars is quite common in general dental practice. The diagnosis and surgical management of oro-antral communication requires the surgical skills including the flap techniques. Here we present the novel technique of immediate closure of oro-antral communication using the PRF in the form of membrane and mixture of PRF and collagen, which is, sandwiched between the PRF membranes for effective management of oro-antral communications which does not require higher surgical skills.

Regenerative Effect of Platelet Concentrates in Oral and Craniofacial Regeneration.

Platelet concentrates (PCs) are biological autologous products derived from the patient's whole blood and consist mainly of supraphysiologic concentration of platelets and growth factors (GFs). These GFs have anti-inflammatory and healing enhancing properties. Overall, PCs seem to enhance bone and soft tissue healing in alveolar ridge augmentation, periodontal surgery, socket preservation, implant surgery, endodontic regeneration, sinus augmentation, bisphosphonate related osteonecrosis of the jaw (BRONJ), osteoradionecrosis, closure of oroantral communication (OAC), and oral ulcers. On the other hand, no effect was reported for gingival recession and guided tissue regeneration (GTR) procedures. Also, PCs could reduce pain and inflammatory complications in temporomandibular disorders (TMDs), oral ulcers, and extraction sockets. However, these effects have been clinically inconsistent across the literature. Differences in study designs and types of PCs used with variable concentration of platelets, GFs, and leucocytes, as well as different application forms and techniques could explain these contradictory results. This study aims to review the clinical applications of PCs in oral and craniofacial tissue regeneration and the role of their molecular components in tissue healing.

Closure of an Oroantral Communication Using Leucocyte-Platelet Rich Fibrin: A Novel Technique Using Regenerative Medicine

Oroantral communication (OAC) is a common complication following extraction of maxillary posterior teeth because of the close anatomic proximity of the roots to the maxillary sinus. The most frequent methods described in the literature to close an oroantral communication involve buccal or palatal rotational advancement flap surgery or use of the buccal fat pad. These surgical procedures require advanced surgical skill and are associated with donor sit morbidity, such as avascular flap necrosis that can lead to soft tissue graft failure to close the OAC, infection and extreme postoperative patient discomfort that affects patient quality of life. This paper describes a novel technique using leucocyte platelet-rich fibrin matrix obtained from the patient’s own venous blood that leads to predictable soft tissue regeneration and closure of the OAC. This regenerative medicine procedure is clinician friendly, less traumatic compared to traditional methods of OAC closure with minimal postoperative recovery for the patient.
 

Clinical and radiographic evaluation of buccal pad of fat versus sandwiched Bio-Oss® bone graft in closure of oroantral communication

Aim: Evaluation of buccal fat pad versus sandwiched Bio-Ossbone graft in the management of oroantral communication.Materials and Methods: This study was carried out on 12 patients with oroantral communication. They were divided into 2 groups, 6 patients in each. In Group A, the patients were managed with sandwiched Bio-Oss bone graft technique,while in group B, the patients were treated with buccal fat pad technique.Results: There was no significant difference between the two groups regarding pain, swelling and infection during different follow up periods. No recurrence for the oroantral communication was observed in all patients of both groups after one month postoperatively. Panoramic radiographs showed an evidence of bone formation in all the patients of Group A and in zero patients in Group B after 3 months postoperatively.Conclusion: No recurrence for the oroantral communication was observed in all patients of both groups at the end of the clinical follow up period after 1 month. In group A, new bone formation was evident in the panoramic x-rays after 3 months postoperatively where this can allow implant placement at the site of closure. On the other hand, patients in group B didn't show any evidence of new bone formation and no implants can be placed unless further surgical procedures are carried out.

Clinical Therapeutic Usage of Bichat Ball in Dentistry-A Review

The Bichat ball is fat located in the cheeks region, which can be used for various therapeutic purposes. The aim of the present study is to carry out a literature review on the use of Bichat ball and its application for aesthetic and functional issues. A search was performed on PubMed; SciELO, Scopus and Lilacs databases using the keywords we found 76 articles and 8 were selected, based on exclusion criteria (laboratory studies, articles in a language other than English, and literature reviews). The title and abstract of articles that met the inclusion criteria were evaluated. Some articles mentioned the use of the Bichat ball for the repair of small oral defects, such as oroantral communication closure, peri-orbital defects, congenital cleft palate, facial plastic surgery; some treatments were associated with pathologies. Further articles quoted its use for aesthetic purposes such as facial feminization and diminishing of the child's cheek appearance. Thus, the Bichat ball is effective for various purposes and can be used for both aesthetic and functional therapeutic treatment.

Flapless closure of oro-antral communication with PRF membrane and composite of PRF and collagen – a technical note

The incidence of oro-antral communication during removal of maxillary posterior teeth, especially the molars is quite common in general dental practice. The diagnosis and surgical management of oro-antral communication requires the surgical skills including the flap techniques. Here we present the novel technique of immediate closure of oro-antral communication using the PRF in the form of membrane and mixture of PRF and collagen, which is, sandwiched between the PRF membranes for effective management of oro-antral communications which does not require higher surgical skills.

Closure of Oroantral Communication With Plasma-Rich Fibrin Membrane.

Oroantral communication (OAC) is the opening between the maxillary sinus and oral cavity. It may cause oroantral fistula or maxillary sinusitis if left untreated. The surgical closure of the OAC within 48 hours was recommended to avoid the complications like sinus infections. The aim of this study is to evaluate the treatment of OACs with plasma-rich fibrin (PRF) which is safe and easy to implement in the OACs.This study was conducted with the patients, who required the treatment of the OAC, which was developed after the posterior maxillary tooth extraction in the Dental and Maxillofacial Department of the Faculty of Dentistry in Adnan Menderes University.Plasma-rich fibrin membranes were inserted in layers into the tooth socket so that they covered the OAC. Then these membranes were fixated with the sutures to the surrounding gingiva. Antibiotic (amoxicillin/clavulanic acid 1000 mg), analgesic (dexketoprofen trometamol and/or paracetamol), and oral rinse (0.2% chlorhexidine digluconate) agents were prescribed to all patients. The patients were examined in the 3rd and 7th days and 2 months after the operation.All patients tolerated PRF perfectly, and the soft tissue recovery was completed without any problem. Full epithelization was observed in the defect area in all patients. The OAC did not relapse in any patient.Plasma-rich fibrin technique is a simple and effective method, which can be used in the treatment of OACs with a diameter of 5 mm or less with a low risk of complications.

Low quality evidence for treatment approaches for oro-antral communications.

Data sourcesCochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline via Ovid, Embase via Ovid, US National Institutes of Health Trials Registry and the World Health Organisation (WHO) International Clinical Trials Registry Platform were searched until July 2015 followed by hand searching of relevant references.Study selectionUsing no language restrictions, two authors independently assessed for inclusion of randomised controlled trials (RCTs) evaluating any intervention for treating oro-antral communications (OAC) and oro-antral fistulae (OAF) due to dental procedures. Quasi-RCTs and crossover trials were excluded.Data extraction and synthesisTwo authors independently assessed for inclusion, resolved disagreement by discussion and a third reviewer was consulted if necessary.Qualitywas determined independently by using GRADE 2004.For the dichotomous outcome complete closure, they expressed the estimate effect as risk ratio (RR) with 95% confidence interval (CI).ResultsA single study that started with 22 participants was included in the review where the overall risk of bias was judged as unclear. The main outcome was complete closure. The study compared pedicled buccal fat pad flap (PBFPF) with buccal flap (BF) and showed no difference in the closure of OAC, with a calculated RR of 1.00, 95% CI 0.83 to 1.20.ConclusionsVery low quality evidence from a small single study provided insufficient proof to judge if there is a difference in the effectiveness of the interventions.

Clinical application of a buccal fat pad for closure of oroantral communication: a report of two cases

Clinical application of a buccal fat pad for closure of oroantral communication: a report of two cases

Provision of specialist‐led minor oral surgery service in Scottish NHS dental practices – analysis of benefits and costs

AbstractThis article evaluates the benefits of specialist‐led minor oral surgery service in Scottish primary care dental practice.ObjectivesThe aims of the study were to: Study practice‐based minor oral surgery service delivery. Estimate waiting times for these patients. Explore complications. Evaluate cost allocated for procedures in minor oral surgery in primary and secondary sector. Materials and MethodsRetrospective analysis of procedures carried out, waiting times, complications and comparative cost in minor oral surgery from two NHS dental practices located in Lothian health board area.ResultsA total of 1896 procedures in 982 patients having minor oral surgery were analysed across two sites. Of procedures, 51% (971) were simple extractions; 31% (580) of the procedures were surgical removal of non‐third molar teeth; 15% (275) of the procedures were surgical extraction of third molars; and 3% (70) of the procedures were complex procedures such as surgical exposure of canines, removal of simple cysts and closure of oroantral communication. Two hundred and nine procedures were carried out under intravenous sedation. It was difficult to estimate waiting times although all patients were treated within 4 weeks. The overall complication rate was 8.1%. There is a considerable difference in cost allocated to similar procedures in primary and secondary care and the money allocated for carrying out minor oral surgery in primary care is not cost neutral.ConclusionsIt is cost efficient to treat minor oral surgery patients in primary care. Like for like procedures in minor oral surgery are expensive and potentially wait longer before receiving treatment in secondary care.