Closure Of Oroantral Communication Research Articles

Maxillary Sinusitis of Odontogenic Origin- A Case Report and a Short Review of Literature

Maxillary sinusitis of odontogenic origin (MSOO) presents a diagnostic challenge due to its overlapping symptoms with other forms of sinusitis. We present a case of a 17-year-old male with MSOO, emphasizing varied treatment modalities. Clinical assessment revealed facial swelling and pain, prompting a differential diagnosis. Orthopantomogram and Cone Beam Computed Tomography (CBCT) confirmed odontogenic involvement. Surgical intervention included extraction, sinus lavage, and closure of oroantral communication. Postoperative recovery was successful. Discussion highlights the prevalence, diagnosis, and management of MSOO. Contemporary reports suggest odontogenic sources contribute to over half of maxillary sinusitis cases. Radiographs and CBCT aid diagnosis, delineating odontogenic involvement. Effective management includes dental evaluation and endoscopic sinus surgery, and early diagnosis is crucial to prevent complications. However, consensus on antimicrobial therapy and drainage routes is lacking. This case underscores the importance of interdisciplinary collaboration and tailored management strategies for MSOO.

L-PRF como alternativa para tratamento de Comunicações Bucossinusais: uma revisão integrativa

Oroantral communication is defined as a direct access between the sinus cavity and the oral cavity. This condition is often accidentally caused during the dental extraction of a tooth whose roots are closely associated with the floor of the maxillary sinus, in addition to oral pathologies and even traumas. The technique of using the L-PRF membrane associated with flaps is widely used for extensive communications and has several advantages. The present study aims to analyze the efficacy of L-PRF in the treatment of existing oroantral communications in the most current literature. An integrative literature review was conducted to list and analyze the efficacy of L-PRF in tissue healing when obtaining the closure of oroantral communications. Scientific articles from 2014 to 2023, published in full in Portuguese and English, were selected and excluded were literature reviews and systematic reviews, articles in languages other than Portuguese and English, repeated articles in the databases, and articles that deviated from the theme proposed in the guiding question chosen. The data search was conducted in Google Scholar, LILACS, and PubMed, through the combination, using the Boolean operator “AND,” of the descriptors in English: “Oroantral Communication,” “L-PRF,” “Maxillary Sinus.” A total of 205 articles were found, but only 9 satisfactorily met the listed criteria. After a careful analysis, it was observed that the authors suggest that the use of the L-PRF membrane insertion technique for tissue healing involved in oroantral communication associated with sutures or flaps for its closure is feasible, effective, and widely spread in modern Dentistry.

Preoperative antibiotics are not indicated prior to closure of oroantral communication

AbstractObjectiveThe aim of this paper was to determine whether the use of preoperative antibiotics improves surgical outcomes following oroantral communication (OAC) closure.Materials and MethodsA single‐centre, retrospective study was conducted on all OAC repair procedures over a 24‐month period assessing a number of datapoints including the site of OAC occurrence, time to repair, local anaesthetic or general anaesthetic, and any complications noted. Patient follow‐up was up to 3 months post‐operative OAC closure. Data outputs primarily included descriptive statistics for demographic datasets included in the study. Fisher's exact test was used to determine non‐random associations between categorical variables (preoperative antibiotics vs. no preoperative antibiotics; successful closure vs. failed closure).ResultsThirty‐one patients met the inclusion criteria and timeframe of this study. All OACs were a result of dental extraction. For patients who had an OAC visualised immediately after extraction, 18 had an OAC repair completed on the same day. Fifteen patients had a delayed closure, defined as a closure over 48 h following the development of OAC. Thirteen patients had their procedure completed under local anaesthetic; none had preoperative antibiotics prior to surgery. Only one patient with delayed closure of an OAC who had a procedure completed under local anaesthetic had a prophylactic dose 1 h prior to surgery. Patients who underwent OAC closure under general anaesthetic received an intra‐operative dose of antibiotics. Using Fisher's exact test, there was no significant difference between the two groups (preoperative antibiotics given vs. no preoperative antibiotics given) with regard to the likelihood of success following OAC closure (p = 0.1419).ConclusionThis study demonstrates that the routine use of preoperative antibiotics may not improve surgical outcomes following the closure of oroantral communication.

Oro-antral communication closure using collagenated porcine cortical lamina: A retrospective study of 34 cases

Oro-antral communication closure using <i>collagenated porcine cortical lamina</i>: A retrospective study of 34 cases

Komunikasi oro-antral paska pencabutan sisa akar gigi 16

The opening of the sinus cavity due to tooth extraction, infection, or some complications so that an abnormal pathway is formed is oroantral communication. If the abnormal pathway fails to close, it turns into an oro-antral fistula. In this case report, patients performed tooth 16 and 17 extractions, but oroantral communication only occurred in the socket after tooth extraction 16. The diagnosis of oroantral communication is established based on the patient's complaints when gargling after tooth extraction, patients complain of water coming out of the nasal cavity and smell of blood. Then it was confirmed by clinical examination by instructing the patient to close the nose and then blow air while examining the retraction socket area, the results of the examination showed air passing through the blood in the retraction socket. The management of this case is done by giving a gelatin sponge into the socket and suturing with the figure of eight techniques or with non-surgical treatment. The results of the treatment showed the closure of oroantral communication.

Is an Attachable Oral Wound Dressing Effective at Closing an Acute Oroantral Communication?

An oroantral communication (OAC) is an acute opening after tooth extractions in the posterior maxilla that requires immediate closure. The search for a noninvasive and cost-effective OAC treatment method remains ongoing. This study assessed the effect of oral wound dressing (OWD) on acute OACs of 2-5mm and compared it with suturing sterile gauze (SG) and plasma-rich fibrin (PRF). A randomized, double-blind clinical trial was conducted at the Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Erciyes University. The sample included patients aged >18years, a 2-5mm wide OAC without previous maxillary sinus pathology or surgical operation. The primary predictor variable was the closure method used: OWD, SG, or PRF. OWD is a new produced and commercially available product that has been used for closure of oral wounds after periodontal or surgical interventions. The primary outcome variable was OAC closure on postoperative day 30. The secondary outcomes were procedure duration and the pain scores of postoperative days 1, 3, and7. The covariates were age and sex. Quantitative variables were compared between groups using the Kruskal-Wallis test. Qualitative variables were analyzed between groups using the Pearson's χ2 test. Results with a P value <.05 were considered statistically significant. This study included 60 patients (30 females and 30 males). Clot formation was uneventful on postoperative days 1, 3, and 7 in all patients. OAC closure was successful in all patients on postoperative day 30. The success rate of OAC closure did not differ significantly between groups (P>.05). The surgical procedure duration was significantly shorter in the OWD group (1.2±0.41min) than in the SG (5.75±0.97min) and PRF (19.65±2.74min) groups (P<.001). Verbal analog scale scores differed significantly among the OWD (1.05±1.43), SG (4.35±2.85), and PRF (2.5±1.82) groups on postoperative day 1 (P<.001). OWD is a less invasive and practical method for closing OACs.

Bone remodeling of the sinus floor observed 19 years after third molar transplantation to close a maxillary defect: a case report.

Autologous tooth transplantation is the transplantation of an erupted, partially erupted, or unerupted tooth from one site to another in an individual. This is expected to maintain alveolar bone volume through physiological stimulation of the periodontal ligament (PDL). Tooth transplantation can be used for the closure of oroantral communication. As a simple, useful, and minimally invasive method, it should be considered a surgical option when a donor tooth is available in indicated cases. Herein, the authors report the case of a 20-year-old female patient whose left permanent maxillary first molar had to be extracted due to a longitudinal fracture and radicular cyst in the maxillary sinus floor. After the extraction, tooth 28 was exposed through an osteotomy and positioned in the gap. Nineteen years later, the autologous grafted tooth 28 could no longer be retained due to massive external resorption and was replaced by an implant. Human PDL stem cells can differentiate into bone-, fiber-, and cementum-forming cells and have the potential to build a PDL complex. Therefore, care must be taken to avoid damaging the PDL of the donor tooth during extraction. Autotransplanted teeth are expected to retain the alveolar bone volume. This case demonstrates the use of a transplanted tooth 28 for the treatment of a maxillary defect caused by the extraction of tooth 26 and removal of a radicular cyst. External resorption and regeneration of the bone of the maxillary sinus floor around the transplanted tooth occurred after 19 years.

Platelet-rich fibrin vs. buccal advancement flap for closure of oroantral communications: a prospective clinical study

ObjectivesThe primary aim was to evaluate the success of the defect closure (tight or open) of oroantral communications (OAC) after treatment with platelet-rich fibrin (PRF) clots or a buccal advancement flap (BAF). Secondary outcome measurements were the evaluation of the wound healing, the displacement of the mucogingival border (MGB), and the pain level.Material and methodsFifty eligible patients with an OAC defect larger than 3 mm were randomly assigned to either PRF (test group, n = 25) or BAF (control group, n = 25) for defect closure. In a prospective follow-up program of 21 days, the defect closure healing process, the wound healing course using Landry’s wound healing index (score: 0–5), the displacement of the MGB, and the postoperative pain score were evaluated.ResultsFive patients in each group were lost to follow-up resulting in 40 patients (20 in each group) for continuous evaluation. On postoperative day 21 (study endpoint), no difference regarding success rate (defined as closure of OAC) was noticed between the test (90%; 18/20) and control group (90%; 18/20). A univariate analysis showed significant differences for age and defect size/height for the use of PRF between successful-tight and open–failed defect healing. At the final evaluation, a significantly (p = 0.005) better wound healing score, a lower displacement of the MGB as well as lower pain-score were seen for the use of PRF.ConclusionsBased on the findings of the current study, the use of platelet-rich fibrin represents a reliable and successful method for closure of oroantral communications. The use of PRF clots for defect filling is associated with lowered pain levels and less displacement of the mucogingival border.Clinical relevanceThe defect size should be taken into account when choosing the number and size of PRF plugs.

Comparative bacteriological examination of materials, taken from the pathologically altered mucosa of the maxillary sinus and chronic inflammatory processes, developing around the maxillary teeth

Aim: To perform a comparative bacteriological examination of a material, taken from the alveolus of an extracted tooth with chronic inflammatory disease and a material from the maxillary sinus at the closure of oroantral communication, performed immediately after extraction. Background: Odontogenic maxillary sinusitis is a common problem and a well-known condition in the dental practice. This type of maxillary sinusitis differs in its pathophysiology, pathomorphology, microbiology, diagnosis and treatment from the other types of maxillary sinusitis. Chronic inflammatory processes affecting the periodontium and periodontium of the teeth can often reach the maxillary sinuses and thus cause odontogenic maxillary sinusitis. Methods: To perform the task assigned, microbiological samples were prepared, taken intraoperatively from the inflammatory focus around the causative tooth and from the altered mucosa of the maxillary sinus. After taking into account the results of the microbiological examination, a comparative analysis of the microflora isolated from the two sites was performed. This was done in order to prove its identity and to look for the relationship between the two pathological processes. To accomplish the task, we selected 27 patients who had molar teeth extracted, not subjected to conservative treatment, whose roots protrude into the maxillary sinus or stand no more than 3 mm away. In patients where a direct contact with the maxillary sinus was made, we used two sterile swabs to take the microbiological sample – first from the alveolar walls of the extracted tooth and then through the communication made. In other patients, we created such a communication with a fissure burr ourselves, after we had already taken a sample from the alveoli of the extracted tooth. The hole size was no more than 5 mm. Results: When comparing the samples of each patient, taken from the alveoli of the extracted tooth and the pathologically altered mucosa of the maxillary sinus, we obtained the following results – compared to the frequency distribution, we can see in the following table – a match of 88.9% of all cases and in a little over 11% of the cases where not match is found between the samples. Conclusions: When the height of the available bone in the distal parts of the upper jaw between the apexes of the teeth and the floor of the maxillary sinus is below 3 mm, the risk of ascending of the inflammatory process from the periodontal tissues to the maxillary sinus is quite high – 88.89%.

Surgical Closure of Oroantral Communication by Buccal Fat Pad Flap

Surgical Closure of Oroantral Communication by Buccal Fat Pad Flap

Endoscopic tooth extraction after intrusion into the maxillary sinus in a teenager: a clinical case

Relevance . One of the complications of maxillary tooth extraction is its intrusion into the maxillary sinus due to the peculiarities of the anatomy of the upper jaw and possible technical errors of the doctor. The extranasal approach is the most common treatment method of this pathology, namely the Caldwell-Luke surgery (radical antrostomy) or oroantral communication closure and removal of a foreign body from a maxillary sinus. Diagnosis . This article describes two clinical cases. Both patients were admitted to the Pediatric Maxillofacial Surgery Unit with a diagnosis of Foreign body in the maxillary sinus. The paper presents our experience on the endoscopic removal of a foreign body from the TMJ in these patients. Results . Endoscopic removal of foreign bodies from the maxillary sinus was the treatment method in these patients. The postoperative period was unremarkable and without complications. Conclusions . We currently believe that the endoscopic approach to tooth removal from the maxillary sinus is a solution that should be adhered to by all modern surgeons since this method is less invasive and has a short recovery period.

Closure of Oroantral Communication with Gelfoam and Collagen Membrane after Periapical Cyst EnucleationA Case Report

Periapical cyst is the most common inflammatory cyst that occurs in jaw bones. Epithelial cell rests of Malassez in periodontal ligaments are the main cause for the periapical cysts to be formed. Periapical cyst occurs commonly in infected and necrotic periapical area, with male sex predilection and occurs especially in the 3rd to 6th decades of life. Non vital tooth left untreated for long time predisposes to periapical cyst formation. Oroantral Communication (OAC) is one of the most routinely encountered complications during surgical procedure by oral and maxillofacial surgeons when attempting to remove a cyst from maxilla. Oroantral communication is the abnormal, pathologic, unnatural open connection between the oral cavity and maxillary sinus. If such a communication remains open it can cause ingress of microorganisms from the oral cavity into the antrum resulting in maxillary sinusitis, and develops into an Oroantral Fistula (OAF). Hereby, authors presented a case report of a 32-year-old female patient with the complaint of pain and swelling in relation to the left upper back tooth region. The gelfoam and collagen membrane used to close an oroantral communication, which was developed after periapical cyst enucleation.

Combined Endoscopic and Intraoral Approach or Intraoral Alone in Surgical Management of Odontogenic Sinusitis

The physiological behavior of paranasal sinuses depends on the potency of the ostiomeatal complex and on normal mucociliary function. The interruption of this delicate equilibrium can lead to pathological conditions such as sinusitis. Anywhere between 10% and over 25% of cases of maxillary sinusitis have an odontogenic origin, such as: dental infection; alveolar dental trauma; or iatrogenic causes, such as extractions, endodontic therapies, maxillary osteotomies or placement of endosseous implants. The resolution of sinus pathology is related to the resolution of odontogenic pathology. Aim: to evaluate the therapeutic efficacy of a combined oral and endoscopic approach in the treatment of chronic odontogenic sinusitis vs. oral dental management through a case control study. Materials and Methods: all patients showing signs and symptoms of odontogenic sinusitis with obliteration (appreciable radiopacity in CT) of unilateral maxillary sinus between January 2018 and September 2019 at Padua University Hospital were enrolled in this retrospective study. The exclusion criteria were: maxillary sinusitis without odontogenic origin, or resolution with a systemic antibiotic therapy; and presence of anatomical abnormalities that promote the onset of rhinosinusitis. The patients were divided into two groups: one group was treated with a combined surgical approach under general anesthesia (Functional Endoscopic Sinus Surgery-FESS and simultaneous closure of oroantral communication with Bichat’s fat pad advancement); while the other group was treated only with an intraoral approach under local anesthesia and conscious sedation (closure of oroantral communication with Bichat’s fat pad advancement). The variable “success of the surgical procedure” in the two groups was compared by a Student test (with p &lt; 0.05). Results: among the patients enrolled, 10 patients (aged between 42 and 70) made up the case group and the other 10 patients (aged between 51 and 74) constituted the control group. There was no statistically significant difference in success between the two groups (p &lt; 0.025). Conclusions: according to this case study, an exclusive annotation invasive intraoral approach seemed to be comparable to the transoral endoscopic combined method. However, during diagnosis it is necessary and fundamental to distinguish between odontogenic and rhinogenic sinusitis in order for the resolution of odontogenic sinusitis to be achieved.

Buccal fat pad with sandwich graft versus buccal fat pad with block graft in closure of oroantral communication: prospective clinical study

Objective: The present study was performed to evaluate the efficacy of buccal fat pad with sandwich graft versus buccal fat pad with bone block graft in closure of oroantral communication. Subjects and methods: Patients of the present study were selected from those attending the outpatient clinic of Oral and Maxillofacial Department at Faculty of Dental Medicine, Al Azhar University (Assiut Branch). Fourteen patients with oroantral communications were divided in two groups: (group I) treated with sandwich graft covered by buccal fat pad, and (group II) treated by bone block covered by buccal fat pad. Results: Closure of oroantral communication was successful in both groups. No patient had any infection, graft exposure and /or loss, soft tissue dehiscence. Radiographic analysis revealed significant increase in bone density fo both groups, (from 693.5 ± 28.61 immediately postoperative to 805.2 ± 28.06 after 9 months) for G (I) And (from 590.0 ± 30.24 immediately postoperative To 683.3 ± 16.59 after 9 months) for G (II). Also, there was significant decrease in bone height in bone height in both groups at 6 and 9 months. Conclusion: Closure of OAC with buccal fat pad and bone graft not only gives excellent soft tissue healing, but also compensate the underlying bone defect.

Autotransplantation of third molar for oro-antral communication closure: evidence of sinus elevation after healing.

Oro-antral communication is a complication due to the extraction of the posterior teeth of the upper arch. Small lesions are able to spontaneously close, but larger diameter lesions require a surgical treatment. A compromised upper first molar had to be extract determining an oro-antral communication (OAC). Several techniques have been described for the management of OACs, but none of these techniques guarantees bone healing or immediate rehabilitation. In the case of the present report an autotransplantation of the ipsilateral third molar was performed for closing the communication and rehabilitate the extracted tooth. The transplantation of the third molar determined the immediate closure of the oroantral communication without resorting to more invasive surgical procedures. The 1,5 years follow up showed the bone healing and the complete oro-antral communication closure. During healing, the palatal root, that was invading the sinus, caused a vertical bone augmentation making a sinus lifting. When a donor tooth is available, the autogenous transplantation could be used to manage the closure of oro-antral communication due to its high regenerative potential.

Intra-sinus complex odontoma management simultaneously to oroantral communication closure: Why remove it?

The oroantral communication is considered one of the most frequent complications in oral surgery, especially in extractions of posterior teeth in the maxilla, treatment of cystic lesions, neoplasms, osteomyelitis and trauma in the region of the maxillary sinus, forming fistulas. However, ectopic third molar and lesions such as odontomas are rarely found simultaneously in the maxillary sinus. This report shows a successful treatment performed in a specific case of oroantral communication, associated to an underdiagnosed complex odontoma and an impacted ectopic third molar into the maxillary sinus and discuss the requirement of intervention. The treatment strategy involved clinical and surgical management through the oroantral communication, avoiding additional bone access to the maxillary sinus. This proposal presented a satisfactory result, and at six months after surgery, the patient has an excellent evolution, proving to be a successful strategy.

Use of the temporal extension of the buccal fat pad for closure of oro-antral communications

Oro-antral communications/fistulae (OAC/OAF) can cause significant patient morbidity, with treatment for defects greater than 5mm in size requiring surgical reconstruction. This technical note evaluates the effectiveness, and proposes the use of, the temporal extension of the buccal fat pad (TEBFP) for the closure of large OAC. The TEBFP can be an effective means of large OAC closure due to its ease of harvesting, with minimal damage to surrounding structures or aesthetic changes. The use of the TEBFP provides stability, versatility, and tension-free closure, with minimal postoperative complications.

Closure of oro-antral communication using buccal adipose body: case report in elderly patient.

Closure of oro-antral communication using buccal adipose body: case report in elderly patient.

Buccal abscess derived from subcutaneous emphysema caused by the Valsalva maneuver after oral surgery with pedicled buccal fat pad grafting

AbstractPedicled buccal fat pad grafting is applied in a variety of oral surgeries, including the reconstruction of oral defects or the closure of oroantral communication. Pedicled buccal fat pad grafting is a well‐established and relatively safe procedure; however, it may cause complications such as swelling, hematoma and/or infection. There are few reports on the detailed cause and clinical course of these complications. This report discusses the Valsalva maneuver as a cause of complications after oral surgery with pedicled buccal fat pad grafting. A 77‐year‐old man underwent pedicled buccal fat pad grafting for oroantral communication after sequestrectomy for medication‐related osteonecrosis of the maxilla. Postoperatively, the performance of the Valsalva maneuver during defecation caused facial subcutaneous emphysema, hematoma and buccal abscess formation. The abscess could not be treated by antibiotics alone, and required surgical drainage. Prominent subcutaneous emphysema is associated with bleeding due to blood vessel damage, and may cause a large hematoma, especially in patients receiving antithrombotic therapy. Hematomas are susceptible to infection, and infections in the buccal space are often severe due to the tissue continuity in deep spaces. Therefore, buccal abscesses after pedicled buccal fat pad grafting require surgical drainage. This case report suggests that performing the Valsalva maneuver during defecation may cause complications after pedicled buccal fat pad grafting. Patients should be informed that the Valsalva maneuver could lead to serious complications, and that all types of the Valsalva maneuver should be avoided postoperatively.

Autotransplantation of third molar for oro-antral communication closure: case report with evidence of sinus elevation after healing

Background Oro-antral communication is a complication due to the extraction of the posterior teeth of the upper arch. Small lesions are able to spontaneously close, but larger diameter lesions require a surgical treatment. Methods A compromised upper first molar had to be extract determining an oro-antral communication (OAC). Several techniques have been described for the management of OACs, but none of these techniques guarantees bone healing or immediate rehabilitation. In the case of the present report an autotransplantation of the ipsilateral third molar was performed for closing the communication and rehabilitate the extracted tooth. Results The transplantation of the third molar determined the immediate closure of the oroantral communication without resorting to more invasive surgical procedures. The 1,5 years follow up showed the bone healing and the complete oro-antral communication closure. During healing, the palatal root, that was invading the sinus, caused a vertical bone augmentation making a sinus lifting. Conclusions When a donor tooth is available, the autogenous transplantation could be used to manage the closure of oro-antral communication due to its high regenerative potential.