Oroantral Communication Research Articles

Incidence and treatment of complications in patients who had third molars or other teeth extracted

The aim of this study was to compare the incidence of complications after extraction of third molars (M3) or other teeth, and to describe their management. We made a retrospective cohort study of patients having M3 or other teeth extracted, and recorded complications up to two years’ follow-up. A total of 142 complications developed after 2355 procedures (6%) – 7% after extraction of M3 compared with 5% after extractions of other teeth (p=0.024). The three most common complications were wound infection (2%), pain without apparent cause (<1%), and oroantral communication (<1%). Patients who had M3 extracted were at increased risk of complications compared with those who had other teeth extracted (Odds ratio (OR) 1.5, p=0.024), particularly for infection (OR 5.9, p<0.001) and hypoaesthesia (OR 8.4, p=0.027). Half of all patients with a complication were treated with antibiotics orally. The incidence of postoperative bleeding was 0.6% as a result of suboptimal management of antithrombotic drugs in extractions of teeth other than M3. Finally, optimal treatment of the complications was compared with the available evidence. Prevention and treatment of these complications could reduce the incidence, particularly of bleeding.

Risk factors in oroantral communication while extracting the upper third molar: Systematic review.

The removal of the upper third molar is a procedure commonly performed in oral and maxillofacial surgery. Maxillary third molars are generally less difficult to extract than mandibular third molars. The surgical removal of maxillary third molars is usually associated with low complication rates and low morbidity. This procedure involves the risk of developing complications such as oroantral communication, displacement into adjacent anatomic spaces, fracture of the maxillary tuberosity, and root fracture. Orthopantomograms are the standard preoperative imaging modality, but there is no proven tool for predicting oroantral communication. New possibilities have been offered by cone-beam computed tomography, which is increasingly used in dentistry and is an innovative technique that provides more information as it eliminates the superimposition of surrounding structures and allows the acquisition of 3-dimensional images and their qualitative assessment. The aim of this systematic review was to assess risk factors during the extraction of the upper third molar using orthopantomograms and cone-beam computed tomography.

The use of buccal fat pad in surgical treatment of ‘Krokodil’ drug-related osteonecrosis of maxilla

‘Krokodil’ is the street name of a new synthetic drug mixture. It is a light brown liquid that is used intravenously without previous purification. Osteonecrosis of the jaw (ONJ) is a common complication among Krokodil users. Krokodil drug-related ONJ presents as alveolar process exposure in the oral cavity.Surgery is the main method for treatment of Krokodil drug-related ONJ patients. In a study by Poghosyan et al., no cases of recurrence were seen after surgery on the maxilla, but 38% of cases (8/21) developed an oroantral communication after surgical treatment for maxillary osteonecrosis (Poghosyan et al., 2014).The aim of this study is to report on the results of buccal fat pad use in closure of maxillary sinus floor defects after partial maxillary resection in Krokodil drug-related ONJ patients.Six male patients with Krokodil drug-related distal maxillary osteonecrosis were included in this retrospective study. All patients underwent surgical treatment, which included surgical removal of necrotic bone, and closure of formed maxillary sinus floor defects with buccal fat pad and local mucoperiosteal flaps.In all patients the postoperative period was uneventful. After suture removal small areas of buccal fad pad exposure were found in all patients, which epithelialized successfully over the following month. During the postoperative follow-up period (8–12 months) no signs of recurrence were found.

Oroantral communication - A clinical and radiographic retrospective study of 39 Iraqi patients

Background: oroantral communication (OAC) is abnormal connection between oralcavity and maxillary sinus. OAC is a rare, well known complication, mostlyoccurs after the extraction of upper posterior teeth, and if not treated lead toformation of oroantral fistula (OAF) and many complications .surgical repair isvery necessary to prevent further complications .The aim of this study to evaluateand analyze the clinical, radiographic aspects of 39 Iraqi patients with oroantralfistula.Materials and methods :the study was carried on 39 patients with oroantral fistulareported to the Department of oral and maxillofacial surgery ,college of dentistry,University of Baghdad ,and private practice from 1983 to 2010 .data regarding theage ,sex , cause ,site ,radiographic features and types of radiographs ,signs andsymptoms ,duration ,relation to the adjacent teeth , sinus disease ,methods oftreatment .Results: 39 cases of OACs, 26 male, 13 female, the age range was20-65 with a meanage 44.5 year. Highest incidence was seen in the third and fourth decade of life61.4%. The highest frequency of OACs was seen in relation to upper first molar48.7% .the commonest cause was complicated extraction 51.2% .pain andtenderness was the most prominent symptoms 80%, escape of fluid from the nosewas the most prominent sign 75.6%.there was a long delay in the diagnosis andtreatment .most of the OACs occurs near the edentulous areas, occipitomentalradiograph was not reliable in detection of displaced roots. Buccal advancementflap was the main method in treatment 81.2%.Conclusions: OACs a rare complication, its management need good clinical andradiological experience, and the treatment should be individualized to have goodresults.

NONSURGICAL CLOSURE OF OROANTRAL COMMUNICATIONS USING OCCLUSAL SPLINTS

Purpose: Oroantral communications (OACs) may close spontaneously, especially when the defect has a size smaller than 2-3 mm, whereas larger openings require surgical closure. The aim of this retrospective study was to present our experince with non surgical closure of small and large OACs with occlusal splints. Materials and Methods: Clinical and radiographic data of twenty patients who had used occlusal splints after the occurance of an acute OAC were included in this study. Two groups were created according to the size of the defects: Group A: defects smaller (<) than 5 mm; and Group B: 5 mm and wider (≥). In all patients, a well fitted soft occlusal splint was placed for hermetic closure of the opening. All patients were followed up weekly and the splint use was stopped when complete epithelization of the OAC was observed clinically. T he relationship between the size of OACs, treatment outcome, and healing time was compared statistically. Results: OAC was healed spontaneously in all patients, except one. The healing time was found to be significantly higher in goup B than in group A. No significant difference was found between the groups with respect to the success of the treatment. Conclusion: The use of occlusal splints seems to improve the spontaneus healing of the OACs.

OBTURATOR PROSTHESIS TO REHABILIT PALATE AND KENNEDY CLAS III PATIENT

Background: Cleft palate leads to oroantral communication and also malformations of the palate and agenese of teeth adjacent to the defect. Abnormal defect closure was done by replacing the hard, soft tissues and missing teeth using an intraoral maxillofacial prosthesis called obturator. Purpose: Assess the use of prosthetic rehabilitation using frame obturator combination with acrylic resin on patient’s palatum defect to restore esthetic, speech, swallowing, mastication functions.Case: 23 years old male patient with chief complaint palatum defect that cause nasal voice. Intraoral examination revealed a large palate defect in the right of palatum durum segment, also defect on left labial gingiva, and missing teeth in 13, 15, 16, 21, 22, 23, 24, 25, 26, 35, 36, 45, 46.Case Management: Obturator was made to cover defect of palate and replace missing teeth. Impression was taken with hydrocoloid irreversible and gauze that cover the defect to avoid alginate entering nasal cavity. Insertion of obturator showed cleft palate was covered well by frame combination with acrylic resin base. The retention, stabilization and occlusion were good, nasal voice was reduced, defect on left labial gingiva were covered by labial wing.Discussion: Patient was satisfed because nasal voice was reduced, estethic,mastication and swallowing function were restored, also. Patient can clean and use obturator easily.Conclusion: Frame obturator in patient’s palate defect can reduce nasal voice, restore esthetic, swallowing and mastication functions.

The impact of acute post-extraction oroantral communications surgical treatment on patients' quality of life in early post-operative period

The research objective is to study the impact of plastic surgery different methods of acute post-extraction oroantral communications treatment on patients' quality of life in early post-operative period. Materials and methods. The study included 41 patient aged between 18 and 58 years receiving treatment of maxillary sinus perforation, which was caused by tooth extraction. The patients were divided into 3 groups – 14, 12 and 15 persons respectively. Plastic surgery of the oroantral communication in the first group was done in accordance with the methods suggested by the authors using collagen cone and membrane. The same surgery in the second group was done with PRF (Platelet-rich fibrin). In the third (control group), the communication was closed by the vestibular flap following the Rehrmann method. Results of patients' quality of life evaluation after plastic surgery treatment of acute post-extraction oroantral communication show the decrease of its general indicator in early post-operative period in all groups of patients. The general quality of life indicator (well-being indicator) shows a tendency to increase over the first 24 hours after the surgery in both study and control groups. This may mean that a relatively small trauma in a maxillofacial area has a significant influence on patients' perception of their condition and well-being. Absolute numbers of well-being indicator over the first 24 hours after the surgery in the third group were almost 1.5 times higher than those in the groups 1 and2. Ina comparative study of the groups 1 and 3 and then the groups 2 and 3, we observed a significant difference between well-being indicator levels (p < 0.01). The control group demonstrated the return to the pre-operative life quality values on the 7-th day after the surgery. While at the same time, those values in the study groups were equal to the pre-operative ones already on the 4-th day. Conclusions. Operation trauma which was caused by the plastic surgery for closure of acute oroantral communication leads to the decrease of patients' quality of life (oral-related conditions), which correlates with the volume of a surgery and its complexity. The use of less traumatic methods of oroantral communication plastics facilitate the statistically significant decrease of these plastics negative impact on patients' quality of life in early post-operative period and enables the earlier recovery.

EARLY POSTOPERATIVE PERIOD IN PATIENTS AFTER PLASTIC SURGERY OF ACUTE POSTEXTRACTION OROANTRAL COMMUNICATIONS USING A TRAPEZOIDAL FLAP

This article describes the results of the study of changes in quality of life of patients following surgical plastic of acute oroantral communications. The results testify a statistically significant deterioration of both general index of quality of life, and its individual components on the first day after the surgery with its gradual recovery in subsequent postoperative period. Returning to the level of indicators of quality of life observed in preoperative period took place on the 5 - 7th day after the surgery. The study shows that surgical trauma of a relatively small volume in the maxillofacial area is accompanied by a pronounced influence on subjective self-perception of patients

Zygomatic implants placement in conjunction with maxillary sinus augmentation without bone grafting: Prosthetic and surgical consideration in immediate loading with the BARI technique

Aim Zygomatic implants are mainly indicated for the rehabilitation of extremely atrophic maxilla when bone augmentation should be avoided. One disadvantage of zygomatic implants, which typically pass through the sinus, is initial or late bone resorption around the implant neck, which can result in oro-antral communications followed by possible sinusitis. To decrease the risk of sinus infection, a modified technique was developed to preserve the integrity of the sinus membrane and to regenerate bone around zygomatic implants through an extended sinus augmentation approach without bone grafting. Case report This case report describes the treatment of a 53-year-old female patient who was completely edentulous in the upper and lower jaws and was wearing a complete removable denture. The patient’s chief complaint was related to the removable prostheses and she asked for a fixed rehabilitation. The patient was treated with zygomatic implants in the upper atrophic maxilla and with 4 intra-foraminal implantw in the mandible with the immediate loading procedure according to the BARI Technique. Conclusion This approach permitted to deliver two fixed, screw-retained, implant-supported fixed prostheses to the patient.

Functional Anatomic Computer Engineered Surgery Protocol for the Management of Self-Inflicted Gunshot Wounds to the Maxillofacial Skeleton

Virtual surgical planning (VSP) is an indispensable aid in craniomaxillofacial reconstruction, yet no protocol is established in facial gunshot wounds. We review our experience with computer-aided reconstruction of self-inflicted facial gunshot wounds (SIGSW'S) and propose a protocol for the staged repair. A retrospective case series enrolling patients with SIGSW's managed with the Functional Anatomic Computer Engineered Surgical protocol (FACES) was implemented. Subjects were evaluated at least one month postoperatively. Outcome variables were jaw position, facial projection, oro-nasal communication, lip competence, feeding tube and tracheostomy dependence, descriptive statistics were computed. The FACES protocol implemented during the initial hospitalization is as follows 1) damage control; 2) selective debridement; 3) VSP reconstruction back converted into navigation software 4) navigation assisted midfacial skeletal reconstruction; 5) computer aided oro-mandibular reconstruction with or without microvascular free flaps using custom cutting guides/hardware; 6) navigation assisted, computer aided palatomaxillary reconstruction with or without microvascular free flaps using cutting guides/hardware; 7) navigation assisted reconstruction of the internal orbit; 8) and confirmation of accurate reconstruction using intraoperative CT. The sample was composed of 10 patients, mean age of 43 years (range, 28 - 62 years, 70% M), 100% with SIGSW's to the submental/submandibular region. All had satisfactory facial projection (n=10), nine had satisfactory jaw position, were decannulated by one month's follow up and were feeding tube independent (90%). All traumatic oro-antral communications were closed (n=8, 7 surgical, 1 obturator), seven had adequate lip competence (70%). Complications included fibula malunion (n=1), plate exposure (n=2) infection (n=2), intracranial abscess (n=1) and microstomia (n=2). Computer-aided surgery is an indispensable tool in the reconstruction of SIGSW's. Successfully implemented, it proved to be a useful adjunct for: the restoration of orbital volume, facial projection and symmetry; the inset of composite tissue, and the facilitation of dental implant supported prosthetic rehabilitation.

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.

The Use of Platelet-Rich Fibrin for Immediate Closure of Acute Oroantral Communications: An Alternative Approach

Currently, the buccal advancement flap, palatal rotational flap, and buccal fat pad techniques are frequently used to close an oroantral communication (OAC). In this study, platelet-rich fibrin (PRF) clots were used for immediate closure of acute OACs after extraction of posterior maxillary molars. Acute oroantral perforations larger than 3mm in diameter in 21 patients were treated uneventfully using PRF clots. None of the patients had systemic diseases or symptoms of sinus disease. After tooth extraction, the diagnosis of acute OAC was examined by the Valsalva maneuver (compressing the nostrils with the fingers and then blowing out air). After detection of an air leak, a modified ball burnisher instrument 3mm in diameter was used to determine whether the perforation was larger than 3mm. The postextraction socket of the tooth was cleaned with sterile physiologic saline solution and the cavity was filled with PRF. PRF clots were sutured to the gingiva to prevent them from migrating to the sinus and for stabilization. On the seventh day of follow-up, healthy granulation tissue was observed; during the third week of follow-up, epithelialized oral mucosa was detected at the extraction site in all cases. The use of PRF enables the closure of OACs without primary flap closure or any other surgical interventions. Thus, the use of PRF for immediate closure of acute OACs will make the treatment of OACs less traumatic and easier and will eliminate the need for special surgical expertise.

Anatomical relationship of maxillary posterior teeth with the sinus floor and buccal cortex.

This study aimed to evaluate the possibility of root fenestration or oroantral communication by evaluating the distance from root apex to the sinus floor and buccal cortex in maxillary posterior teeth using cone-beam computed tomography (CBCT) images. The study included 2182 roots of the maxillary posterior teeth from 219 patients after reviewing CBCT images of 462 patients according to the location of roots by two endodontists. The distances from each root apex to the maxillary sinus floor and buccal and palatal cortices were evaluated according to sex and age, and the mean values were compared by one-way analysis of variance and Mann-Whitney U-test. The distance between root apex and maxillary sinus floor was the greatest in maxillary first premolars and shortest in the mesio-buccal roots of maxillary second molars. The distances from root apex to the buccal and palatal cortical bones were significantly greater in male patients than those in female patients (P<0·05). The palatal roots of maxillary first molars exhibited the highest incidence as well as the greatest mean length (1·96mm) of protrusion into the maxillary sinus. The distance from root apex to the sinus floor was found to increase with age, except in case of maxillary second premolars. Understanding the relationship of maxillary posterior teeth with the sinus floor and buccal cortex could provide clinicians valuable information to help reduce iatrogenic damage.

Maxillary resection for cancer, zygomatic implants insertion, and palatal repair as single-stage procedure: report of three cases

BackgroundOronasal/antral communication, loss of teeth and/or tooth-supporting bone, and facial contour deformity may occur as a consequence of maxillectomy for cancer. As a result, speaking, chewing, swallowing, and appearance are variably affected. The restoration is focused on rebuilding the oronasal wall, using either flaps (local or free) for primary closure, either prosthetic obturator. Postoperative radiotherapy surely postpones every dental procedure aimed to set fixed devices, often makes it difficult and risky, even unfeasible. Regular prosthesis, tooth-bearing obturator, and endosseous implants (in native and/or transplanted bone) are used in order to complete dental rehabilitation. Zygomatic implantology (ZI) is a valid, usually delayed, multi-staged procedure, either after having primarily closed the oronasal/antral communication or after left it untreated or amended with obturator.The present paper is an early report of a relatively new, one-stage approach for rehabilitation of patients after tumour resection, with palatal repair with loco-regional flaps and zygomatic implant insertion: supposed advantages are concentration of surgical procedures, reduced time of rehabilitation, and lowered patient discomfort.Cases presentationWe report three patients who underwent alveolo-maxillary resection for cancer and had the resulting oroantral communication directly closed with loco-regional flaps. Simultaneous zygomatic implant insertion was added, in view of granting the optimal dental rehabilitation.ConclusionsAll surgical procedures were successful in terms of oroantral separation and implant survival. One patient had the fixed dental restoration just after 3 months, and the others had to receive postoperative radiotherapy; thus, rehabilitation timing was longer, as expected. We think this approach could improve the outcome in selected patients.

Advanced Stage of Medication‐Related Osteonecrosis of the Jaw Associated With Oral Bisphosphonates: Report of Three Cases

Introduction: Bisphosphonates (BPs) are prescribed for treating diseases exhibiting high bone turnover rates. Medication‐related osteonecrosis of the jaw (MRONJ) is a major adverse effect of BPs. Cases of MRONJ associated with oral BPs for treatment of osteoporosis are much less common compared with intravenous BPs. Most reports of oral BP–associated MRONJ are either stage 1 or stage 2 as classified by the 2014 American Academy of Oral and Maxillofacial Surgeons position paper (Ruggiero et al., J Oral Maxillofac Surg 2014;72:1938‐1956). There are ≈24 reported cases of oral BP–induced stage 3 MRONJ presenting as an area of exposed necrotic bone with pain and infection along with a pathologic fracture, an extraoral fistula, oroantral communication, or osteolysis extending to the inferior border of the mandible or sinus floor.Case Series: Three cases of stage 3 MRONJ associated with oral BPs are presented. All three patients had a long history of use of alendronate for over 10 years. Diagnosis of stage 3 MRONJ was made based on clinical, radiographic, and histopathologic findings. Patients were managed with a course of antibiotics and removal of the necrotic bone.Conclusions: Development of stage 3 MRONJ associated with oral BPs is relatively rare. However, there is an increased risk of advanced MRONJ associated with oral BPs in the presence of longer duration of therapy, dentoalveolar surgery, denture trauma, inflammatory oral diseases, and presence of comorbid factors. Therefore, it is recommended that clinicians educate patients about the advanced adverse effects of oral BPs.

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

Instant cast for an immediate obturator

Obturators are constructed to prevent the oro-antral communication that is ensued in maxillary lesions postsurgery. Often, the postsurgical rehabilitation of patients with maxillary defects is not given adequate time, which results in hypernasality and compensatory articulation. To prevent such complications fabricating immediate obturators within the minimal time that is often allotted to the dentist will be of immense aid to the patient. Fabrication of cast for these immediate obturators is often elaborate and time consuming. This article highlights a unique technique of making a cast that is instant, precise, and economical for construction of immediate surgical obturator.

Oro-Antral Fistula: Radio-diagnostic lessons from a rare case.

An unnatural communication between the maxillary sinus and oral cavity is known as Oro-antral communication. If this communication fails to close spontaneously, it gets epithelialized to form an Oro-antral fistula. The most common cause of an Oro-antral communication/fistula is the extraction of a maxillary molar or premolar. Spontaneous healing may occur in defects which are smaller in size, but for larger communications it requires immediate attention and should be treated without delay, in order to avoid sinusitis or any such further complications leading to patient discomfort.

Palatal obturator prosthesis: case series

ABSTRACT Surgical treatment for palate cancers can result in oral-nasal/sinus communication, which impairs the swallowing, speech and chewing ability of patients with reflux of ingested food into the nasal cavity, reducing their quality of life. This article aims to report how three cancer patients, with different types of palate cancer undergoing partial maxillectomy with oroantral or oral-nasal communication as postoperative sequelae were prosthetically rehabilitated from 2009 to 2015. The prostheses were made by dental-surgeons interns in the service of the Multidisciplinary Residency in Oncological Healthcare of the Hospital School of the Federal University of Pelotas (HE/UFPel). One of the patients is completely edentulous, the second partially toothed and in the third case the patient is totally toothed, only requiring the obturator. The creation of prosthetic rehabilitation followed the steps of conventional prostheses, especially observing the particularities in the planning, molding, installation and adjustment stages of the prosthesis. In all cases there was improvement on speech immediately after the prosthesis installation and patients reported greater ease to feed.

Complications after use of elastomeric pressure-indicating media at 24-hour follow-up visit for immediate maxillary complete removable dental prosthesis: A clinical report

Various pressure-indicating media are available to assess the adaptation of the intaglio surface of a removable dental prosthesis at the insertion and follow-up appointments. This clinical report describes the use of an elastomer that entered the maxillary sinus through an undetected oroantral communication at the 24-hour follow-up for an immediate maxillary complete removable dental prosthesis. A Caldwell-Luc sinusotomy procedure was required to remove the material, and the patient required over 1 year of healing time before his reported symptoms resolved.