How to close an oral antral communication after extraction

The focal teeth to be extracted

Teeth with no hope of preservation should be extracted. And following dental surgeries will applied depending on different intra-operative findings: Maxillary sinus floor Bone is continuous . In this situation, (alveolar ridge preservation, ARP) is recommended after teeth extraction. Maxillary sinus floor Bone is not continuous . If maxillary sinus mucosa is intact after extraction (no communication between oral cavity and maxillary sinus), ARP is recommended after teeth extraction. If there is membrane perforation (communication between oral cavity and maxillary sinus), simultaneous or delayed maxillary sinus leak and fistula repairment are recommended after extraction.

Expert consensus on odontogenic maxillary sinusitis multi-disciplinary treatment. © The Author(s) 2024. Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0/).

4. Discussion

There are different treatment options available for oroantral communications depending on factors such as the size and location of the defect, the absence of keratinized tissue, and the presence or absence of adjacent teeth. In a systematic review, we analyzed randomized controlled trials and prospective and retrospective studies that compared two or more surgical techniques for treating OACs/OAFs. Our study confirmed previously found data in the literature regarding the causes and effects of oroantral communications. According to the data extracted from the selected articles, the removal of posterior teeth is the primary reason for an oroantral communication (OAC) with an incidence rate of 76%. The second most common cause is cystectomy, accounting for 12%, followed by failed implant positioning at 6%. The buccal advancement flap is the most frequently used technique for treating OACs, with a utilization rate of 43.7%. This technique was first described by Rehrman in 1936 and is still in use today. However, one of its disadvantages is that it can cause a significant decrease in the vestibule due to the coronal positioning of the mucogingival line, which may necessitate vestibuloplasty to increase the width of the keratinized tissue. Buccal edema and postoperative pain are also potential complications associated with this technique. In most cases, the buccal sulcus returns to its original form within 4–8 weeks, but up to 40% of patients may experience lifelong vestibular loss. The vestibular flap technique is effective in treating small- and medium-sized oral communication issues. It is a simple and versatile flap, but it is not suitable for defects that have moved to the palatal region. In such cases, greater flap sliding and vestibular depth loss are required.

The Treatment and Management of Oroantral Communications and Fistulas: A Systematic Review and Network Metanalysis. © 2024 by the authors. Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0/).

1. Introduction

There is a variation of loco-regional flaps that can be used in closing oro-antral communications, depending on the dimension of the defect and the available soft tissue surrounding the dental alveoli. For a proper wound closure, local flaps should consist of healthy tissue, without pathological modifications and should present a sufficient blood supply to promote healing. There are two most used flaps, those being the buccal advancement flap and the palatal rotational flap [5]. Recent studies recommend the use of the Bichat buccal fat pad flap for the closure of oro-antral communications [5,6]. Currently, the literature describes using collagen membranes and bone grafts for the closure of oro-antral communications with satisfactory results [7].

Selecting the Best Surgical Treatment Methods in Oro-Antral Communications. © 2022 by the authors. Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0/).

Introduction

An oroantral communication (OAC) is an open connection between the oral cavity and a maxillary sinus (1). Its appearance is relatively common in oral surgery, caused by either simple or surgical extraction of antral teeth, cysts and tumors, or infectious processes (2). Oroantral communications less than 2 mm in diameter tend to close spontaneously, whereas those larger than 3mm require surgical closure (3). Numerous techniques for their closure have been described, including proximity or distance grafts and flaps, such as the pedicled Bichat´s ball (3,4).

Closure of oroantral communications with Bichat´s buccal fat pad. Level of patient satisfaction. Copyright: © 2015 Medicina Oral S.L. Creative Commons Attribution 2.5 International (https://creativecommons.org/licenses/by/2.5/).

Abstract

The most common cause of oroantral communication was the extraction of molars. The average widest diameter of the oroantral communication was 7.1 mm. One week after the surgeries no complications were found. One month after surgery, one patient presented persistence of the oroantral communication; in this patient, the buccal fat pad technique was considered a failure, and a second intervention was performed using a buccal mucoperiosteal flap to achieve primary closure of soft tissues. After six months, patient showed closure of the communication and complete healing. All the other communications had been solved with Bichat´s ball technique, yielding a success rate of 90.9%. Mean patient overall satisfaction was 9.1 out of 10; patients were satisfied with phonetics (9.4), aesthetics (9) and chewing (9). Conclusions: The buccal fat pad technique was successful in closing 10 out of 11 oroantral communications and few complications were found. Patients were highly satisfied in overall with the treatment and with phonetics, aesthetics and chewing. Key words:Bichat’s fat pad, buccal fat pad, oroantral communication.

Closure of oroantral communications with Bichat´s buccal fat pad. Level of patient satisfaction. Copyright: © 2015 Medicina Oral S.L. Creative Commons Attribution 2.5 International (https://creativecommons.org/licenses/by/2.5/).

4. Discussion

Oroantral communications and fistulas are complications of oral and maxillofacial surgeries that may specifically result from an anatomical situation or iatrogenic events. The primary goal of this review was to identify the best surgical procedures for the management of oroantral communications following dental surgery. The main outcome of the treatment of oroantral communications is to eradicate the infection site and achieve a complete closure of the communication with no risk of recurrence. Our work primarily focused on identifying the best surgical options in terms of reducing the risk of relapse, safety, and efficacy and a reduced morbidity for the patient.

The Treatment and Management of Oroantral Communications and Fistulas: A Systematic Review and Network Metanalysis. © 2024 by the authors. Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0/).

1. Introduction

Currently, the literature describes using collagen membranes and bone grafts for the closure of oro-antral communications with satisfactory results [7]. The buccal advancement flap, the most commonly used flap by dentists and dental surgeons for the closure of oro-antral communications, is created by placing a horizontal incision in the gingival sulcus and two divergent buccal vertical incisions, obtaining a trapezoidal flap. In most of the cases periosteal scoring is necessary to mobilize the flap [8]. It is a simple and quick technique, which does not need special manoeuvres to create it. The disadvantages include a reduced vestibule and, in case of larger defects, wound dehiscence because of the affected blood supply in case of supplemental scoring. In addition, a constant traction is exercised on the flap during mastication and phonation, which may affect the healing process [9].

Selecting the Best Surgical Treatment Methods in Oro-Antral Communications. © 2022 by the authors. Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0/).

1. Introduction

The purpose of this article is to compare different surgical treatment methods currently used to close oro-antral communications, to determine relapse rates in case of different types of flaps used, the advantages and disadvantages of each therapeutic solution, in order to assess the best treatment option. The size of the defect, the anatomical particularities, the existing general conditions, and further complications of the oro-antral communication, must be considered to obtain a complex treatment plan. Moreover, particularly important in developing the correct treatment plan is radiological examination. Computed tomography (CT) or cone beam computed tomography (CBCT) evaluates not only alveolar and the sinus floor defect, but it also presents the mucosal transformations [5,6].

Selecting the Best Surgical Treatment Methods in Oro-Antral Communications. © 2022 by the authors. Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0/).

Introduction

Oroantral communication (OAC) refers to an abnormal connection between the oral cavity and the maxillary sinus. It most commonly occurs after the extraction of maxillary posterior teeth, although other causes include maxillary cysts, tumors, and trauma. OACs require closure to prevent fluids, food particles, and oral bacteria from entering the maxillary sinus. Therefore, the preferred approach after an OAC forms is prompt surgical closure. Early intervention reduces the risk of oroantral fistula (OAF), chronic sinusitis, and treatment failure. Buccal advancement flaps, palatal rotational flaps, and buccal pad fat grafts are commonly used surgical techniques.

Platelet-rich fibrin as a therapeutic modality for oroantral communication closure: a systematic review and meta-analysis. © 2026 Almutiri, Almutairi, Almutairy, Alwosaibai, Alruwaili, Al-Mutairi, Almutairi, Alsaairi, Albader and Aljazeeri. Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0/).