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References

Hassan O, Shoukry T, Raouf AA, Wahba H Combined palatal and buccal flaps in oroantral fistula repair. Egypt J Ear Nose Throat Allied Sci. 2012; 13:77-81
Khandelwal P, Hajira N Management of oro-antral communication and fistula: various surgical options. World J Plast Surg. 2017; 6:3-8
Eberhardt JA, Torabinejad M, Christiansen EL A computed tomographic study of the distances between the maxillary sinus floor and the apices of the maxillary posterior teeth. Oral Surg Oral Med Oral Pathol. 1992; 73:345-346 https://doi.org/10.1016/0030-4220(92)90133-b
Kiran Kumar Krishanappa S, Prashanti E, Sumanth K Interventions for treating oro-antral communications and fistulae due to dental procedures. Cochrane Database Syst Rev. 2016; 5 https://doi.org/10.1002/14651858.CD011784.pub2
Voss PJ, Vargas Soto G Sinusitis and oroantral fistula in patients with bisphosphonate-associated necrosis of the maxilla. Head Face Med. 2016; 12 https://doi.org/10.1186/s13005-015-0099-0
Nicoli TK, Oinas M, Niemelä M Intracranial suppurative complications of cinusitis. Scand J Surg. 2016; 105:254-262 https://doi.org/10.1177/1457496915622129
Martines F, Salvago P, Ferrara S Parietal subdural empyema as complication of acute odontogenic sinusitis: a case report. J Med Case Rep. 2014; 8 https://doi.org/10.1186/1752-1947-8-282
Lizé F, Verillaud B, Vironneau P Septic cavernous sinus thrombosis secondary to acute bacterial sinusitis: a retrospective study of seven cases. Am J Rhinol Allergy. 2015; 29:e7-12 https://doi.org/10.2500/ajra.2015.29.4127
El Mograbi A, Ritter A, Najjar E, Soudry E Orbital complications of rhinosinusitis in the adult population: analysis of cases presenting to a tertiary medical center over a 13-year period. Ann Otol Rhinol Laryngol. 2019; 128:563-568 https://doi.org/10.1177/0003489419832624
Levine MH, Spivakovsky S Low quality evidence for treatment approaches for oro-antral communications. Evid Based Dent. 2017; 18:90-91 https://doi.org/10.1038/sj.ebd.6401260
Bell G Oro-antral fistulae and fractured tuberosities. Br Dent J. 2011; 211:119-23 https://doi.org/10.1038/sj.bdj.2011.620
Dym H, Wolf JC Oroantral communication. Oral Maxillofac Surg Clin North Am. 2012; 24:239-247
Logan RM, Coates EA Non-surgical management of an oro-antral fistula in a patient with HIV infection. Aust Dent J. 2003; 48:255-228 https://doi.org/10.1111/j.1834-7819.2003.tb00040.x
Scattarella A, Ballini A, Grassi FR Treatment of oroantral fistula with autologous bone graft and application of a non-reabsorbable membrane. Int J Med Sci. 2010; 7:267-271 https://doi.org/10.7150/ijms.7.267
Shetty L, Kulkarni D, Pradhan R Oroantral fistula resulting from chronic periodontitis: a rare case report. Clin Adv Periodont. 2016; 6:(1)
Huang CH, Brunsvold MA Maxillary sinusitis and periapical abscess following periodontal therapy: a case report using three-dimensional evaluation. J Periodontol. 2006; 77:129-34 https://doi.org/10.1902/jop.2006.77.1.129
Kim SM Definition and management of odontogenic maxillary sinusitis. Maxillofac Plast Reconstr Surg. 2019; 41 https://doi.org/10.1186/s40902-019-0196-2
Mehra P, Murad H Maxillary sinus disease of odontogenic origin. Otolaryngol Clin North Am. 2004; 37:347-364 https://doi.org/10.1016/S0030-6665(03)00171-3
Mora C Penetration to maxillary sinus during periodontal therapy. J Periodontol. 1962; 33:200-201
Moskow BS A histomorphologic study of the effects of periodontal inflammation on the maxillary sinus mucosa. J Periodontol. 1992; 63:674-681 https://doi.org/10.1902/jop.1992.63.8.674
Naito T, Hosokawa R, Yokota M Three-dimensional alveolar bone morphology analysis using computed tomography. J Periodontol. 1998; 69:584-589 https://doi.org/10.1902/jop.1998.69.5.584
Waldrop TC, Semba SE Closure of oroantral communication using guided tissue regeneration and an absorbable gelatin membrane. J Periodontol. 1993; 64:1061-1066 https://doi.org/10.1902/jop.1993.64.11.1061
Ogunsalu C A new surgical management for oro-antral communication: the resorbable guided tissue regeneration membrane – bone substitute sandwich technique. West Indian Med J. 2005; 54:261-263 https://doi.org/10.1590/s0043-31442005000400011
Lee BK One-stage operation of large oroantral fistula closure, sinus lifting, and autogenous bone grafting for dental implant installation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 105:707-713 https://doi.org/10.1016/j.tripleo.2007.09.020

A case of grafted repair of an oro-antral fistula following non-surgical periodontal therapy

From Volume 48, Issue 6, June 2021 | Pages 487-491

Authors

Claudia Heggie

BDS, MFDS (Ed)

Dental Core Trainee, Liverpool University Dental Hospital

Articles by Claudia Heggie

Email Claudia Heggie

Kelly Smorthit

MChD/BChD(Dist), BSc, MFDS (Ed)

Dental Core Trainee, Liverpool University Dental Hospital

Articles by Kelly Smorthit

Banoo Sood

BDS, MSc, FDSRCS, FDS(Rest Dent)RCS

Consultant in Restorative Dentistry, Liverpool University Dental Hospital

Articles by Banoo Sood

Tom Thayer

BChD, LDS, FDS, RCPS, MAMEd

Consultant and Honorary Senior Lecturer in Oral Surgery, University of Liverpool Dental School, Pembroke Place, Liverpool L3 5PS, UK

Articles by Tom Thayer

Abstract

Oro-antral communication is a well-recognized complication of dental extractions in the maxilla, but is rarely reported to occur from periodontal causes. This article describes the formation of an oro-antral communication following non-surgical periodontal therapy, and its subsequent management.

CPD/Clinical Relevance: This article presents a previously unreported formation of an oro-antral communication following non-surgical periodontal therapy, in a patient with localized periodontitis and presence of a root cementum defect. It is of relevance to all dentists managing periodontal disease.

Article

In this article, we report a case of oro-antral communication following non-surgical periodontal therapy. Oro-antral communication most commonly occurs during extraction of upper molar and premolar teeth due to the proximity of the roots of these teeth to the antral floor.1,2 The average distance of apices of maxillary molars from the sinus floor has been reported as 1.97 mm.3 Other well-accepted causes of an oro-antral communication include: tuberosity fracture; peri-apical infection; trauma; displacement of an implant or apex of a root into the antrum; maxillary cysts or tumours; osteoradionecrosis; and medicine-related osteonecrosis.4,5

Oro-antral communication may lead to significant complications and may have a considerable impact on quality of life. Consequent acute maxillary sinusitis with pain and discharge, that may potentially lead to serious complications, is common.6,7,8,9 When a communication persists, maxillary sinusitis may become intractable. However, symptoms may be less severe over time, reflecting a change to a chronic state. There is debate in the literature between conservative and surgical management of oro-antral communication, and evidence for definitive approaches is lacking.10 In many cases, small communications (<5 mm), in the presence of a healthy sinus may heal spontaneously and may occur more commonly than recognized. Larger communications typically require repair.11,12 Surgical splints can be used to keep the site clean and reduce symptoms during conservative management.13 Approaches for repair of an oro-antral communication all involve placing a material to fill the defect, and range from classical soft tissue with buccal or palatal advancement flaps, through fat pad grafts, to the use of autologous, allogeneous grafting materials, or xenografts.4,11,14

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