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Introduction: Oro-antral communications (OAC) is a common complication in oral surgery. Many surgical techniques have been described, but traditional closure techniques have limitations, leading to the exploration of alternative approaches using resorbable biomaterials. This study aimed to assess the success of repairing OAC larger than 5 mm using collagenated porcine cortical lamina. Materials and methods: This retrospective study included 34 cases of OAC larger than 5 mm who underwent surgical repair using a porcine-derived collagenated cortico-cancellous plate, (Lamina Curve®). The median patient age was 46 yr. The study cohort consisted of 12 females and 22 males. The median follow-up time was 54 days. The primary outcome was the presence of complete mucosal closure, assessed at the 4th week postoperatively. Secondary outcomes included adverse events and stitching disunion. Results: Success rate was 97%. 9 patients (26.5% [12.1 ; 44]) had complications : 5 stitch disunions, 1 failure, 1 epistaxis, 1 infection and 1 nerve paresis. Of the 5 patients with stitch disunions (14.7% [4.12 ; 30.2]), all patients had complete mucosal closure at the primary outcome endpoint. Conclusion: Cortical lamina shows promising results in OAC repair. Success rates compare favorably with traditional flap-based methods. Further research is needed to validate these findings. [ABSTRACT FROM AUTHOR]

Introduction: Oro‐control communication is one of the complications associated with dental extraction and oral surgeries. This case report presents a minimally invasive surgical approach for bone regeneration at the site of oro‐antral communication utilizing a prefabricated computer‐aided design and computer‐aided manufacturing (CAD‐CAM) allogenic bone block. Methods: A 20‐year‐old healthy female, nonsmoker, with a badly destructed upper right first molar was referred for dental implant placement after extraction. Cone beam computerized tomography images revealed the presence of a large bone defect associated with oro‐antral communication with the maxillary sinus and insufficient bone for dental implant placement. A prefabricated CAD‐CAM allogenic bone scaffold was fabricated. After surgical exposure, the scaffold was secured in place and covered with a non‐resorbable membrane. A dental implant was placed after 5 months, and a trephining biopsy was processed for histological evaluation. Results: Closure of the oro‐antral communication was clinically observed. The average width of the alveolar bone was 12 mm, and the average height was 11 mm. Histological analysis at 5‐month intervals showed thin newly formed bone trabeculae encircling remnants of graft material surrounded by osteoid tissue. The newly formed bone percentages were 32 ± 18% and 28 ± 17% volume remained after the biodegradation of the scaffold. Specific immune‐histochemical staining by anti‐vascular epithelial growth factor expression index value was 32.06%. Conclusions: A prefabricated CAD‐CAM scaffold was successfully used to seal a large oro‐antral communication and regenerate sufficient bone to place a dental implant. [ABSTRACT FROM AUTHOR]

Oral antral communications (OAC) are unnatural openings between the maxillary sinus and the oral cavity. Their cause is essentially iatrogenic (post-dental or post-surgical treatment), but also tumoral, traumatic and infectious. Multidisciplinary care is important involving dental and maxillofacial surgeons but also otolaryngologists due to pre-existing sinus infection or secondary to lack of treatment. Depending on the location and size of the OAC, surgeons will use closure techniques via an intraoral approach to which an endonasal procedure must be associated to manage sinusinfectious complications. Thissinussurgical approach can be done with a transfacial access, but current progress in surgery and the new consensus that results from it agree on the application of minimally invasive techniques that cause less postoperative morbidity. We report the case of a large posterior oral-sinus communication of 1.42 cm on a dystrophic and infected sinus, successfully managed by a combined endoscopic surgical approach and the mobilizing of a fat body flap of the cheek (Bichat's fatty ball). This clinical presentation aims to highlight the functional impact of a large OAC and the significance of endoscopic sinus surgery treatment associated with the closure of the OAC. [ABSTRACT FROM AUTHOR]

(1) Background: The demands of patients for aesthetic and functional rehabilitation of edentulous areas led to the use of dental implants as therapeutic means on an increasingly large scale. This aspect determined the appearance of some infectious pathologies with a peri-implant starting point that can be complicated by various sinus diseases. The purpose of this review article is to synthesize the existing information in the specialized literature regarding the existing correlations between peri-implant and maxillary sinusitis. (2) Methods: The articles published in five databases were researched using different combinations of search terms. We selected 12 articles from the 250 found, by applying the inclusion and exclusion criteria and removing duplicates. (3) Results: We analyzed the included studies and we found that all of them reported a positive correlation between maxillary sinusitis and peri-implant infectious diseases. There are also reported other pathologies with a peri-implant infectious disease as a starting point such as abscesses, oro-antral communications, or foreign body reactions due to implant or bone graft materials migration. (4) Conclusions: This scoping review highlighted the existence of correlations between peri-implant and sinus pathology and the importance of preventing peri-implant diseases of an infectious nature to avoid the occurrence of these complications. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to show our experience with the correct management of patients suffering from odontogenic sinusitis with oroantral communication and fistula. Methods: According to the inclusion criteria, 41 patients were enrolled in this retrospective study with a diagnosis of odontogenic sinusitis with oroantral communication and fistula; 1 patient with pre-implantological complication, 14 with implantological complications, and 26 with classical complications. Results: Two patients were treated with a fractioned combined approach, 13 patients were treated with an oral approach only, and 26 patients were treated with a combination. There was a complete resolution of the symptoms and closure of the fistula in all the patients enrolled. Conclusions: In our study, in all 41 patients, there was a surgical success. The best option is to use a multidisciplinary approach for patients suffering from odontogenic sinusitis. [ABSTRACT FROM AUTHOR]

The extraction of teeth carries a risk of associated complications, some of which may be predicted, providing an opportunity for them to be prevented or their effects minimised. Prior to embarking on any extraction, the dentist must be confident that they are able to deal with any complication that may arise. This paper provides an overview of the complications of dental extraction which are commonly encountered, considers the factors which predispose to them arising, suggests how the risk of them occurring can be reduced, and describes how they should be managed. [ABSTRACT FROM AUTHOR]

Oro‐antral communication (OAC) is an opening between the maxillary sinus and the oral cavity, which can provide a pathway to cause an infection of the maxillary sinus. Although surgical techniques propose many advantages, several drawbacks have been reported in the previous studies. Bioactive modifiers such as platelet‐rich fibrin (PRF) are widely being used in oral surgery. Various studies have been conducted for closure of OACs using PRF. Due to the heterogeneity of the techniques found, we opted for a literature review to highlight the variety of techniques discussed in the literature. A comprehensive search of the PubMed, Google Scholar and Cochrane databases was performed for published articles between 2014 and 2021. Keywords for OAC management and repair and inclusion criteria were used to screen articles for final review. Out of 195 articles found, 12 articles were included to the study. Eight studies performed simple direct application of PRF clots, 2 studies used PRF in combination with collagen membrane and in 2 studies the treatment plan was to use buccal advancement flap reinforced by PRF. There were several variations among approaches to the closure of OAC using PRF in terms of treatment planning, pre‐ and post‐operative medication and preparation of PRF. Despite the mentioned variations, review of recent studies showed that all of the cases experienced full epithelialisation of OAC. This technique, without manipulation of any additional flaps and auto‐grafts, has several advantages. However, further research, both experimental and clinical, is necessary to unravel the success rate of using PRF in the management of OACs. [ABSTRACT FROM AUTHOR]

Background: Oro-antral communication (OAC) is a common complication following the extraction of upper molar teeth. The Archer and the Root Sinus (RS) systems can be used to classify impacted teeth in panoramic radiographs. The Archer classes B-D and the Root Sinus classes III, IV have been associated with an increased risk of OAC following tooth extraction in the upper molar region. In our previous study, we found that panoramic radiographs are not reliable for predicting OAC. This study aimed to (1) determine the feasibility of automating the classification (Archer/RS classes) of impacted teeth from panoramic radiographs, (2) determine the distribution of OAC stratified by classification system classes for the purposes of decision tree construction, and (3) determine the feasibility of automating the prediction of OAC utilizing the mentioned classification systems. Methods: We utilized multiple supervised pre-trained machine learning models (VGG16, ResNet50, Inceptionv3, EfficientNet, MobileNetV2), one custom-made convolutional neural network (CNN) model, and a Bag of Visual Words (BoVW) technique to evaluate the performance to predict the clinical classification systems RS and Archer from panoramic radiographs (Aim 1). We then used Chi-square Automatic Interaction Detectors (CHAID) to determine the distribution of OAC stratified by the Archer/RS classes to introduce a decision tree for simple use in clinics (Aim 2). Lastly, we tested the ability of a multilayer perceptron artificial neural network (MLP) and a radial basis function neural network (RBNN) to predict OAC based on the high-risk classes RS III, IV, and Archer B-D (Aim 3). Results: We achieved accuracies of up to 0.771 for EfficientNet and MobileNetV2 when examining the Archer classification. For the AUC, we obtained values of up to 0.902 for our custom-made CNN. In comparison, the detection of the RS classification achieved accuracies of up to 0.792 for the BoVW and an AUC of up to 0.716 for our custom-made CNN. Overall, the Archer classification was detected more reliably than the RS classification when considering all algorithms. CHAID predicted 77.4% correctness for the Archer classification and 81.4% for the RS classification. MLP (AUC: 0.590) and RBNN (AUC: 0.590) for the Archer classification as well as MLP 0.638) and RBNN (0.630) for the RS classification did not show sufficient predictive capability for OAC. Conclusions: The results reveal that impacted teeth can be classified using panoramic radiographs (best AUC: 0.902), and the classification systems can be stratified according to their relationship to OAC (81.4% correct for RS classification). However, the Archer and RS classes did not achieve satisfactory AUCs for predicting OAC (best AUC: 0.638). Additional research is needed to validate the results externally and to develop a reliable risk stratification tool based on the present findings. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to show our experience with the correct management of patients suffering from odontogenic sinusitis with oroantral communication and fistula. Methods: According to the inclusion criteria, 41 patients were enrolled in this retrospective study with a diagnosis of odontogenic sinusitis with oroantral communication and fistula; 1 patient with pre-implantological complication, 14 with implantological complications, and 26 with classical complications. Results: Two patients were treated with a fractioned combined approach, 13 patients were treated with an oral approach only, and 26 patients were treated with a combination. There was a complete resolution of the symptoms and closure of the fistula in all the patients enrolled. Conclusions: In our study, in all 41 patients, there was a surgical success. The best option is to use a multidisciplinary approach for patients suffering from odontogenic sinusitis.

Background: Oro-antral communication (OAC) is a common complication following the extraction of upper molar teeth. The Archer and the Root Sinus (RS) systems can be used to classify impacted teeth in panoramic radiographs. The Archer classes B-D and the Root Sinus classes III, IV have been associated with an increased risk of OAC following tooth extraction in the upper molar region. In our previous study, we found that panoramic radiographs are not reliable for predicting OAC. This study aimed to (1) determine the feasibility of automating the classification (Archer/RS classes) of impacted teeth from panoramic radiographs, (2) determine the distribution of OAC stratified by classification system classes for the purposes of decision tree construction, and (3) determine the feasibility of automating the prediction of OAC utilizing the mentioned classification systems. Methods: We utilized multiple supervised pre-trained machine learning models (VGG16, ResNet50, Inceptionv3, EfficientNet, MobileNetV2), one custom-made convolutional neural network (CNN) model, and a Bag of Visual Words (BoVW) technique to evaluate the performance to predict the clinical classification systems RS and Archer from panoramic radiographs (Aim 1). We then used Chi-square Automatic Interaction Detectors (CHAID) to determine the distribution of OAC stratified by the Archer/RS classes to introduce a decision tree for simple use in clinics (Aim 2). Lastly, we tested the ability of a multilayer perceptron artificial neural network (MLP) and a radial basis function neural network (RBNN) to predict OAC based on the high-risk classes RS III, IV, and Archer B-D (Aim 3). Results: We achieved accuracies of up to 0.771 for EfficientNet and MobileNetV2 when examining the Archer classification. For the AUC, we obtained values of up to 0.902 for our custom-made CNN. In comparison, the detection of the RS classification achieved accuracies of up to 0.792 for the BoVW and an AUC of up to 0.716 for our custom-made CNN. Overall, the Archer classification was detected more reliably than the RS classification when considering all algorithms. CHAID predicted 77.4% correctness for the Archer classification and 81.4% for the RS classification. MLP (AUC: 0.590) and RBNN (AUC: 0.590) for the Archer classification as well as MLP 0.638) and RBNN (0.630) for the RS classification did not show sufficient predictive capability for OAC. Conclusions: The results reveal that impacted teeth can be classified using panoramic radiographs (best AUC: 0.902), and the classification systems can be stratified according to their relationship to OAC (81.4% correct for RS classification). However, the Archer and RS classes did not achieve satisfactory AUCs for predicting OAC (best AUC: 0.638). Additional research is needed to validate the results externally and to develop a reliable risk stratification tool based on the present findings.

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. [ABSTRACT FROM AUTHOR]

Lefort I osteotomies are one of the most commonly performed surgeries in the maxillofacial spectrum. There had been reports of umpteen number of complications after Lefort I ostetomy. The authors present a case of an oro-antral communication after Trimble's modification of Lefort I osteotomy, which has not been published before in the English literature. [ABSTRACT FROM AUTHOR]

A maxillofacial prosthesis intends to replace missing oral or facial structures and its associated functions, but the restoration gets complicated when patients are subjected to en bloc surgical removal of oral and facial structures due to metastasized neoplasm. The post-surgical radiation therapy may hold-up reconstructive procedures and implant therapy. Conventional hollow obturators constructed out of polymethyl methacralate can be reliable interim prostheses. However, whether an edentulous maxillary defect can retain a long serving interim prosthesis is questionable. In this case report, the advanced room temperature vulcanizing silicone material was used to construct the hollow obturator and the same was employed as a long serving retentive aid for the interim prosthesis in an edentulous maxillary defect.

We present the case of a retrobulbar abscess that developed secondary to the repair of an oroantral communication. Orbital abscesses have been described in relation to odontogenic infections, facial injury, sinusitis, and after dental extractions but, to the best of our knowledge, none has been reported in these circumstances. Retrobulbar abscess is a rare complication, but early clinical and radiological diagnosis, and urgent decompression are vital because it comes with considerable risk of irreversible visual impairment. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this study was to compare the clinical results of pedicled buccal fat pad flap (PBFPF) with the standard buccal flap in the closure of oro-antral fistula (OAF). Twenty-two patients aged 25–56 years with oro-antral communication were randomly divided into two groups using Rand List 1.2 software. In group 1, OAF was treated with the classic buccal sliding flap and in group 2 a pedicled buccal fat pad was used. All patients were visited 48h, 1 week and 1 month after surgery for assessment of primary (success of surgery) and secondary outcomes (pain, swelling, maximum mouth opening (MMO) reduction). Both methods were equally successful for the closure of OAF. The pain score was statistically greater in the experimental group (U =9, P =0.001). MMO was statistically less in the experimental group 2 and 7 days after surgery (P <0.001). 1 month after surgery, no statistically significant difference was found in MMO between the two groups (P =0.09). In general, the PBFPF group had more pronounced swelling than the control group. Despite the statistical evidence, none of the patients complained of pain and swelling following the PBFPF procedure. [Copyright &y& Elsevier]

Abstract: This study retrospectively analyses paranasal sinus complications following displacement of oral implants in the maxillary sinus treated according to clinical situation by functional endoscopic sinus surgery (FESS), an intraoral approach, or a combination of both procedures. Over 5 years, 27 patients (13 male; 14 female), aged 27–73 years (mean 53.9 years), underwent treatment for postoperative complications involving the paranasal sinuses following displacement of oral implants in the maxillary sinuses. According to the complication (implant displacement, implant displacement with or without reactive sinusitis and/or with or without associated oro-antral communication), patients were treated with FESS, intraoral approach to the sinus, or FESS associated with an intraoral approach. Follow up lasted for at least 1 year with clinical and radiographic controls. 26 patients recovered completely; one patient underwent re-intervention with FESS and an intraoral approach 2 years after implant removal, due to persistent signs and symptoms of maxillary sinusitis and oro-antral communication. Postoperative recovery after the second procedure was followed by complete recovery. The results demonstrate that a rational choice of surgical protocol for the treatment of complications involving the paranasal sinuses following displacement of implants in the maxillary sinuses may lead to reliable results. [Copyright &y& Elsevier]

Abstract: Background: Our aim was to evaluate the incidence of perforations of the sinuses and their related treatment after the removal of upper wisdom teeth depending on various anatomical and clinical variables. Material and methods: A total of 1057 upper wisdom teeth were removed under local anaesthetic in the departments of oral surgery at the Universities of Bonn, Düsseldorf, Frankfurt and Mainz, Germany. Data were collected with the help of an anonymised questionnaire dealing with information about the patients, and the position and stage of the development of teeth, as well as the occurrence and size of an oro-antral communication and its treatment. Results: Of 465 extractions and 592 osteotomies of the upper third molars, 134 interventions (13%) were related directly to the diagnosis of a perforated maxillary sinus. Acute oro-antral communication occurred as a result of the removal of completely impacted teeth in 88 of 370, (24%) by removal of partially impacted teeth in 23 of 222 (10%) and in fully erupted third molars in 23 of 465 (5%) of all cases. These differences are significant (p <0.001). In 111 (83%), the diameter of the oro-antral perforation was less than 3mm. In 25 (19%) of all sinus openings, a buccal sliding flap was used to close the extraction wound. We conclude that intraoperative fracture of the root, higher degree of impaction and higher age of the patient are associated with a greater likelihood of oro-antral perforation. [Copyright &y& Elsevier]

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., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Background and aim: The most common etiology of creating the communication between maxillary sinus and oral cavity is upper premolars or molars extraction. The aim of this study was to assess the efficacy of the surgical treatment using bone augmentation of the oro-antral perforation (OAP) following maxillary posterior teeth extraction. Methods and materials: The study was performed in 1 patient at age 28. The OAP was diagnosed after 16 and 26 tooth extraction. First OAP was sutured closed by buccal flap method, the second one was augmented and sutured closed by the same method. The measure of postoperative defect and bone regeneration progress were conducted basing on CBCT. Results: Bone thickness after 6 months was 1 mm where 16 tooth was extracted and 11,72 mm on the side, where 26 tooth was extracted. Conclusions: The buccal flap method does not ensure bone regeneration after OAP. The thickness of the regenerated bone after augmentation was satisfactory for implantology treatment. [ABSTRACT FROM AUTHOR]