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Keywords = oro-sinus communication

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16 pages, 2309 KiB  
Article
Efficacy of Bichat’s Buccal Fat Pad Advancement in the Treatment of Odontogenic Maxillary Sinus Fistulas
by Christian Bacci, Claudia Manera, Davide Meneghetti, Iris Dhelpra and Luca Sbricoli
Surgeries 2025, 6(1), 10; https://doi.org/10.3390/surgeries6010010 - 8 Feb 2025
Viewed by 2093
Abstract
Background/Objectives: Oroantral fistulas (OF) are a challenging complication in oral and maxillofacial surgery, often requiring surgical intervention to restore sinus integrity. The Bichat’s buccal fat pad (BFP) has gained attention as a viable option for OF closure. This study aimed to evaluate the [...] Read more.
Background/Objectives: Oroantral fistulas (OF) are a challenging complication in oral and maxillofacial surgery, often requiring surgical intervention to restore sinus integrity. The Bichat’s buccal fat pad (BFP) has gained attention as a viable option for OF closure. This study aimed to evaluate the efficacy, safety, and clinical outcomes of BFP advancement for OF treatment. Methods: This prospective study included 20 patients diagnosed with OF. The surgical procedure involved isolation and advancement of the BFP to close the defect. Patients were followed up at 7 days, 45 days, and 6 months postoperatively, with clinical and radiographic assessments. The primary outcome was successful fistula closure at 6 months, while secondary outcomes included complication rates, sinus opacification on CT scans, pain levels, and quality of life improvements. Results: The overall success rate was 85.7%, with complete fistula closure achieved in 18 out of 21 cases (including one bilateral case). Minor complications occurred in 14.3% of cases. CT scans at 6 months showed complete resolution of sinus opacification in 81% of cases. Patients reported significant improvements in pain scores and quality of life. Conclusions: BFP advancement is an effective, safe, and minimally invasive technique for OF closure, offering high success rates and favorable clinical and radiographic outcomes. These findings support the use of BFP as a reliable option for managing OF in oral and maxillofacial surgery. Full article
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33 pages, 7151 KiB  
Systematic Review
Management of Oro-Antral Communication: A Systemic Review of Diagnostic and Therapeutic Strategies
by Gianna Dipalma, Angelo Michele Inchingolo, Irma Trilli, Laura Ferrante, Angela Di Noia, Elisabetta de Ruvo, Francesco Inchingolo, Antonio Mancini, Stefan Cocis, Andrea Palermo and Alessio Danilo Inchingolo
Diagnostics 2025, 15(2), 194; https://doi.org/10.3390/diagnostics15020194 - 16 Jan 2025
Cited by 3 | Viewed by 7254
Abstract
Aim: This study aims to evaluate the management of oro-antral communications (OAC) and fistulas (OAF), focusing on treatment strategies based on defect size, epithelialization, and the presence of sinus infections, while exploring both traditional and emerging techniques. Materials and Methods: The systematic review [...] Read more.
Aim: This study aims to evaluate the management of oro-antral communications (OAC) and fistulas (OAF), focusing on treatment strategies based on defect size, epithelialization, and the presence of sinus infections, while exploring both traditional and emerging techniques. Materials and Methods: The systematic review was conducted following the PRISMA guidelines and registered on PROSPERO (CDR ID 623251). Using targeted keywords, articles in English published within the last 10 years were analyzed from databases such as PubMed, WoS and Scopus, selecting only clinical studies on human patients. After thorough screening, 20 publications were included in the qualitative analysis, among 734 initially identified. Results: Small OACs (<5 mm) were managed conservatively with hemostatic materials, while larger defects (>5 mm) required surgical closure, with the Bichat flap proving highly effective for large defects. Innovative treatments using autologous bone grafts and PRF showed promise in supporting tissue regeneration. In cases with sinusitis, the combination of FESS and intra-oral closure techniques resulted in high success rates for infection resolution and defect closure. Conclusions: Treatment outcomes for OAC and OAF are highly dependent on the size of the defect and the presence of sinusitis. Multidisciplinary collaboration, along with timely surgical intervention and adherence to medical therapies, is essential for successful management. Emerging techniques and minimally invasive procedures continue to improve patient outcomes, offering hope for more effective and sustainable solutions in complex cases. Full article
(This article belongs to the Special Issue Diagnostic Approach and Innovations in the Different Dentistry Fields)
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14 pages, 3604 KiB  
Systematic Review
The Treatment and Management of Oroantral Communications and Fistulas: A Systematic Review and Network Metanalysis
by Stefano Oliva, Felice Lorusso, Antonio Scarano, Maurizio D’Amario and Giovanna Murmura
Dent. J. 2024, 12(5), 147; https://doi.org/10.3390/dj12050147 - 20 May 2024
Cited by 12 | Viewed by 9854
Abstract
Objectives: The aim of this work was to systematically review and carry out a statistical metanalysis to identify the best treatment for close oroantral communications and fistulas and to avoid the risk of recurrence. Materials and Methods: An electronic search was conducted on [...] Read more.
Objectives: The aim of this work was to systematically review and carry out a statistical metanalysis to identify the best treatment for close oroantral communications and fistulas and to avoid the risk of recurrence. Materials and Methods: An electronic search was conducted on the MEDLINE database (Pubmed), Scopus, and Google scholar using the following keywords: “oro antral communication (OAC)” OR “oro antral fistula (OAF)” OR “antro-oral communication” OR “communication between maxillary sinus and oral cavity” OR “oro-sinusal communication” OR “oro-sinusal fistula” OR “sinus communication” OR “sinus fistula” OR “antral communication” AND “treatment” OR “management” OR “surgical treatment” OR “surgical interventions”. This work was performed in accordance with the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses). After article screening, 9 RCTs (randomized controlled trials), comparing two or more techniques, were included in this review. Results: A statistically significant difference was detected in favor of the buccal fat pad compared to the buccal advancement flap and palatal rotational flap. Conclusions: With the limitations of this study, the buccal fat pad showed the best results in terms of communication closure and reducing the risk of relapse. Full article
(This article belongs to the Section Oral and Maxillofacial Surgery)
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13 pages, 13195 KiB  
Case Report
Treatment of Odontogenic Maxillary Sinusitis with the Use of Growth Factors in Advanced Platelet-Rich Fibrin for Immediate Closure of Oro-Antral Communication: A Case Report
by Paulina Adamska, Dorota Pylińska-Dąbrowska, Marcin Stasiak, Magdalena Kaczoruk-Wieremczuk, Ewa Kozłowska, Adam Zedler and Michał Studniarek
Int. J. Mol. Sci. 2024, 25(8), 4339; https://doi.org/10.3390/ijms25084339 - 14 Apr 2024
Cited by 4 | Viewed by 2880
Abstract
Chronic odontogenic maxillary sinusitis (COMS), a prolonged inflammation of the maxillary sinus lasting over 12 weeks, is often a result of periapical lesions, marginal periodontitis, and complications like oro-antral communication (OAC) and fistula (OAF). OAC, commonly emerging post-teeth extraction in the lateral maxilla, [...] Read more.
Chronic odontogenic maxillary sinusitis (COMS), a prolonged inflammation of the maxillary sinus lasting over 12 weeks, is often a result of periapical lesions, marginal periodontitis, and complications like oro-antral communication (OAC) and fistula (OAF). OAC, commonly emerging post-teeth extraction in the lateral maxilla, lacks documented treatments using advanced platelet-rich fibrin (A-PRF). This study evaluates A-PRF’s efficacy in treating COMS and immediately sealing extensive OAC. A case of a 28-year-old male with COMS linked to a periapical lesion and supernumerary molars is presented. Treatment involved extracting specific teeth while preserving adjacent ones and using A-PRF for immediate OAC closure. A-PRF, enriched with growth factors, was pivotal in healing, showcasing enhanced tissue regeneration, pain reduction, and faster recovery. The findings suggest A-PRF as an effective adjunct in treating extensive OAC and COMS, proposing its inclusion in standard treatment protocols. This study underscores A-PRF’s potential in improving outcomes for patients with COMS and related complications. Full article
(This article belongs to the Special Issue Precision Medicine for Oral Diseases and Cancers)
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13 pages, 511 KiB  
Systematic Review
Correlations between Dental Implant Infectious Pathologies and Maxillary Sinusitis: A Review Article
by Simina Angela Lăcrimioara Iușan, Carmen Costache, Ondine Patricia Lucaciu, Bianca-Nausica Petrescu, Ioana Codruța Mirică, Dan-Alexandru Toc and Silviu Albu
J. Clin. Med. 2023, 12(15), 5059; https://doi.org/10.3390/jcm12155059 - 1 Aug 2023
Cited by 3 | Viewed by 2005
Abstract
(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 [...] Read more.
(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. Full article
(This article belongs to the Special Issue Implant Dentistry—Trends, Challenges and Innovations)
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16 pages, 6127 KiB  
Case Report
Guided Zygomatic Implantology for Oral Cancer Rehabilitation: A Case Report
by Francesco Grecchi, Roberto Giuseppe D’Ambrogio, Luigi Vito Stefanelli, Fabrizio Grivetto, Funda Goker, Massimo Del Fabbro, Alberto Schreiber, Cesare Piazza, Stefano Salgarello, Camilla Dosio and Emma Grecchi
J. Clin. Med. 2023, 12(11), 3653; https://doi.org/10.3390/jcm12113653 - 24 May 2023
Cited by 6 | Viewed by 2665
Abstract
Oral rehabilitation after maxillary oncological resection is challenging. This case report presents the rehabilitation of a 65-year-old Caucasian male adenoid cystic carcinoma patient using a myo-cutaneous thigh flap, zygomatic implant placement, and an immediate fixed provisional prosthesis made with computer-aided technologies. The patient [...] Read more.
Oral rehabilitation after maxillary oncological resection is challenging. This case report presents the rehabilitation of a 65-year-old Caucasian male adenoid cystic carcinoma patient using a myo-cutaneous thigh flap, zygomatic implant placement, and an immediate fixed provisional prosthesis made with computer-aided technologies. The patient presented complaints of asymptomatic enlarged swelling of 5-mm on the right hard hemi-palate. There was an oro-antral communication deriving from a previous local excision. Preoperative radiographs showed the involvement of the right maxilla, maxillary sinus, and nose with a suspect involvement of the maxillary division of the trigeminal nerve. Treatment was planned through a fully digital workflow. A partial maxillectomy was performed endoscopically, and maxilla was reconstructed using an anterolateral thigh free flap. Two zygomatic implants were inserted simultaneously. A provisional fix full-arch prosthesis was manufactured preoperatively through a fully digital workflow and was placed in the operating room. Following post-operative radiotherapy, the patient received a final hybrid prosthesis. During the follow-up period of two years, the patient reported good function, aesthetics, and significant enhancement in quality of life. According to the results of this case, the protocol represented can be a promising alternative for oral cancer patients with large defects, and can lead to an improved quality of life. Full article
(This article belongs to the Section Oncology)
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11 pages, 711 KiB  
Article
Selecting the Best Surgical Treatment Methods in Oro-Antral Communications
by Despina Luciana Bereczki-Temistocle, Simona Gurzu, Ioan Jung, Adina Cosarca, Gabriela Beresescu, Vlad Golu, Cecilia Petrovan and Alina Ormenisan
Int. J. Environ. Res. Public Health 2022, 19(21), 14543; https://doi.org/10.3390/ijerph192114543 - 5 Nov 2022
Cited by 14 | Viewed by 3827
Abstract
Introduction: an oro-antral communication is defined as a permanent pathological connection between the maxillary sinus and the septic oral cavity. Several flaps can be used for the closure (buccal flap, palatal flap, combination techniques) but relapses occur often in case of a large [...] Read more.
Introduction: an oro-antral communication is defined as a permanent pathological connection between the maxillary sinus and the septic oral cavity. Several flaps can be used for the closure (buccal flap, palatal flap, combination techniques) but relapses occur often in case of a large defects and underlying general conditions. Bichat fad pad flap is a multipotent pedicled fatty tissue that is easily accessible from the oral cavity that can be used for the closure of medium-sized defects, even in immunocompromised patients due to its stem cell capacity. Materials and methods: the medical information of the patients diagnosed with oro-antral communications who were admitted and treated in the Oral and Maxillo-Facial Clinic Targu Mures, between 2013 and 2020 were analyzed. A database containing general information, reported causes, associated diseases, surgical methods used during admission, and relapses, was created. The information was statistically processed. The written consent and ethical approval were obtained. Results: the study shows that from a total of 140 cases, 72 were treated using buccal advancement flap, 49 using Bichat fat pad flap, and 19 using palatal flaps. The dimensions of the communications ranged between 0.3 cm and 1.5 cm. Several statistically significant results could be found when comparing the surgical methods. Of the 72 patients treated with buccal advancement flaps, 25 presented relapses as opposed to the patients treated with Bichat fat pad flaps who showed no complications, p < 0.05. Analysing this aspect further, all large defects (10 cases) ranging from 0.6 cm to 1.5 cm treated with advancement buccal flaps (Rehrmann flaps) showed relapses (p < 0.05). Considering the general conditions, out of 7 patients who received radiotherapy 4 presented relapses, as opposed to the healthy patients, p < 0.05. Regarding the reintervention for the relapsed cases, the majority of the cases treated a second time with buccal advancement flap (5 out of 7 cases) failed as opposed to the Bichat fat pad flap with no further relapses (p < 0.05). Conclusions: the most frequently used surgical treatment is the buccal flap, which also has the highest relapse rate. Both primary treatment with Bichat fat-pad flap and re-treatment of relapses using this flap have had 100% success rates, even in patients with general associated conditions, in contrast with patients treated by using the buccal flap. The dimensions of the oro-antral communication and general conditions are crucial factors for the success of the surgical treatment. Full article
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19 pages, 5561 KiB  
Article
Performance Analysis of Supervised Machine Learning Algorithms for Automatized Radiographical Classification of Maxillary Third Molar Impaction
by Andreas Vollmer, Michael Vollmer, Gernot Lang, Anton Straub, Alexander Kübler, Sebastian Gubik, Roman C. Brands, Stefan Hartmann and Babak Saravi
Appl. Sci. 2022, 12(13), 6740; https://doi.org/10.3390/app12136740 - 3 Jul 2022
Cited by 9 | Viewed by 5823
Abstract
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, [...] Read more.
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. Full article
(This article belongs to the Special Issue Artificial Intelligence Applied to Dentistry)
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9 pages, 3562 KiB  
Case Report
Implant Placement after Closure of Oroantral Communication by Sinus Bone Graft Using a Collagen Barrier Membrane in the Shape of a Pouch: A Case Report and Review of the Literature
by Jae-Ha Baek, Byung-Ock Kim and Won-Pyo Lee
Medicina 2021, 57(6), 626; https://doi.org/10.3390/medicina57060626 - 16 Jun 2021
Cited by 19 | Viewed by 6432
Abstract
Oro-antral communication (OAC) acts as a pathway for bacteria between the maxillary sinus and oral cavity, and is a common complication after the removal of a dental implant or extraction of a tooth from the maxillary posterior area. In the case of an [...] Read more.
Oro-antral communication (OAC) acts as a pathway for bacteria between the maxillary sinus and oral cavity, and is a common complication after the removal of a dental implant or extraction of a tooth from the maxillary posterior area. In the case of an untreated OAC, oro-antral fistula develops and becomes epithelialized. We aimed to introduce a treatment for OAC closure via a sinus bone grafting procedure using bone tacks and a collagen membrane with an allograft. The procedure was performed by applying an absorbable membrane made in pouch form. This membrane acted as a barrier for closing the large sinus membrane perforation. Bone tacks were used to fix the membranes. Subsequently, the maxillary sinus was filled with the allograft, and the absorbable membrane was reapplied. Primary closure was achieved by performing a periosteum-releasing incision for a tension-free suture. After 6 months, sufficient bone dimensions were gained without any occurrence of maxillary sinusitis or recurrence of OAC. Additional bone grafts and implantation could be performed to rehabilitate the maxillary posterior area. We conclude that this technique might be a useful treatment for reconstructing the maxillary posterior area with simultaneous sinus bone graft and OAC closure. Full article
(This article belongs to the Special Issue Current Trends in Regenerative Medicine: Less is More Effective)
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2 pages, 759 KiB  
Extended Abstract
A Case of Difficult Diagnosis: A Squamous Cell Carcinoma with Bone Exposure and Oro-sinus Communication in a Patient Receiving Alendronate
by Francesca Pavanelli, Roberto Parrulli, Giuseppe Lizio, Roberta Ippolito, Salvatore Emanuele Teresi and Claudio Marchetti
Proceedings 2019, 35(1), 70; https://doi.org/10.3390/proceedings2019035070 - 12 Dec 2019
Viewed by 1116
Abstract
Medication-Related Osteonecrosis of the Jaw (MRONJ). [...] Full article
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