Article

Bioabsorbable root analogue for closure of oroantral communications after tooth extraction: A prospective case-cohort study

Authors:
  • Center of Dental Medicine - University of Zurich
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Abstract

To assess the clinical capacity of a bioabsorbable root analog to close oroantral perforations after extraction. In this prospective case-cohort study, 20 consecutive patients with oroantral communications greater than 2 mm were treated with a bioabsorbable root analog (RootReplica). Patients were followed up clinically and radiographically for 3 months to monitor the healing process. Root replicas could be placed in 14 patients, whereas 6 patients required the socket to be covered with a buccal sliding flap. In the latter cases, fragmentary roots or overly large defects prohibited replica fabrication or accurate fitting of the analog, respectively. Healing was uneventful in all patients, and epistaxis, swelling, or pain was observed only in patients treated with flaps. The method described is a valuable alternative method with which to close oroantral communications but cannot be performed in all patients because of technical limitations.

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... Nonetheless, the closure of an OAC with flap elevation has some disadvantages: (i) it requires that the operator has proper experience in oral surgery; (ii) in some cases specific instruments and materials are necessary; (iii) the patient can be more prone to postoperative swelling and pain; (iv) sometimes a decrease of vestibular depth is unavoidable 1,15 . The possibility of limiting the surgical trauma and, consequently, the overall discomfort for the patient has raised the interest in flapless surgical techniques [16][17][18][19] , which are less complex and more conservative, but their efficacy has still to be ascertained. This can be particularly relevant in case of small-sized non-complicated OACs following tooth extraction, in which flap-based surgical techniques might constitute an overtreatment. ...
... The flapless techniques for OACs closure already described in the literature are found on positioning a material that stabilises the blood clot into the fresh extraction socket. Some examples are the thermally moulded poly(lactide-co-glycolic) acid-coated porous -tricalcium phosphate (RootReplica, Degradable Solutions, Schlieren, Switzerland) 18 , the biodegradable polyurethane foam 20 (Polyganics BV, Groningen, The Netherlands) and the resorbable haemostatic gauze composed of reconstituted oxidised cellulose 19 (Surgicel; Johnson and Johnson, Somerville, NJ, USA). The application of these materials does not require particular technical ability and it seems reasonable that the majority of the general dentists can safely perform these flapless treatments of OACs. ...
... The classic closure techniques with flap elevation, by far the most studied, can carry the frequent disadvantage of second intention healing and soft tissue topography alteration 19 . The reduction of the vestibular depth could jeopardise the stability of a removable prosthesis 18 and vestibuloplasty could be indicated in a later period. Moreover, the preparation, the positioning and the suturing of the flap may require a long time to be learned and sometimes to be performed 18 . ...
Article
An oroantral communication (OAC) is a common complication in alveolar surgery that usually occurs as a result of the extraction of maxillary posterior teeth. To avoid further complications, several closure techniques are used; most of them need a flap elevation. Recently, simpler conservative flapless techniques for OAC closure have been described. To appraise the effectiveness of different techniques for closure of OACs also in comparison to nothing. The following electronic databases were searched for randomised controlled trials regarding techniques for closure of OACs: PubMed; SciVerse Scopus; Latin American and Caribbean Health Sciences; The Scientific Electronic Library Online and The Cochrane Library (from January 1949 to August 2014). Unspecific algorithms were chosen in order to maximise search sensibility. Additional manual searching was performed in PubMed related citations, in five journals and in the references of the selected articles. There were no restrictions with regard to publication language. Randomised controlled trials (RCTs) comparing techniques for closing oroantral communications to nothing, or different techniques for closing oroantral communications reporting the success rate with at least two months follow-up. The screening of eligible studies, the assessment of methodological quality and data extraction were done by two independent reviewers working in duplicate. The research individuated 1256 publications. After screening, only five articles were assessed for eligibility. Only two RCTs evaluating the effectiveness of techniques for OAC closure fulfilled the inclusion criteria of the present review. One trial including 30 patients assessed whether flapless techniques (resorbable root analogues and haemostatic gauze) could be as effective as the Rehrmann's buccal flap; all the patients were reported as successfully healed in the three intervention groups. Another RCT with 20 patients compared the effectiveness of the buccal fat pad flap (100% success rate) with a sandwich graft with hydroxyapatite crystals within collagen sheaths (90% success rate). The authors found no significant difference. There are no RCTs evaluating whether an oroantral communication should be closed or not. There is weak evidence from two RCTs showing good results with five different techniques for closure of OACs (resorbable root analogues, haemostatic gauze, Rehrmann's buccal flap, buccal fat pad flap, sandwich graft with hydroxyapatite crystals). Until sufficiently high quality RCTs are conducted, elevating or not a flap for closure of OACs will be left to the personal choice of the surgeon. Conflict of interest notification: The authors declare no competing financial interest.
... Communications between the oral cavity and the maxillary sinus occur with frequencies between 0.31% and 4.7% after the extraction of upper teeth. [1][2][3][4] If untreated, oroantral fistulas may form, which can result in chronic infection of the maxillary sinus. Smaller oroantral communications (OACs), with a diameter of Ͻ2 mm, are often closed by a coagulum and heal spontaneously. ...
... Furthermore, preparation, adaptation, and fixation of flaps take a significant amount of practice and time. 1 The closure of OACs with synthetic bone graft substitutes constitutes an alternative to flap-based techniques. 1,[14][15][16] Besides closure of the opening, these materials may positively affect the surrounding hard tissue, because the insertion of biomaterials into extraction sockets has been reported to reduce alveolar ridge resorption. ...
... Furthermore, preparation, adaptation, and fixation of flaps take a significant amount of practice and time. 1 The closure of OACs with synthetic bone graft substitutes constitutes an alternative to flap-based techniques. 1,[14][15][16] Besides closure of the opening, these materials may positively affect the surrounding hard tissue, because the insertion of biomaterials into extraction sockets has been reported to reduce alveolar ridge resorption. 17 However, this potential benefit of perforation closure with biomaterials has not been assessed yet. ...
Article
The aim of this study was to compare the treatment of oroantral communications (OACs) with bioresorbable root analogs made of poly(lactide-co-glycolide) (PLGA)-coated beta-tricalcium phosphate (beta-TCP), hemostatic gauze or a buccal flap technique. In this prospective clinical study, 30 patients with oroantral communications were randomly assigned to a treatment. Clinical success, vestibular depth at the defect site, pain, and swelling were monitored. The OAC closure was successful in all cases. The vestibular depth stayed constant in the groups treated with the PLGA-beta-TCP composite or hemostatic gauze. In contrast, a vestibular depth reduction of 1.2 +/- 0.2 mm was observed in the buccal flap group, indicating atrophy of the alveolar ridge in these patients. Furthermore, pain and swelling were more pronounced in this group. Closures of OACs with PLGA-beta-TCP composite or hemostatic gauze are reliable minimally invasive methods that minimize atrophy of the alveolar ridge, swelling, and pain compared with a buccal flap technique.
... The use of a bioabsorbable root analog made of β-tricalcium phosphate for closure of oroantral fistulas was proposed by Thoma et al. [68]. The root replicas were fabricated chair side, using a mold of the extracted tooth [10]. ...
... One week later, granulation tissue is formed and the prolamin gel completely dissolves after 2 to 3 weeks [72]. This technique proved to be well tolerated by patients and results in fewer postoperative complaints compared with other procedures [68]. The disadvantage of this technique is chiefly its high material cost. ...
... The disadvantage of this technique is chiefly its high material cost. Additionally, the technique is less appropriate for closure of OAFs greater than 3 mm [68]. ...
Article
Full-text available
Abstract An oroantral fistula (OAF) is a pathological abnormal communication between the oral cavity and the maxillary sinus which may arise as a result of failure of primary healing of an OAF, dental infections, osteomyelitis, radiation therapy, trauma, or iatrogenic complications. With the presence of a fistula, the maxillary sinus is permanently open. Microbial flora passes from the oral cavity into the maxillary sinus, and the inflammation of the sinus occurs with all potential consequences. In literature, various techniques have been proposed for closure of OAFs. Due to the heterogeneity of the data and techniques found, we opted for a narrative review to highlight the variety of techniques discussed in the literature. Techniques of particular interest include the bone sandwich with resorbable guided tissue regeneration (GTR) membrane and platelet-rich fibrin (PRF) used alone as both a clot and a membrane. The great advantage of these techniques is that no donor site surgery is necessary, making the outcome valuable in terms of time savings, cost and, more importantly, less discomfort to the patient. Additionally, both bony and soft tissue closure is performed for OAF, in contrast to flaps, which are typically used for procedures in the sinus area. The reconstructed bony tissue regenerated from these techniques will also be appropriate for endosseous dental implantation.
... That can lead to bacterial contamination of the maxillary sinus, causing a chronic sinusitis. One of the most common etiology is the extraction of the first and the second maxillary molars [1][2][3]. ...
... Even after 24 h, the closure of the oroantral fistula can be effective if there is no active infection nor foreign body (endodontic filling material for example) [2]. ...
... When the oroantral fistula is less than 5 mm in diameter, a stable blood clot may be sufficient for a spontaneous closure. It is recommended to attempt a water tight mucosal closure, regardless of the fistula's diameter [2,[4][5][6]. ...
Article
Full-text available
Introduction: The management of the oroantral fistula is mainly focused on th closure of the mucosa. The surgical management restoring the underlying bone defect are seldom. Maintaining this defect may compromise implant rehabilitation in this sector. The purpose of this article was to show, through a clinical case, an alternative way to manage an oroantral fistula and the bone tissue defect in the same time. Observation: After a rigourous clinical and radiological observation of a 2-year oroantral fistula, an impacted autologous bone graft of the maxillary tuberosity followed by a water tight closure of the mucosa, were realized in a 50-year old patient. Commentary: Using this surgical technique was successful for the closure of the mucosa as for the bone defect reconstruction. A consolidation was noticed and an pre-implant management and a dental implant placement could be realized. Conclusion: The choice of this surgical technique for the management of an oroantral fistua had a direct influence on the future prosthetic rehabilitation. The surgical technique presented for this case could be an interesting approach because the fixed or removable prosthetic treatment will be more effective if the maxillary bone tissue is reconstructed.
... This technique proved to be fast and simple, but cannot be performed in all patients due to technical limitations. 56 ...
... Most of these studies, however, did not assess bone formation objectively. Therefore, strategies that do not involve autogenous bone grafts such as the Bio-Guide-Bio-Oss technique, 43 root analog, 56 or metals such as gold 10,12,[49][50][51][52][53][54] and aluminum 55 might also result in adequate bone formation for implant rehabilitation, although this has not yet been objectified. ...
... Implant placement is possible after closure of OAC with chin graft, but coverage of graft with flap may lead to reduced vestibule, that have to be deepened before or during the implant placement. Transplant rejection, displacement of a graft into a sinus cavity, are potential serious complications of this technique, both consequenc­ ing a relapse [6, 12, 20]. GTR technique is relatively simple and minimally inva­ sive procedure that could be usefull for closure of OAC and OAF with large bony defects, denuded neighbouring teeth, and lack of soft tissue for local flaps. ...
... Po­ sle za tva ra nja OAK ovim tran splan ta tom, nje go vo po kri va nje re žnjem mo že do ve sti do sma nje nja ve sti bu lu ma, ko ji mo ra da se pro du bi pre ili to kom po sta vlja nja im plan ta ta. Od ba ci va nje tran splan ta ta, od no sno nje go vo po gre šno po sta vlja nje u si nu­ snu šu plji nu po ten ci jal ne su kom pli ka ci je ove teh ni ke jer mo­ že do ći do re ci di va [6, 12, 20]. Teh ni ka VRT je re la tiv no jed no sta van i mi ni mal no in va zi­ van po stu pak za za tva ra nje OAK i OAF sa ve li kim ošte će nji ma ko sti, ogo lje nim okol nim zu bi ma i ne do stat kom me kog tki va za lo kal ne re žnje ve. ...
Article
Full-text available
Oroantral fistula is pathologic communication between oral cavity and maxillary sinus, usually localized between antrum and buccal vestibulum. Persisting OAF always causes chronic maxillary sinusitis. A technique for closure of a large oroantral fistula with resorbable collagen membrane is described.
... An oroantral communication (OAC) is an open connection between the oral cavity and maxillary sinus. OACs are usually caused by the extraction of the maxillary posterior teeth [1][2][3]. The incidence rates are 0.31 and 4.7% after the extraction of upper teeth [1,4]. ...
... Because of the disadvantages of surgical closure, several alternative treatment modalities have been suggested, including the third molar transplantation, hydroxylapatite blocks, bioabsorbable root analog, the Bio-Oss-Bio-Gide sandwich technique (Osteohealth, Shirley, NY) and biodegradable polyurethane foam [3,[13][14][15][16]. In addition, some metals like gold [17], tantalum [18] and aluminum [19] are used for closures. ...
Article
Full-text available
In this study, the effects of Curacel TM oxidized regenerated cellulose and bone wax on the healing bone were compared to each other by means of CT based bone density measurement and histopathological evaluation. The bone density measurements of the control group were significantly higher than those of both Curacel and bone wax groups. There was no significant difference between Curacel and bone wax. Histopathologically, the bone wax group showed more osteoblastic activation than Curacel group. For all measurement parameters (osteoblastic activation, osteoclastic activation, fibrous connective tissue, osseous trabeculae), Curacel and bone wax groups had worse results than control group. It is concluded that Curacel has no superiority over bone wax in terms of osseous healing in the oroantral region. There is no need to use oxidized regenerated cellulose or bone wax for small oroantral openings since the healing is better without any intervention. In addition, bone density measurement and histopathological evaluation were consistent in terms of osseous healing of the oroantral opening.
... [2] However, mostly it occurs as a complication of oral and maxillofacial surgical procedures such as maxillary posterior teeth extractions, implant surgery, cyst and tumor enucleations, orthognathic surgery (LeFort osteotomies), osteomyelitis, trauma, and pathologic lesions. [3] The most common etiology of OAF is the extraction of posterior maxillary teeth because of their roots proximity to the maxillary sinus and thin antral floor in this area. [3] OAF is a complex defect that involves the soft and hard tissue layers. ...
... [3] The most common etiology of OAF is the extraction of posterior maxillary teeth because of their roots proximity to the maxillary sinus and thin antral floor in this area. [3] OAF is a complex defect that involves the soft and hard tissue layers. In the absence of sinus infection, most of the small acute OAF with a diameter of 1 to 2mm will heal spontaneously by the formation of a blood clot and secondary healing. ...
Article
Full-text available
Statement of the problem: An oro-antral fistula (OAF) creates a passage for oral microbes into maxillary sinus with numerous possible complications. Purpose: This retrospective study evaluates the success of three different surgical techniques of OAF repair. Materials and method: Records of patients that were treated for OAF repair were retrieved and reviewed. Data recorded were patients' age, gender, etiology, size, location, duration, and method of repair. According to the surgical technique used to repair the OAF, patients were divided into three groups including buccal flap, palatal flap, and buccal fat pad. All of the patients were locally anesthetized with 2% lidocaine and 1/100000 or 1/80000 epinephrine. Then the edges of the fistula were excised and fistula wall was dissected in a stitched layer by three surgical methods. The three groups were compared concerning the success or failure of surgical technique based on complete closure of OAF after three months postoperatively. Results: 147 patients (116 males and 31 females) with adequate records were included in the study. The surgical methods used in patients were, buccal flap in 59 (40.1%), buccal fat pad in 42 (40.8%), and palatal flap in 28 (19%) individuals. Success rates of these techniques were significantly different. Buccal fat pad was the most successful flap (98.3%), followed by buccal flap (89.8%), and palatal flap (85.7%). The most common cause of OAF in this group of patients was dental extraction. Conclusion: Buccal fat pad flap seems to be one of the best treatments for the closure of OAF lager than 5 mm.
... Extraction of maxillary posterior teeth is the most common cause of OAC. Maxillary cysts, benign or malignant tumors and trauma can be other causes of OAC [1]. ...
Article
Full-text available
The aim of this study is to evaluate oroantral communication (OAC) repair using one bone substitute (Fisiograft) and platelets rich fibrin (PRF).
... Vojnosanit Pregl 2011; 68(4): 366-371. eration and the use of root analogues [3][4][5][6][7][8][9][10] . The use of root analogues as preimplant therapy can provide adequate quantity of bone and soft tissue for implant placement. ...
Article
Full-text available
Bone resorption is a physiological process after tooth extraction. The use of bone substitutes to fill the tooth socket is suggested to prevent bone resorption and establish good bone architecture for implant placement. A pure beta-tricalcium phosphate coated with copolymer (polylactic-polyglycolic acid) as a root analogue, is suitable for filling tooth sockets. We presented a patient successfully treated with root analogue after extraction of the right second lower premolar. Three months later, the patient was planned for the placement of six TE ITI dental implants into the mandible. During the sugery, the biopsy of bone-like tissue from the previously treated socket was taken. All the implants were immediately loaded due to good primary stability. Histological analysis of the specimen revealed fibrous healing in the area treated with root analogue. The use of beta-tricalcium phosphate coated with copolymers after tooth extraction enables satisfactory bone architecture for consequent implant treatment.
... blood), they harden within minutes to defect-analog, porous bodies. In defects of adequate shape, no membrane is necessary to prevent graft dislocation (Gacic, et al. 2009, Thoma, et al. 2006). ...
Article
OBJECTIVE: Moldable in situ self-stabilizing and hardening bone graft materials facilitate handling and may be suitable for membrane-free bone regeneration methods. This study aimed to compare two moldable synthetic calcium phosphate materials in a rabbit calvarial defect model. METHOD: In 12 New Zealand white rabbits, four evenly distributed 6 mm diameter defects were drilled in the calvarial bone. Three filler materials were randomly applied to 48 defects: an in situ hardening polylactide-coated ß-tricalcium phosphate (TCP), an in situ hardening polylactide-coated biphasic calcium phosphate (BCP), and a granular deproteinized bovine bone matrix (DBBM, positive control). One defect remained untreated and served as a negative control. Six animals were sacrificed after 4 weeks, and the remaining animals were sacrificed after 16 weeks. Biocompatibility, bone graft substitute integration and resorption, bone formation, defect bridging, and height of reconstructed hard tissue were assessed histologically and histomorphometrically. RESULTS: All tested materials showed good biocompatibility. Semi-quantitative analysis and pair-wise comparison suggested that BCP was more efficient in centripetal bone formation when compared with TCP. After 4 weeks, significantly more bone had formed in the defects treated with either TCP or BCP materials compared with the untreated sites. BCP and DBBM did not show macroscopic signs of degradation, whereas the TCP material was partially resorbed after 16 weeks. Otherwise, no major differences were detected between the three materials. CONCLUSION: The moldable, synthetic calcium phosphates are safe and suitable bone graft substitutes with outcomes that are comparable to the control material.
... Furthermore, the hardening has the advantage that dental membranes are not necessary for retaining bone graft substitutes. The in situ hardening property is beneficial or even mandatory for membrane-free techniques, which are described for the treatment of extraction sockets (Nair et al. 2006;Aimetti et al. 2009) oroantral communications (Thoma et al. 2006;Gacic et al. 2009), peri-implantitis (Roos-Jansaker et al. 2007), and subperiosteal augmentation (Nevins et al. 2009). ...
... However, barrier membrane exposure during healing has an important negative effect on GBR since wound dehiscence may lead to infection and disintegration of the membrane followed by loss of bone at the grafted area (Malchiodi et al., 1998;Machtei, 2001;Artzi et al., 2003). Several studies describe procedures for ridge preservation that do not rely on the use of membranes and primary tissue closure (Nair et al., 2006;Thoma et al., 2006;Aimetti et al., 2009;Brkovic et al., 2012). On the other hand, when the membrane is excluded from the treatment protocol, the bone graft substitutes that are used for such procedures will be exposed to the oral environment and potentially the risk of material loss and post-surgical infection may be increased. ...
Article
Full-text available
Biphasic calcium phosphates (BCP) are widely used in alveolar ridge regeneration as a porous scaffold for new bone formation. The aim of this case series was to evaluate the regenerative effect of the combination of BCP and polylactide-co-glycolide (PLGA) which can serve as a barrier membrane during bone regeneration. The study included five patients. Four months into the healing period, bone samples were collected for histological and morphometric analyses. The results of morphometric analysis showed that newly formed bone represented 32.2 +/- 6.8% of the tissue, 31.9 +/- 8.9% was occupied by residual graft and 35.9 +/- 13.5% by soft tissue. Active osteogenesis was seen around the particles of the graft. The particles were occupied mostly by immature woven bone and connective tissue. The quality and quantity of newly formed bone, after the use of BCP/PLGA for ridge preservation, can be adequate for successful implant therapy after tooth extraction.
... Surgical technique Kitagawa et al. 2003 OAC closure with autotransplantation of maxillary 3rd molar (N = 2) Watzak et al. 2005 Intraorally harvested monocortical block grafts were press-fit for OAC closure + Rehrmann flap (N = 21) Thoma et al. 2006 Placement of chair-side fabricated root analogues made of absorbable TCP/polylactide (N = 20) Doobrow et al. 2008 Multiple layers of collagen matrix + freeze-dried demineralized bone/calcium sulfate + dental implant (N = 1) Gacic et al. 2009 Resorbable hemostatic gauze composed of reconstituted oxidized cellulose (N = 10) or root analogues made with PLGA-coated synthetic, phase-pure, porous beta-TCP granules (N = 10) Hariram et al. 2010 Pouch the most commonly involved tooth (OAC incidence 0.64%) with the palatal socket affected most frequently (Punwutikorn et al. 1994). The same authors found no statistically significant difference in the incidence of OAC with regard to gender and age groups. ...
Article
The objective of this study was to analyze the outcome of first-time surgical closures of oroantral communications (OAC) after tooth extractions. Using a billing software, all patients treated in a surgery department were filtered for interventions of the maxillary sinus indicative of OAC therapy. Out of 221 initially eligible cases, the charts of 162 cases fulfilling the inclusion criteria were retrospectively evaluated for the outcome in terms of symptom-free OAC closure as well as possibly influencing patient and treatment factors. The analyzed cohort included 98 males (60.5%) and 64 females (39.5%) with a mean age of 48.6 years (range 17 to 86 years). The maxillary 1st molar (38.3%) was the most common site requiring OAC closure. In 60.5% of the cases, surgical OAC closure was performed immediately after tooth extraction. The Rehrmann flap (72.2%) was the most frequently used technique for surgical OAC closure. 94.4% of surgical OAC closures were successful. Gender and age did not influence the outcome. In contrast, the site of OAC and the time interval from tooth extraction to OAC closure affected the results. Furthermore, the Rehrmann flap, alone or in combination with biomaterials, was superior to the mere suturing (with or without biomaterials) of the OAC site. In conclusion, the Rehrmann flap alone or in combination with biomaterials provided high success rates for first-time surgical OAC closure. With regard to the study parameters, an OAC in the 3rd molar area and an extended interval from tooth extraction to OAC closure negatively influenced the resolution of OAC. However, results must be interpreted cautiously considering the retrospective study design and the limited number of cases.
... Various methods for closure of OAC and OAF have been described over the years, including gold foil, buccal flaps, various palatal flaps, tongue flaps, pedicled buccal fat pad (PBFP), cheek flaps, and placement of bioabsorbable root analogs [56][57][58][59][60][61][62][63][64][65][66][67][68][69]. The authors prefer the use of the PBFP for closure of OAFs. ...
This article addresses the incidence of specific complications and, where possible, offers a preventive or management strategy. Injuries of the inferior alveolar and lingual nerves are significant issues that are discussed separately in this text. Surgical removal of third molars is often associated with postoperative pain, swelling, and trismus. Factors thought to influence the incidence of complications after third molar removal include age, gender, medical history, oral contraceptives, presence of pericoronitis, poor oral hygiene, smoking, type of impaction, relationship of third molar to the inferior alveolar nerve, surgical time, surgical technique, surgeon experience, use of perioperative antibiotics, use of topical antiseptics, use of intra-socket medications, and anesthetic technique. Complications that are discussed further include alveolar osteitis, postoperative infection, hemorrhage, oro-antral communication, damage to adjacent teeth, displaced teeth, and fractures.
... K. Thoma, G. Pajarola [29] воспроизводили корень зуба из В-трикальций фосфата, используя форму удаленного зуба. Осложнений не наблюдалось. ...
Article
The objective of the present study was the comparative analysis of various methods for the plastic correction of the oroantral fistula with the use of the mucosal flap and the osteoplastic materials based on the data from the literature and on-line publkations. The characteristics of an ideal material for the plastic correction ot the oroantral fistula and the conditions for carrying out this surgery are discussed.
... Комбинированные методы могут включать в себе одновременные трансплантации аутокости и PRF-мембраны, что представляет собой более «физиологичный» способ устранения ороантрального сообщения, в результате которого производится реконструкция не только мягкотканного компонента но и кости, что особенно актуально при работе в современной концепции протезирования с опорой на дентальные имплантаты [5,22,33,38,39]. ...
Article
This article includes a review of Russian and foreign literature concerning the current situation in problem of oroantral fistula closure. This review considers main concepts and methods of plastic surgery directed to reconstruct tightness of mouth. Moreover, the advantages and disadvantages of presented methods among themselves and appreciated long-term results and aftermath of different ways of surgical technics.
... Third molar tooth transplantation, hydroxyapatite blocks, bioabsorbable root analogs, and Bio-Oss and Bio-Gide sandwich techniques are some of these alternatives. [8][9][10][11] Nevertheless, these techniques have their own disadvantages. They are not frequently implemented, some of them are expensive and have no standard methodology. ...
Article
Full-text available
Oroantral communication (OAC) is the opening between the maxillary sinus and oral cavity. It may cause oroantral fistula or maxillary sinusitis if left untreated. The surgical closure of the OAC within 48 hours was recommended to avoid the complications like sinus infections. The aim of this study is to evaluate the treatment of OACs with plasma-rich fibrin (PRF) which is safe and easy to implement in the OACs.This study was conducted with the patients, who required the treatment of the OAC, which was developed after the posterior maxillary tooth extraction in the Dental and Maxillofacial Department of the Faculty of Dentistry in Adnan Menderes University.Plasma-rich fibrin membranes were inserted in layers into the tooth socket so that they covered the OAC. Then these membranes were fixated with the sutures to the surrounding gingiva. Antibiotic (amoxicillin/clavulanic acid 1000 mg), analgesic (dexketoprofen trometamol and/or paracetamol), and oral rinse (0.2% chlorhexidine digluconate) agents were prescribed to all patients. The patients were examined in the 3rd and 7th days and 2 months after the operation.All patients tolerated PRF perfectly, and the soft tissue recovery was completed without any problem. Full epithelization was observed in the defect area in all patients. The OAC did not relapse in any patient.Plasma-rich fibrin technique is a simple and effective method, which can be used in the treatment of OACs with a diameter of 5 mm or less with a low risk of complications.
... Extraction of maxillary posterior teeth is the most common cause of OAC. Maxillary cysts, benign or malignant tumors and trauma can be other causes of OAC [1]. OACs must be sealed in order to prevent the escape of fluids, other mouth contents, and oral bacteria into the maxillary sinus. ...
... Non-surgical interventions (Grzesiak-Janas 2001;Thoma 2006;Gacic 2009;Visscher 2010;Buric 2012). ...
Article
Full-text available
Background: An oro-antral communication is an unnatural opening between the oral cavity and maxillary sinus. When it fails to close spontaneously, it remains patent and is epithelialized to develop into an oro-antral fistula. Various surgical and non-surgical techniques have been used for treating the condition. Surgical procedures include flaps, grafts and other techniques like re-implantation of third molars. Non-surgical techniques include allogenic materials and xenografts. Objectives: To assess the effectiveness and safety of various interventions for the treatment of oro-antral communications and fistulae due to dental procedures. Search methods: We searched the Cochrane Oral Health Group's Trials Register (whole database, to 3 July 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2015, Issue 6), MEDLINE via OVID (1946 to 3 July 2015), EMBASE via OVID (1980 to 3 July 2015), US National Institutes of Health Trials Registry (http://clinicaltrials.gov) (whole database, to 3 July 2015) and the World Health Organization (WHO) International Clinical Trials Registry Platform (http://www.who.int/ictrp/en/) (whole database, to 3 July 2015). We also searched the reference lists of included and excluded trials for any randomised controlled trials (RCTs). Selection criteria: We included RCTs evaluating any intervention for treating oro-antral communications or oro-antral fistulae due to dental procedures. We excluded quasi-RCTs and cross-over trials. We excluded studies on participants who had oro-antral communications, fistulae or both related to Caldwell-Luc procedure or surgical excision of tumours. Data collection and analysis: Two review authors independently selected trials. Two review authors assessed trial risk of bias and extracted data independently. We estimated risk ratios (RR) for dichotomous data, with 95% confidence intervals (CI). We assessed the overall quality of the evidence using the GRADE approach. Main results: We included only one study in this review, which compared two surgical interventions: pedicled buccal fat pad flap and buccal flap for the treatment of oro-antral communications. The study involved 20 participants. The risk of bias was unclear. The relevant outcome reported in this trial was successful (complete) closure of oro-antral communication.The quality of the evidence for the primary outcome was very low. The study did not find evidence of a difference between interventions for the successful (complete) closure of an oro-antral communication (RR 1.00, 95% Cl 0.83 to 1.20) one month after the surgery. All oro-antral communications in both groups were successfully closed so there were no adverse effects due to treatment failure.We did not find trials evaluating any other intervention for treating oro-antral communications or fistulae due to dental procedures. Authors' conclusions: We found very low quality evidence from a single small study that compared pedicled buccal fat pad and buccal flap. The evidence was insufficient to judge whether there is a difference in the effectiveness of these interventions as all oro-antral communications in the study were successfully closed by one month after surgery. Large, well-conducted RCTs investigating different interventions for the treatment of oro-antral communications and fistulae caused by dental procedures are needed to inform clinical practice.
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Le comunicazioni oro-naso-sinusali sono, il più delle volte, iatrogene dopo le estrazioni dentarie. I problemi funzionali posti da questi tragitti anormali tra la cavità orale e le cavità nasosinusali richiedono un trattamento chirurgico. Ci si propone, qui, di fare il punto sulle tecniche chirurgiche più affidabili per realizzare la chiusura di queste fistole, senza compromettere la prognosi funzionale ed estetica dei pazienti.
Article
Purpose: This study evaluated the long-term effectiveness of the pedicled buccal fat pad (BFP) in the closure of a large oroantral fistula (OAF). Materials and methods: Twenty-five consecutive patients with OAFs larger than 5 mm were treated with a pedicled BFP. They were followed clinically and radiographically for 10 years after surgery to monitor the durability and effectiveness of the pedicled BFP in the closure of the OAF. Results: The procedure was successful in all patients. The healing process was satisfactory, with no breakdown or liquefaction necrosis postoperatively. No complications were observed during the follow-up period. Conclusions: The results of this study support the view that the use of the pedicled BFP is a durable, straightforward, convenient, and reliable method for the treatment of a large OAF.
Article
Las comunicaciones buconasosinusales son iatrogénicas en la mayoría de las ocasiones, secundarias a extracciones dentales. Los problemas funcionales que plantean estos trayectos anormales entre la cavidad oral y las cavidades nasosinusales requieren un tratamiento quirúrgico. En este artículo, se analizan las técnicas quirúrgicas más fiables para realizar el cierre de estas fístulas, sin comprometer el pronóstico funcional y estético de los pacientes.
Article
The aim of this study was to assess the feasibility of biodegradable polyurethane (PU) foam for closure of oroantral communications (OACs). Ten consecutive patients with OACs (existing <24 hours) were treated with PU foam. Standardized evaluations were performed at 2 weeks and 8 weeks after closure of the OAC. In 5 patients, the OACs were closed successfully without complications. Three patients developed sinusitis, which was conservatively managed with antibiotics in 2 cases. In 1 case the sinus was reopened for irrigation, after which a buccal flap procedure was performed. In 2 patients the OAC recurred and was surgically closed with a buccal flap after thorough irrigation. In this feasibility study, closure was achieved in 7 of the 10 patients without further surgical intervention. Complications of the procedure using PU foam may be related to the fit of the foam in the socket and the size of the perforation. In general, closure of OACs with biodegradable polyurethane foam is feasible and has the potential to spare a large number of patients with OACs a surgical procedure. Furthermore, in case the treatment with PU foam fails to close the OAC, the attending physician can always fall back on the standard surgical procedure.
Article
Several techniques have been used to treat the oroantral fistula with similar rates of success and failure. Some of them frequently present anatomical disadvantages. They can reduce vestibular depth, cause lack of support bone, or cause fusion of the Schneiderian and mucosal membranes. In this report, we present 3 cases of orosinusal fistulas successfully treated with a simultaneous closure of the communication and sinus floor augmentation. At the same time, this technique enables the restoration of the alveolar process with enough bone volume, which facilitates later implant surgery, prosthetic rehabilitation, or even some orthodontic treatments.
Article
Background: An oro-antral communication is an unnatural opening between the oral cavity and maxillary sinus. When it fails to close spontaneously, it remains patent and is epithelialized to develop into an oro-antral fistula. Various surgical and non-surgical techniques have been used for treating the condition. Surgical procedures include flaps, grafts and other techniques like re-implantation of third molars. Non-surgical techniques include allogenic materials and xenografts. This is an update of a review first published in May 2016. Objectives: To assess the effectiveness and safety of various interventions for the treatment of oro-antral communications and fistulae due to dental procedures. Search methods: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 23 May 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2018, Issue 4), MEDLINE Ovid (1946 to 23 May 2018), and Embase Ovid (1980 to 23 May 2018). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. We also searched the reference lists of included and excluded trials for any randomised controlled trials (RCTs). Selection criteria: We included RCTs evaluating any intervention for treating oro-antral communications or oro-antral fistulae due to dental procedures. We excluded quasi-RCTs and cross-over trials. We excluded studies on participants who had oro-antral communications, fistulae or both related to Caldwell-Luc procedure or surgical excision of tumours. Data collection and analysis: Two review authors independently selected trials. Two review authors assessed trial risk of bias and extracted data independently. We estimated risk ratios (RR) for dichotomous data, with 95% confidence intervals (CI). We assessed the overall quality of the evidence using the GRADE approach. Main results: We included only one study in this review, which compared two surgical interventions: pedicled buccal fat pad flap and buccal flap for the treatment of oro-antral communications. The study involved 20 participants. The risk of bias was unclear. The relevant outcome reported in this trial was successful (complete) closure of oro-antral communication.The quality of the evidence for the primary outcome was very low. The study did not find evidence of a difference between interventions for the successful (complete) closure of an oro-antral communication (RR 1.00, 95% Cl 0.83 to 1.20) one month after the surgery. All oro-antral communications in both groups were successfully closed so there were no adverse effects due to treatment failure.We did not find trials evaluating any other intervention for treating oro-antral communications or fistulae due to dental procedures. Authors' conclusions: We found very low quality evidence from a single small study that compared pedicled buccal fat pad and buccal flap. The evidence was insufficient to judge whether there is a difference in the effectiveness of these interventions as all oro-antral communications in the study were successfully closed by one month after surgery. Large, well-conducted RCTs investigating different interventions for the treatment of oro-antral communications and fistulae caused by dental procedures are needed to inform clinical practice.
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The closure of post extraction gingival defects has not been studied in depth, although their achievement is of great importance in certain situations, such as prior to radiotherapy treatment in patients with oral cancer. The aim of this study is to assess the influence of bone substitutes on the time of closure of post extraction gingival defects. 22 patients underwent two symmetrical dental extractions. Using a split mouth model, with random assignment to one or other group, one was considered a control group (no filling with any type of material post extraction), whereas the other was considered the experimental group (filling with bone substitute and calcium sulphate post extraction). Gingival closure and healing were assessed in the first group at 2, 3, 4 and 6 weeks after extraction. No differences were seen between both groups in gingival health. Gingival closure was greater and faster in the experimental group than in the control group, and was statistically significant in the first and second week after extraction (1st week, control: 19.63 mm(2) +/- 2.52--experimental: 11.76 mm(2) +/- 2.40 - p < 0.05) (2nd week, control: 15.09 mm(2) +/- 2.77--experimental: 7.98 mm(2) +/- 1.99 - p < 0.05), although these differences evened out during subsequent periods. No medical accidents were seen and tolerance to treatment was good in both groups. According to our data, the use of filling material allows a faster initial gingival closure of the socket post extraction. However, we must assess the cost of intervention, with the aim of applying it in situations in which it may be of significant advantage (for example, patients that will undergo radiotherapy treatment), or in cases in which the use of these materials is justified due to other reasons in addition to the one mentioned (such as maintenance of bone crest architecture for implant restoration).
Article
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To determine the optimum surgical treatment for oral antral communications (OAC) and to understand the main post-operative complications. Meta-analytical, observational and retrospective study of 1.072 cases of OAC obtained from a literature review of 15 articles. OAC occur slightly more often in men and during the fourth decade of life. Its primary etiological factor is dental extraction, most often affecting the third molar. The most common treatment has been the use of Bichat's fat pad grafts, whereas the technique with the highest percentage of complications has been the use of the palatal rotation flap. The most frequent complication has been the fistulization of the OAC. Early diagnosis of OAC and its treatment within 48 hours of evolution are fundamental in order to properly resolve this pathology. The use of Bichat's fat pad grafts is a simple technique that offers excellent vascularization and results.
Article
Oroantral communication can be defined as a pathologic space created between the maxillary sinus and the oral cavity. This communication and subsequent formation of a chronic oroantral fistula is a common complication often encountered by oral and maxillofacial surgeons. Although various techniques have been proposed in published studies, long-term successful closure of oroantral fistulas is still one of the most difficult problems confronting the surgeon working in the oral and maxillofacial region. The decision of which treatment modality to use is influenced by many factors, such as the amount and condition of tissue available for repair, the size and location of the defect, the presence of infection, the time to the diagnosis of the fistula, and, even, the surgeon's past experience. In the present study, 23 patients with a chronic oroantral fistula who underwent surgical correction at Istanbul University Faculty of Dentistry, Department of Oral and Maxillofacial Surgery from 2002 to 2009 were included. The fistulas were treated with a buccal advancement flap in 10 patients and a palatal island flap in 13 patients. The advantages, limitations, and complications of each technique are discussed.
Article
The oroantral fistula is a solution of pathological continuity between the maxillary sinus and the oral cavity, frequently produced after a teeth extraction in most of cases of the first or second molars. The commonest symptom provoked is an acute sinusitis evolving to chronicity if the fistula remains. The diagnosis is made by transalveolar, orthopantography or dental computerized tomography. Its surgical closure is necessary when the fistula has more than 3 mm or not seal by itself in three weeks. For it, there are some techniques using different materials and flaps where its objective is to occlude the bone defect as well as the mucous one thus solving the fistula and the sinus problem.
Article
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Hepatocellular carcinoma (HCC) is the most frequent primary malignant tumor of the liver. It is usually seen in the 6th and 7th decades of life and chronic hepatitis B is the most frequent cause. Extrahepatic metastasis of HCC is an indicator of a poor prognosis and the most common sites are lungs, bones, lymph nodes, kidneys and adrenal glands. We reported a case of isolated metastasis in the right maxilla, which had been found initially, before the tumor in the liver was diagnosed. A 70-year-old man underwent dental surgery of the upper right molar. Prolonged bleeding control was difficult for up to two weeks, so the biopsy was performed. Histopathological analysis revealed a metastatic hepatocellular carcinoma. Computerized tomography (CT) of the abdomen revealed a diffusely heterogeneous liver parenchyma with irregular borders and two foci of mass lesions. There were metastasis in the spleen and also two pathological retroperitoneal lymph nodes were detected, but no ascit, liver cirrhosis, cholestasis or portal vein thrombosis were seen. CT of the orbital and maxillary regions revealed a tumor mass in the right maxillary sinus, spreading to the alveolar sinus, nasal cavity and partially infratemporal space. A tumor mass was in the right orbit as well, infiltrating the surrounding bones and muscles. Clinically, there was proptosis of the right eye accompanied by amaurosis. The treatment started with chemotherapy based on 5-fluorouracil (sorafenib was not available). After three cycles, control CTs showed a stable disease in the liver, but progression in the right maxillary sinus and orbit. Enucleation of the right eye was performed and postoperative radiotherapy was planed. The patient deteriorated rapidly and died, about 6 months after the disease had been diagnosed. Extrahepatic metastasis of HCC represents a progressive phase of the disease with poor prognosis, so the main aim of the treatment should be palliation and care of symptoms.
Article
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. The 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.
Article
The oroantral fistula is a solution of pathological continuity between the maxillary sinus and the oral cavity, frequently produced after a teeth extraction in most of cases of the first or second molars. The commonest symptom provoked is an acute sinusitis evolving to chronicity if the fistula remains. The diagnosis is made by transalveolar, orthopantography or dental computerized tomography. Its surgical closure is necessary when the fistula has more than 3 mm or not seal by itself in three weeks. For it, there are some techniques using different materials and flaps where its objective is to occlude the bone defect as well as the mucous one thus solving the fistula and the sinus problem.
Chapter
Bij het extraheren van een gebitselement in de maxilla kan een open verbinding tussen de mondholte en de sinus maxillaris ontstaan. Per definitie wordt van een antrumperforatie gesproken als deze opening korter dan 24 uur aanwezig is. Bij een bestaansduur van meer dan 24 uur is er al epithelialisatie van de verbinding opgetreden en wordt gesproken van een oroantrale fistel. Met andere woorden, een antrumperforatie dient binnen 24 uur primair te worden gesloten om de kans op sinusitis en het ontstaan van een oroantrale fistel te minimaliseren.
Article
PURPOSE: The objective of this study was to determine the effectiveness of the bony press-fit technique in closing oroantral communications (OACs) and oroantral fistulas (OAFs) and in identifying potential intraoral donor sites. PATIENTS AND METHODS: Ten patients, 4 with OACs and 6 with OAFs, were treated with autogenous bone grafts using the bony press-fit technique. In 9 patients, dental extractions caused OACs or OAFs; in 1 patient, an OAC appeared after cyst enucleation. Donor sites included the chin (3 patients), buccal exostosis (1 patient), maxillary tuberosity (2 patients), ramus (1 patient), and the lateral wall of the maxillary sinus (3 patients). The preoperative evaluation of the patients, surgical technique, and postoperative management were examined. RESULTS: In all 10 patients, a stable press fit of the graft was achieved. Additional fixation methods were not needed. In 2 patients, mucosal dehiscence developed, but healed spontaneously. In 2 patients, dental implant surgery was performed in the grafted area. CONCLUSION: Treatment of 10 patients with OACs or OAFs was performed, with a 100% success rate. The bony press-fit technique can be used to safely close OACs or OAFs, and it presents some advantages compared with other techniques.
Article
This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effectiveness and safety of various interventions for the management of oro-antral communications and fistula.
Article
One hundred and fourteen patients with oroantral communication were operated at the Department of Oral Surgery and Oral Medicine, Dental Faculty, University of Oslo, during the 4-year period 1968–1972. The closure method used was the buccal nonrotating flap technique as described by Môczár in 1930. Five cases (4.3 %) failed to heal primarily. Three of these healed spontaneously within 1 month postoperatively. Preoperative diagnostic procedures are described as well as the Môczár surgical approach and the follow-up regime. Vestibular height was found to have normalized in 88% of the patients examined. The gingival condition was examined before and after surgery in 61 patients. In all these cases, pocket depths were found to have been reestablished to preoperative values within 3 months postoperatively. Requirements of the optimal surgical procedure for closure of oroantral communication are stressed, and the most common errors causing failure or recurrence are listed.
A statistical analysis of 250 cases of oro-antral fistula has been presented, and the clinical and radiologic features of the condition have been discussed. As a result of experience gained during the study, it is our opinion that repair by the buccal flap operation is a simple surgical technique which when properly performed, is almost invariably successful.
Article
— The frequency of oro-antral fistulae after perforations to the maxillary sinus by extraction of teeth or displacement of roots into the maxillary sinus is investigated. The material comprises 116 patients with a sinus perforation during the period 1950 to 1967. No patients had maxillary sinusitis in relation to the extraction. 104 patients (90 %) were followed-up two months or more after treatment. In nine cases of sinus perforation without root displacement, no treatment was instituted and seven (78 %) formed an oro-antral fistula. In 82 cases a primary suture over the perforation was used, resulting in an oro-antral fistula in six (7 %). In the 13 cases of root displacement into the maxillary sinus, the root was removed and there was a primary suture over the perforation; in three cases (23 %) an oro-antral fistula was formed. Apparently the usual primary treatment does not prevent oro-antral fistulae, but the frequency will be less. After treatment of displaced roots, the frequency of oro-antral fistulae is higher than after treatment of simple sinus perforations. Different methods for closure of sinus perforations are discussed.
Article
The incidence of clinically significant oroantral communications (OACs) after simple tooth extraction during the period 1980-9, at the Faculty of Dentistry, Mahidol University, Bangkok, Thailand, was studied retrospectively. The total number of OACs was 87. The tooth most frequently involved was the upper first molar, followed by the second and third molars. The difference, however, was not statistically significant (P > 0.05). The sockets of the palatal roots of the first and the second molars were most frequently involved. There was no statistically significant difference between the incidence of OACs on the right and the left sides (P > 0.05).
Article
A periodontally affected tooth was prepared for a special treatment: Calcium hydroxide was introduced into the apical half of the root canal whereas its cervical part was filled with glass ionomer cement. The tooth was shortened subgingivally. After 6 weeks of epithelization over the residual root a palatal full-thickness flap was mobilized. The root was carefully extracted and chairside copy-milled from the biodegradable polylactic acid (PLA) material. The PLA-replica was implanted immediately into the socket and the flap was sutured. Aim of the treatment was to prevent the ridge collapse of the extraction area. Ridge height could be preserved during the 21 months of observation. With time the radiographic density of the cancellous bone increased in the implanted area, indicating that a PLA-replica is replaced by host's bone tissue.
Article
The report presented is an analysis of 98 patients with an oroantral fistula (OAF). The tooth most frequently involved was the upper second molar, followed by the first molar. The highest incidence was seen in the fourth and third decades of life and the lowest incidence in the second decade. In this study, intercurrent sinusitis was the most obvious cause of the chronic oroantral communication. The closure of OAF is one of the more challenging problems in oral surgery. Long-term successful closure of OAF depends on the technique used, the size and location of the defect, and on the presence or absence of sinus disease. Among the several techniques proposed for treatment of OAFs, in the majority of cases, the buccal advancement flap technique was used in this study. The advantages and limitations of the technique are discussed.
Oroantral and oronasal fistulas present with a broad range of causation, size, duration, and extent of infection involving the nose and paranasal sinuses. Accurate diagnosis of the extent of the disease with appropriate radiographic evaluation will guide the surgeon to select an approach that addresses all of the infected sites. When significant sinus disease is found, an endoscopic approach to restoring drainage in all of the involved sinuses can promote predictably successful closure of oroantral and oronasal fistulas. The multispecialty team approach to this disease, with the concomitant management of the sinusitis and fistula closure, is a significant advance in the successful management of this chronic condition.
Article
Oro-maxillary sinus perforation occurs occasionally at the extraction of a maxillary tooth, and it may be a cause of maxillary sinusitis or antro-oral fistula. Our purpose was to investigate the most frequent site of perforation, and to understand the clinical course of patients after perforation. We examined 2,038 maxillary teeth extracted from 1,337 patients (473 males and 864 females) at the First Department of Oral and Maxillofacial Surgery, Tokyo Medical and Dental University, from January 1991 to December 1993. Perforation occurred in 77 of all 2,038 teeth (3.8%). Of these, 38 teeth were from males (38/733; 5.2%), and 39 were from females (39/1,305; 3.0%). The perforation rate was significantly higher in males. Perforation occurred most often with extraction of an upper first molar, and in the third decade of life. The perforation rate gradually decreased with higher age. We classified 38 cases into 3 categories according to panorama X-P: 1) The tip of the root crossed over the bottom line of the maxillary sinus (29 cases), 2) Not crossed over distinctly (4 cases), 3) Just lie on, or whether the tip of the root crossed over the bottom line of the maxillary sinus was not distinct (5 cases). As to treatment, 30 perforations (39.0%) closed spontaneously in the course of observation, irrigation with physiological saline was used in 43 cases (55.8%), radical sinusotomy accompanied by closure of the perforation was performed in 4 cases, and only flap closure was used in 7 cases. There were no cases of relapse.
Article
This clinical report introduces a promising and unique method for the immediate closure of the oroantral communication (OAC) after tooth extraction: the use of the transplanted third molar with closed apices. In 2 adult patients, OAC caused by the extraction of an upper molar was immediately closed by using a transplanted third molar with complete root formation. After tooth extraction at the recipient site, OAC with perforated mucosa of the sinus floor was confirmed and the donor third molar was transferred to the prepared recipient socket. Endodontic therapy of the transplanted third molar began at 3 weeks after surgery, and prosthetic treatment was completed at 5 months after the operation. These 2 patients were carefully observed both clinically and radiographically. Closure of the OAC was successfully performed, and the transplanted teeth became fixed with the passage of time in these 2 patients. Root resorption did not occur, and good functional results were obtained without any complications. Tooth transplantation of a mature third molar for closure of the OAC is a simple and excellent method because the transplanted tooth not only closes the communication to the maxillary sinus, but it also satisfactorily functions at the recipient site during mastication, even in adult patients.
Article
This investigation studies porcine tissue response in tooth extraction sockets treated with root replicas made out of Beta-tricalcium phosphate (Beta-TCP; Beta-Ca(3)(PO(4))(2)) granules, molded and held together by thermal fusion of a thin film of polyglycolic-polylactic acid copolymer. Six left mandibular third incisors (n (1)/4 6) of experimental pigs are treated with the root replicas and four contralateral incisors are used as nontreated controls (n (1)/4 4). Two animals each were killed at 20, 40, and 60 weeks of observation periods. The mandibular jaw segments were prepared in toto for light microscopy by resin embedding and serial ground sectioning. Additionally, one Beta-TCP-treated socket at 60 weeks was thoroughly investigated by correlative light, electron microscopic and electron probe X-ray microanalysis to assess the bio-absorbability and host removal of the replica material from the implant site. The extraction wounds of the animals healed satisfactorily with very little histologically observable differences in the healing pattern of the test and control sites. The Beta-TCP was completely removed from extracellular sites, but at 60 weeks, remnants of it were found in the cytoplasm of multinucleated giant cells. The root replicas made out of Beta-TCP were biocompatible and bioabsorbable. Osseous healing occurred both in the test and control sockets, but the healing process was delayed due to the presence of Beta-TCP particles.