![]() Further complications of OAC may result from the removal of cysts or tumors, implant placement, maxillofacial surgery (Le Fort osteotomies), and pathological procedures like osteomyelitis. Periodontal infections and other factors are the least prevalent. Oroantral communication may be developed as a result of prevalence of the inflammatory odontogenic pathologic processes through the maxillary alveolar process to the Schneiderian sinus membrane. Pathological lesions in the sinus, trauma, and failed external sinus floor elevation and augmentation can also lead to the formation of an OAC. Due to the close relationship of the roots to the antrum and partially very thin maxillary sinus floor, the extraction of the upper molars and premolars, especially the extraction of the first molars, is considered the most common etiology of OAC. It was reported that about 2.2% of the first molars apices perforated the maxillary sinus floor, followed by the second molars 2% of the described cases. ![]() Thus, the first premolars accounted for 5.3% of OACs, the second molars were the most frequently with an incidence of 45%, followed by the third molars 30% and the first molars 27.2%. Harrison demonstrated that the bone lamella between the maxillary posterior teeth and the maxillary sinus is occasionally 0.5 mm. Identifying the etiology of the OAC is essential to create an effective procedure. The present study aims to illustrate all the factors that have to be considered in the management of OACs and OAFs that determine optimal treatment. This approach enables to recognize uncertainty in clinical diagnosis and therapeutic decisions and hence develop strategies to manage these uncertainties. The method presented is decision tree design. Moreover, the selection of management strategy is influenced by the quantity and quality of tissue available for closure of OAF/OAC and the potential placement of dental implants in the future. Thus, the decision-making process has not yet been described comprehensively.Ĭlinical decision-making in closure of an OAC/OAF depends on multiple factors that include the size of the communication, time of diagnosis, presence of infection, and clinician’s experience. Previous narrative research has focused on assessments and comparisons of various surgical techniques for closure of OAC/OAF. Consequently, it requires a combination of knowledge, experience, and information gathering. Ĭlinical decision-making determines the optimal strategy in a particular clinical situation. The oroantral fistula has its origin either from iatrogenic complications or from dental infections, trauma, radiation therapy, or osteomyelitis. The oroantral fistula (OAF) develops if the OAC remains open and becomes epithelialized. Oroantral communication (OAC) acts as a pathological pathway for bacteria and can cause infection of the antrum, which further obstructs the healing process as it is an unnatural communication between the oral cavity and the maxillary sinus. Thus, the decision-making process has not yet been described comprehensively. Previous narrative research has focused on assessments and comparisons of various surgical techniques for the closure of OAC/OAF. The decision-making in closure of oroantral communication and fistula is influenced by many factors. There are different ways to perform the surgical closure of the OAC. ![]() After removal of a dental implant or extraction of a tooth in the upper jaw, the closure of an oroantral fistula (OAF) or oroantral communication (OAC) can be a difficult problem confronting the dentist and surgeon working in the oral and maxillofacial region. ![]()
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