The Treatment and Management of Oroantral Communications and Fistulas: A Systematic Review and Network Metanalysis
Abstract
:1. Introduction
- -
- Antibiotics: a combination of antibiotics, such as amoxicillin and clavulanate potassium (625 mg), clindamycin (300 mg), 4 times daily, or moxifloxacin (400 mg), have been used in the treatment of OACs.
- -
- Nasal decongestants: these can be used as adjuvants to heal OACs/OAFs, if the patient has any sinus infection 5.
1.1. Local Flaps
1.1.1. Buccal Advancement Flap
1.1.2. Buccal Pad of Fat Flap (BFP)
1.1.3. Palatal Rotational Flap
1.1.4. Platelet Rich Fibrin
2. Materials and Methods
2.1. Search Strategy
2.2. Study Selection
- -
- Studies reporting data on incidences and causes of OACs/OAFs;
- -
- Studies in which an OAC/OAF was treated with one of these different surgical treatments: BFP, buccal advancement flap, palatal flap, PRF;
- -
- A post-operative follow-up of at least 3 weeks;
- -
- The number of patients considered was ≥20;
- -
- The following exclusion criteria were applied;
- -
- The number of patients was <20;
- -
- Case series;
- -
- Case reports;
- -
- A post-operative follow-up of <3 weeks.
2.3. Data Extraction
2.4. Quality and Risk-of-Bias Assessment
2.5. Data Analysis
2.6. Heterogeneity/Meta-Regression
2.7. Inconsistency Assessment
2.8. Study Data Analysis
3. Results
3.1. Study Characteristics
3.2. Risk of Bias
3.3. Comparison of Network Contributions
3.4. Buccal Flap vs. Palatal Flap
3.5. Buccal Flap vs. Buccal Fat Pad
3.6. Palatal Flap vs. Buccal Fat Pad
4. Discussion
5. Conclusions
- -
- The oral and maxillofacial surgeon who treats patients with OACs/OAFs must be aware of and knowledgeable about the numerous treatment options.
- -
- Local soft tissue flaps are a successful modality to treat OACs/OAFs.
- -
- The size and localization of the defect could guide the surgeon in choosing the type of treatment.
- -
- BFP could be the gold standard surgical approach to treat OACs/OAFs because of its lower risk of recurrence.
- -
- The follow-up treatment after communication closure should also be considered.
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Shamseer, L.; Moher, D.; Clarke, M.; Ghersi, D.; Liberati, A.; Petticrew, M.; Shekelle, P.; Stewart, L.A.; PRISMA-P Group. Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015: Elaboration and Explanation. BMJ 2015, 350, g7647. [Google Scholar] [CrossRef]
- Brook, I. Sinusitis of Odontogenic Origin. Otolaryngol. Head. Neck Surg. 2006, 135, 349–355. [Google Scholar] [CrossRef] [PubMed]
- Salgado-Peralvo, A.-O.; Mateos-Moreno, M.-V.; Uribarri, A.; Kewalramani, N.; Peña-Cardelles, J.-F.; Velasco-Ortega, E. Treatment of Oroantral Communication with Platelet-Rich Fibrin: A Systematic Review. J. Stomatol. Oral. Maxillofac. Surg. 2022, 123, e367–e375. [Google Scholar] [CrossRef] [PubMed]
- Pandikanda, R.; Singh, R.; Patil, V.; Sharma, M.; Shankar, K. Flapless Closure of Oro-Antral Communication with PRF Membrane and Composite of PRF and Collagen—A Technical Note. J. Stomatol. Oral. Maxillofac. Surg. 2019, 120, 471–473. [Google Scholar] [CrossRef] [PubMed]
- Dym, H.; Wolf, J.C. Oroantral Communication. Oral. Maxillofac. Surg. Clin. N. Am. 2012, 24, 239–247. [Google Scholar] [CrossRef]
- Bhalla, N.; Sun, F.; Dym, H. Management of Oroantral Communications. Oral. Maxillofac. Surg. Clin. N. Am. 2021, 33, 249–262. [Google Scholar] [CrossRef] [PubMed]
- Haas, R.; Watzak, G.; Baron, M.; Tepper, G.; Mailath, G.; Watzek, G. A Preliminary Study of Monocortical Bone Grafts for Oroantral Fistula Closure. Oral. Surg. Oral. Med. Oral. Pathol. Oral. Radiol. Endod. 2003, 96, 263–266. [Google Scholar] [CrossRef]
- Stacchi, C.; Bernardello, F.; Spinato, S.; Mura, R.; Perelli, M.; Lombardi, T.; Troiano, G.; Canullo, L. Intraoperative Complications and Early Implant Failure after Transcrestal Sinus Floor Elevation with Residual Bone Height ≤5 Mm: A Retrospective Multicenter Study. Clin. Oral. Implant. Res. 2022, 33, 783–791. [Google Scholar] [CrossRef] [PubMed]
- Bereczki-Temistocle, D.L.; Gurzu, S.; Jung, I.; Cosarca, A.; Beresescu, G.; Golu, V.; Petrovan, C.; Ormenisan, A. Selecting the Best Surgical Treatment Methods in Oro-Antral Communications. Int. J. Environ. Res. Public. Health 2022, 19, 14543. [Google Scholar] [CrossRef]
- Khandelwal, P.; Hajira, N. Management of Oro-Antral Communication and Fistula: Various Surgical Options. World J. Plast. Surg. 2017, 6, 3–8. [Google Scholar]
- Eneroth, C.M.; Martensson, G. Closure of Antro-Alveolar Fistulae. Acta Otolaryngol. 1961, 53, 477–485. [Google Scholar] [CrossRef]
- Borgonovo, A.E.; Berardinelli, F.V.; Favale, M.; Maiorana, C. Surgical Options in Oroantral Fistula Treatment. Open Dent. J. 2012, 6, 94–98. [Google Scholar] [CrossRef] [PubMed]
- Krishanappa, S.K.K.; Eachempati, P.; Nagraj, S.K.; Shetty, N.Y.; Moe, S.; Aggarwal, H.; Mathew, R.J. Interventions for Treating Oro-antral Communications and Fistulae Due to Dental Procedures. Cochrane Database Syst. Rev. 2018, 8. [Google Scholar] [CrossRef] [PubMed]
- Parvini, P.; Obreja, K.; Begic, A.; Schwarz, F.; Becker, J.; Sader, R.; Salti, L. Decision-Making in Closure of Oroantral Communication and Fistula. Int. J. Implant. Dent. 2019, 5, 13. [Google Scholar] [CrossRef] [PubMed]
- del Rey-Santamaría, M.; Valmaseda Castellón, E.; Berini Aytés, L.; Gay Escoda, C. Incidence of Oral Sinus Communications in 389 Upper Thirmolar Extraction. Med. Oral. Patol. Oral. Cir. Bucal 2006, 11, E334–E338. [Google Scholar]
- Awang, M.N. Closure of Oroantral Fistula. Int. J. Oral. Maxillofac. Surg. 1988, 17, 110–115. [Google Scholar] [CrossRef]
- Visscher, S.H.; Van Minnen, B.; Bos, R.R.M. Closure of Oroantral Communications: A Review of the Literature. J. Oral. Maxillofac. Surg. 2010, 68, 1384–1391. [Google Scholar] [CrossRef] [PubMed]
- Killey, H.C.; Kay, L.W. Observations Based on the Surgical Closure of 362 Oro-Antral Fistulas. Int. Surg. 1972, 57, 545–549. [Google Scholar]
- von Wowern, N. Closure of Oroantral Fistula with Buccal Flap: Rehrmann versus Môczár. Int. J. Oral. Surg. 1982, 11, 156–165. [Google Scholar] [CrossRef]
- Kim, M.-K.; Han, W.; Kim, S.-G. The Use of the Buccal Fat Pad Flap for Oral Reconstruction. Maxillofac. Plast. Reconstr. Surg. 2017, 39, 5. [Google Scholar] [CrossRef]
- Kwon, M.-S.; Lee, B.-S.; Choi, B.-J.; Lee, J.-W.; Ohe, J.-Y.; Jung, J.-H.; Hwang, B.-Y.; Kwon, Y.-D. Closure of Oroantral Fistula: A Review of Local Flap Techniques. J. Korean Assoc. Oral. Maxillofac. Surg. 2020, 46, 58–65. [Google Scholar] [CrossRef] [PubMed]
- Parvini, P.; Obreja, K.; Sader, R.; Becker, J.; Schwarz, F.; Salti, L. Surgical Options in Oroantral Fistula Management: A Narrative Review. Int. J. Implant. Dent. 2018, 4, 40. [Google Scholar] [CrossRef] [PubMed]
- Anavi, Y.; Gal, G.; Silfen, R.; Calderon, S. Palatal Rotation-Advancement Flap for Delayed Repair of Oroantral Fistula: A Retrospective Evaluation of 63 Cases. Oral. Surg. Oral. Med. Oral. Pathol. Oral. Radiol. Endod. 2003, 96, 527–534. [Google Scholar] [CrossRef]
- Choukroun, J.; Adda, F.; Schoeffler, C.; Vervelle, A. Une opportunité en paro-implantologie: Le PRF. Implantodontie 2001, 42, 55–62. [Google Scholar]
- Higgins, J.P.T.; Altman, D.G.; Gøtzsche, P.C.; Jüni, P.; Moher, D.; Oxman, A.D.; Savovic, J.; Schulz, K.F.; Weeks, L.; Sterne, J.A.C.; et al. The Cochrane Collaboration’s Tool for Assessing Risk of Bias in Randomised Trials. BMJ 2011, 343, d5928. [Google Scholar] [CrossRef]
- Gülşen, U.; Şentürk, M.F.; Mehdiyev, İ. Flap-Free Treatment of an Oroantral Communication with Platelet-Rich Fibrin. Br. J. Oral. Maxillofac. Surg. 2016, 54, 702–703. [Google Scholar] [CrossRef]
- Demetoglu, U.; Ocak, H.; Bilge, S. Closure of Oroantral Communication With Plasma-Rich Fibrin Membrane. J. Craniofac Surg. 2018, 29, e367–e370. [Google Scholar] [CrossRef] [PubMed]
- Bilginaylar, K. The Use of Platelet-Rich Fibrin for Immediate Closure of Acute Oroantral Communications: An Alternative Approach. J. Oral. Maxillofac. Surg. 2018, 76, 278–286. [Google Scholar] [CrossRef]
- Batra, H.; Jindal, G.; Kaur, S. Evaluation of Different Treatment Modalities for Closure of Oro-Antral Communications and Formulation of a Rational Approach. J. Maxillofac. Oral. Surg. 2010, 9, 13–18. [Google Scholar] [CrossRef]
- Nezafati, S.; Vafaii, A.; Ghojazadeh, M. Comparison of Pedicled Buccal Fat Pad Flap with Buccal Flap for Closure of Oro-Antral Communication. Int. J. Oral. Maxillofac. Surg. 2012, 41, 624–628. [Google Scholar] [CrossRef]
- Shukla, B.; Singh, G.; Mishra, M.; Das, G.; Singh, A. Closure of Oroantral Fistula: Comparison between Buccal Fat Pad and Buccal Advancement Flap: A Clinical Study. Natl. J. Maxillofac. Surg. 2021, 12, 404–409. [Google Scholar] [CrossRef] [PubMed]
- El-Hakim, I.E.; El-Fakharany, A.M. The Use of the Pedicled Buccal Fat Pad (BFP) and Palatal Rotating Flaps in Closure of Oroantral Communication and Palatal Defects. J. Laryngol. Otol. 1999, 113, 834–838. [Google Scholar] [CrossRef]
- Yalçın, S.; Oncü, B.; Emes, Y.; Atalay, B.; Aktaş, I. Surgical Treatment of Oroantral Fistulas: A Clinical Study of 23 Cases. J. Oral. Maxillofac. Surg. 2011, 69, 333–339. [Google Scholar] [CrossRef] [PubMed]
- Amaratunga, N.A. Oro-Antral Fistulae—A Study of Clinical, Radiological and Treatment Aspects. Br. J. Oral. Maxillofac. Surg. 1986, 24, 433–437. [Google Scholar] [CrossRef] [PubMed]
- Bilginaylar, K. Comparison of the Clinical Outcomes of Buccal Advancement Flap Versus Platelet-Rich Fibrin Application for the Immediate Closure of Acute Oroantral Communications. J. Craniofac. Surg. 2019, 30, e45–e49. [Google Scholar] [CrossRef]
- Gheisari, R.; Hosein Zadeh, H.; Tavanafar, S. Oro-Antral Fistula Repair With Different Surgical Methods: A Retrospective Analysis of 147 Cases. J. Dent. 2019, 20, 107–112. [Google Scholar] [CrossRef]
- Faber, T.; Ravaud, P.; Riveros, C.; Perrodeau, E.; Dechartres, A. Meta-Analyses Including Non-Randomized Studies of Therapeutic Interventions: A Methodological Review. BMC Med. Res. Methodol. 2016, 16, 35. [Google Scholar] [CrossRef]
- Gülşen, U.; Şentürk, M.F. Effect of Platelet Rich Fibrin on Edema and Pain Following Third Molar Surgery: A Split Mouth Control Study. BMC Oral. Health 2017, 17, 79. [Google Scholar] [CrossRef]
- Dohan Ehrenfest, D.M.; Bielecki, T.; Mishra, A.; Borzini, P.; Inchingolo, F.; Sammartino, G.; Rasmusson, L.; Everts, P.A. In Search of a Consensus Terminology in the Field of Platelet Concentrates for Surgical Use: Platelet-Rich Plasma (PRP), Platelet-Rich Fibrin (PRF), Fibrin Gel Polymerization and Leukocytes. Curr. Pharm. Biotechnol. 2012, 13, 1131–1137. [Google Scholar] [CrossRef]
Buccal flap | 227 | 44% |
Buccal fat pad | 156 | 30.00% |
Palatal flap | 115 | 22.1% |
Prf | 21 | 4% |
Dental extraction | 203 | 76.30% |
Failed implants | 16 | 6% |
Cystectomy | 32 | 12% |
Sinus lift | 6 | 2.20% |
Tumor resection | 6 | 2.20% |
Endodontic therapy | 2 | 0.70% |
Osteonecrosis | 1 | 0.30% |
Authors | Year | Type of Study | OAC/OAF Size | Surgical Method | Total Patients | Success (%) | Complication (s) | Follow-Up | VAS Score |
---|---|---|---|---|---|---|---|---|---|
Gheisari et al. [36] | 2019 | Retrospective | 5–10 mm | Buccal flaps | (59) | 89.8% | 2 dehiscence | 3 weeks | |
Palatal flaps | (28) | 85.7% | 4 dehiscence | ||||||
Buccal fat pad | (60) | 98.3% | 1 dehiscence | ||||||
Batra et al. [29] | 2010 | RCT | 5–10 mm | Buccal flap | (7) | 72% | 2 dehiscence | 3 months | |
Buccal fat pad | (8) | 100% | - | ||||||
BFP + BF | (6) | 100% | - | ||||||
Bereczki et al. [8] | 2022 | Retrospective | 3–15 mm | Buccal flap | (72) | 73% | 25 dehiscence | 6 months | |
Buccal fat pad | (49) | 100% | - | ||||||
Palatal flap | (19) | 75% | 4 dehiscence | ||||||
Shukla et al. [31] | 2021 | RCT | Buccal flap | (10) | 100% | - | 3 weeks | 2.9 | |
Buccal fat pad | (10) | 100% | 3.5 | ||||||
Nezafati et al. [30] | 2012 | RCT | 6–8 mm | Buccal flap | (10) | 100% | - | 1 month | 2.5 |
Buccal fat pad | (10) | 100% | 4.2 | ||||||
El-Hakim et al. [32] | 1999 | RCT | Buccal fat pad | (19) | 100% | - | 12 months | ||
Palatal flap | (7) | 100% | |||||||
Yalcin et al. [33] | 2011 | RCT | Buccal flap | (10) | 100% | 6 months | |||
Palatal flap | (13) | 92% | 1 dehiscence | ||||||
Amaratunga [34] | 1986 | RCT | Buccal flap | (44) | 86% | 6 dehiscence | 1 month | ||
Palatal flap | (42) | 93% | 3 dehiscence | ||||||
Bilginaylar [35] | 2019 | RCT | >3 mm | PRF | (21) | 100% | - | 3 weeks | 6 |
Buccal flap | (15) | 100% | 1.4 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Oliva, S.; Lorusso, F.; Scarano, A.; D’Amario, M.; Murmura, G. The Treatment and Management of Oroantral Communications and Fistulas: A Systematic Review and Network Metanalysis. Dent. J. 2024, 12, 147. https://doi.org/10.3390/dj12050147
Oliva S, Lorusso F, Scarano A, D’Amario M, Murmura G. The Treatment and Management of Oroantral Communications and Fistulas: A Systematic Review and Network Metanalysis. Dentistry Journal. 2024; 12(5):147. https://doi.org/10.3390/dj12050147
Chicago/Turabian StyleOliva, Stefano, Felice Lorusso, Antonio Scarano, Maurizio D’Amario, and Giovanna Murmura. 2024. "The Treatment and Management of Oroantral Communications and Fistulas: A Systematic Review and Network Metanalysis" Dentistry Journal 12, no. 5: 147. https://doi.org/10.3390/dj12050147
APA StyleOliva, S., Lorusso, F., Scarano, A., D’Amario, M., & Murmura, G. (2024). The Treatment and Management of Oroantral Communications and Fistulas: A Systematic Review and Network Metanalysis. Dentistry Journal, 12(5), 147. https://doi.org/10.3390/dj12050147