The maxillary sinus and the roots of the posterior teeth are closely related. Occasionally following infection or dental treatment damage can result in openings between the mouth and the sinus. These oro-antral communications (OAC) as can occur following extraction with rates reported to vary between 0.3 to 4.7%. A wide range of surgical and non-surgical techniques have been used to treat the condition.

The aim of this review was to assess the effectiveness and safety of various interventions for the treatment of oro-antral communications and fistulae due to dental procedures.

Methods

Searches were conducted in the Cochrane Oral Health Group’s Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, US National Institutes of Health Trials Registry and the World Health Organization (WHO) International Clinical Trials Registry Platform (http://www.who.int/ictrp/en/).

Randomised controlled trials (RCTs) evaluating any intervention for treating oro-antral communications and oro-antral fistulae (OAF)  due to dental procedures. Studies in patients with oro-antral communications, fistulae or both related to Caldwell-Luc procedure or surgical excision of tumours were excluded. Complete closure of the OACs /OAFs assessed clinically and with patient reported outcomes was the primary outcome.

Two reviewers independently selected studies abstracted data and assessed risk of bias. Risk ratios (RR) and 95% confidence intervals were presented were presented and overall quality of the evidence was assessed using the GRADE approach.

Results

• Only 1 study involving 20 patients was included.
• The risk of bias was unclear.
• The study compared pedicled buccal fat pad and buccal flap.
• No evidence of a difference between interventions for the successful (complete) closure of an oro-antral communication was seen one month after the surgery, RR=1.00 (95% Cl; 0.83 – 1.20).
• All oro-antral communications in both groups were successfully closed so there were no adverse effects due to treatment failure.

Conclusions

The authors concluded

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.

Comments

This review title was identified as a priority title by an oral and maxillofacial surgery expert panel as part of the Cochrane Oral Health Group prioritisation exercise. An earlier review of this topic was published in 2011 although that review only included observational and retrospective studies. Despite an extensive database search this Cochrane review only identified one small study that only compared two of the wide range of surgical and non-surgical approaches that have been used to manage OACs. Large well conducted RCTs are needed to provide better quality evidence to inform clinical practice.

Links

Primary paper

Kiran Kumar Krishanappa S, Prashanti E, Sumanth KN, Naresh S, Moe S, Aggarwal H, Mathew RJ. Interventions for treating oro-antral communications and fistulae due to dental procedures. Cochrane Database of Systematic Reviews 2016, Issue 5. Art. No.: CD011784. DOI: 10.1002/14651858.CD011784.pub2.

Other references

Cochrane Oral Health Group Blog – Treating communications between the oral cavity and maxillary sinus: insufficient evidence

Cochrane Oral Health Group –Priority reviews

Franco-Carro B, Barona-Dorado C, Martínez-González MJ, Rubio-Alonso LJ, Martínez-González JM. Meta-analytic study on the frequency and treatment of oral antral communications. Med Oral Patol Oral Cir Bucal. 2011 Aug 1;16(5):e682-7. PubMed PMID: 20711106.