Dental Tribune Middle East & Africa Edition

started to return to the normal color of the mucosa. Final general results It has been shown that all fistulae were closed successfully in both groups. There was no discomfort and no burning sensa- tion in G2. They all showed relatively fast healing. Interestingly, patients in G2 need- ed fewer amounts of analgesics than in G1 (Figures 5 and 6). Discussion The oroantral communication is a rather frequent complication of oral surgery in the maxilla. Most of these complications can be treated adequately at the time of oc- currence. However, some of them become chronic and may cause considerable prob- lems to the patient and to the surgeon8. Such fistulae usually occur in association with an extraction of premolars or molars in the upper jaw9 . Oroantral fistula in the alveolar ridge of the molar region can also occur after enu- cleation of cysts, or surgery for treatment of maxillary sinus. Such openings are diffi- cult to be closed surgically10 . In our study, cases of oroantral communi- cation had developed as complications af- ter teeth extraction with a percentage of 80 % of the communications resulted after re- moval of the upper first molar; four cases due to extraction of upper right first mo- lars, four cases due to extraction of upper left first molars, one case due to extraction of upper right third molar, and one case due to extraction of upper right second pre- molar. Killey and Kay (1967) analyzed 250 cases of OAF. They found that 50 % of the cases oc- curred after the removal of the upper first molar11 . Hirata et al. (2001) mentioned that the per- foration rate occurred most often after ex- traction of upper first molar, and that it was significantly higher in males who were in the third decade of life12 . In our study, male to female ratio was 1:1, and the age range of the patients was be- tween 25 and 59 years with an average of 40 years. It seems to be that the incidence of OAF is more frequent in elder patients. Punwu- tikorn et al. (1994) noted that the elder the patient, the higher the chance of having OAF after simple tooth extraction4 . They have also shown that removal of the first molars is the most etiological factor in OAF. An oroantral defect larger than 5 mm or present for three or four weeks rarely heals spontaneously, and the subsequent OAF that develops usually requires surgical clo- sure. The problem of adequate, tension- free tissue coverage becomes significant as the size of the defect increases13 . If the patients are suffering from acute sinusitis, this must be first controlled by pre-surgi- cal treatment, but its presence should not affect the ultimate choice of surgical pro- cedures. The most significant factors influ- encing the choice of the technique are the size of the fistula and the amount of eden- tulous space available for surgery. In cases where the fistula is extremely large and/or located in the third molar region, the pala- tal pedicle flap is preferable14-15 . Patients who present with a chronic OAF not only require closure of the fistula but they also require management of the in- flammatory sinus disease that co-exists with the fistula before its closure16 . All the patients in our study were instructed to take antibiotics and sinus irrigation three days before operation to control the sinus infection and to be sure about the cleanli- ness of the sinus. Numerous techniques have been described for closure of OAF. Most of them share an equal degree of success and failure13, 17 . A modified palatal flap technique has been introduced and successfully used in eight patients for closure of OAF18 . Successful closure of OAF is dependent upon the following principles: • Control of maxillary sinus infection. • Removal of as much of the epithelial lin- ing of the fistula as possible, making sure that there is a raw surface throughout the periphery of the wound. • Maintenance of adequate blood supply to palatal pedicle flap with minimum ten- sion on the flap. • Causation of minimal trauma to the ped- icle flap, and the tissue around the OAF. • Use of a nasal antrostomy, with or with- out a Caldwell-Luc procedure, to ensure adequate sinus drainage18 . Gordon and Brown (1992) mentioned that the treatment of OAF was considered suc- 1 um 100 60 45 30 15 0 Meanpercentagesurface microhardnessrecovery Pronamel (1450ppm NaF) A leading toothpaste (1450ppm NaF) Placebo (oppm F) P<0.001 Pronamel is proven to reharden acid-softened enamel and provide ongoing protection from the effects of Acid Wear: 3 Low abrasivity 3 Neutral pH (7.1) 3 SLS*-free Fig. 4: Preparation of the Palatal Submucosal flap and dissection into two layers Fig. 5: Six weeks postoperatively shows complete healing of the palatal flap in G1 with successful closure of the fistula Fig. 6: postoperative view shows complete healing of the palatal submucosal flap in G2 with successful closure of the fistula Fig. 4: Preparation of the Palatal Submucosal flap and dissection into two layers Fig. 5: Six weeks postoperatively shows complete healing of the palatal flap in G1 with successful closure of the fistula Fig. 6: postoperative view shows complete healing of the palatal submucosal flap in G2 with successful closure of the fistula Fig. 5: Six weeks postoperatively shows complete healing of the palatal flap in G1 with closure of the fistula Fig. 6: postoperative view shows complete healing of the palatal submucosal flap in G2 w closure of the fistula Fig. 4: Preparation of the Palatal Submucosal flap and dissection into two layers. Fig. 5: Six weeks postoperatively shows complete healing of the palatal flap in G1 with successful closure of the fistula. Fig. 6: postoperative view shows complete healing of the palatal submucosal flap in G2 with successful closure of the fistula 25Dental acaDeMia triBUneDental tribune Middle East & Africa Edition | March-April 2013