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66 — issue 1/2015 Periodontics Article OROANTRAL FISTULA CLOSURE — using the modified roll envelope technique — André Antonio Pelegrine, Ph.D., is Professor of Implant Dentistry at São Leopoldo Mandic dental school in Campinas in Brazil. He can be contacted at: pelegrineandre@gmail.com — Rafael de Mello e Oliveira, M.Sc., is a specialist trainee in implant dentistry and prosthodontics at São Leopoldo Mandic dental school. — Contact, Rua das Areias, 37 Cambuí Campinas São Paulo 13024-530 Brazil T +55 19 3272 5219 Introduction Oroantral communication is an abnormal connection between the oral cavity and the maxillary sinus, and mainly arises as a complication of exodontia of maxillary molars with roots too close to the sinus1, 2 or unsuccessful sinus lift procedures with rupture of the Schneiderian membrane.3 There is a relatively low risk of oroantral communication after exodontia of maxil- lary posterior teeth, ranging from 0.31% to 4.7%; however, an oroantral fistula (OAF) may be a source of chronic infec- tion in the maxillary sinus and is of great discomfort to the patient.4, 5 OAFswithdiameterssmallerthan2mm have been reported to close sponta- neously;however,theextentofthefistula may then become difficult to establish clinically. Patients with larger fistulas or thosewithhealingimpairmentrequiresur- gical repair techniques.4, 1 Common tech- niques may be used, such as deepithelial- ization of the edges of the fistula and suturing, bone regeneration techniques using bone particles and membranes,6the use of the Bichat’s fat pad combined with mucogingival flaps,3 as well as periodontal plastic surgery using pedicle flaps,6 all of which should be considered based on fac- tors such as the size of the defect and duration of the infection. Surgical inter- ventions that permit future implant reha- bilitation should be considered when selecting the ideal method. The literature highlights simplicity and predictability as being paramount in the choice of the periodontal plastic surgical technique,suchasthepediclepalatalflap, which allows for ample thickness of kera- tinized tissue in the periimplant mucosa.7 Yet, the use of the modified roll envelope technique has not been reported as a treatmentoptionforOAFrepair.Thepur- pose of this study was therefore to de- scribe a surgical technique to repair an OAF using the modified roll envelope technique and report on its effectiveness as a possible treatment option. Clinical case report A 52-year-old Caucasian female patient and a smoker presented in October 2010 with three OAFs measuring 6mm, 4mm and2mmintheedentulousmaxillaryright premolar and molar regions (Fig. 1), two monthsaftercurettageofthemaxillarysi- nus, which was prescribed after an unsuc- cessful maxillary sinus lift for implant treatment. The OAF treatment reported in this article was only begun afterthe pa- tient had signed an informed consent form. Fig.1 Fig.2 Fig.3 T +551932725219