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Clinical Master Magazine

issue 1/2015 — 67PeriodonticsArticle Fig. 1 Oroantral fistulas measur- ing 6mm, 4mm and 2mm. Fig. 2 Supra-crestal incision. Fig. 3 Dissection of the flap. Fig. 4 The pedicle graft dislodged. Fig. 5a Straight partial incision to release the flap for folding. Fig. 5b Positioning of the pedicle graft. Fig. 6 Irrigation of the surgical bed with tetracycline. Fig. 7 Flap fixation using polyglactin sutures. Fig.6 Fig.4 Fig.5b Thesurgicalprocedureswerepreceded by extra- and intra-oral decontamination using 2% and 0.12% chlorhexidine diglu- conate,respectively.Ano.15cscalpelblade was used to make a supra-crestal partial incision (not touching the bone) palatally (Fig. 2). The palatal soft tissue was dis- sected using the trapdoortechnique until the extension into the connective tissue was sufficient to cover the area of the fis- tulas (Fig. 3). Subsequently, two further incisionsweremadeattheendsoftheflap and one at the base of the dissected con- nective tissue with the blade at a right an- gle to the palatal bone (Fig. 4). A full-thickness connective tissue flap wasthenraisedandplacedbuccally.Using the no. 15c blade, afurtherstraight partial incision was made buccally to allow the flap to fold under and cover the defect (Figs. 5a and b). Tetracycline diluted in saline solution (50mg/ml) was used to ir- rigateanddecontaminatethearea(Fig. 6). Careful suturing of the pedicle flap using biodegradable polyglactin sutures (5-0;Vicryl,Ethicon)wasperformedinor- der to stabilize the graft (Fig. 7). Finally, the openings of the fistulas were deep- ithelialized and sutured to achieve a com- plete seal (Figs. 8 and 9). Six-monthfollow-upfoundcompleteseal- ing of the fistulas and the area showed considerable improvement in tissue qual- ity, including an increase in keratinized tissue (Fig. 10). Discussion This clinical case report with a six-month follow-up presented a modification ofthe rollenvelopetechniqueforconnectivetis- sue grafting in a surgical model for OAF repair. Radiographic examination con- firmed adequate tissue quality with com- pleteclosureofthedefectandnorelapse. Lesionsthatconnecttheoralcavitywith the maxillary sinus usually occur after ex- odontiaofmaxillaryposteriorteethwhose apices are located very close to the mem- brane lining the maxillary sinus.2 The size of the tract may result in an OAF. The lit- erature reports that lesions smaller than 2 mm in diameter may resolve sponta- neously in the presence of a blood clot;8 however,difficultvisualaccesstothearea for inspection may create an obstacle to measuringtheclinicalextentofthefistula, which,whenpresentinapatientwithheal- ingimpairment,willrequiresurgicalinter- vention.4, 1 Fig.7 Fig.5a

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