Highlighted review: Treatment of communications between the oral cavity and the maxillary sinus due to dental procedures

Salian Kiran Kumar Krishanappa, Prashanti Eachempati, Sumanth Kumbargere Nagraj, Naresh Yedthare Shetty, Soe Moe, Himanshi Aggarwal, Rebecca J Mathew

Plain language summary: Treatment of communications between the oral cavity and the maxillary sinus due to dental procedures

Review question
What evidence is available for the safe and effective treatment of openings between the mouth and main sinus caused by dental procedures?

Background
The floor of the main sinus near the nose is thin and lies directly above the roots of the teeth at the back of the mouth. Sometimes following infection or dental treatment, this structure becomes damaged and openings or channels between the mouth and the sinus are formed. These are known as oro‐antral communications (OAC). If the OAC is left open (then described as an oro‐antral fistula (OAF), it may become permanent, leading to long‐lasting sinus infections.

This condition can be treated surgically by using flaps, grafts and other techniques; or non‐surgically using a variety of methods and materials. There is little evidence for the most effective and safe treatments for closing OACs and OAFs and clinicians who treat these conditions have identified an urgent need for this. This is an update of a review first published in May 2016.

Study characteristics
We searched various databases until 23 May 2018. Only one study, which was conducted in Iran, is included in our review. The study ran for two years and involved 20 people with OAC aged between 25 and 56 years. Participants were divided into two groups and two surgical treatments were compared for treating oro‐antral communications; one group was treated with pedicled buccal fat pad flap (PBFPF) and the other with buccal flap (BF).

Key results and quality of evidence
The study did not find evidence of a difference between PBFPF and BF in terms of successful (complete) closure of OAC. Both interventions resulted in successful closure by one month after surgery. The study did not therefore report any adverse effects of treatment failure.

It may not be possible to generalise these findings because the quality of the evidence was very low, due to unclear risk of bias and the small numbers studied in the single included trial.

Conclusion
The evidence currently available is insufficient to draw reliable conclusions regarding the effects of interventions used to treat OAC or fistulae due to dental procedures. More well‐designed and well‐reported trials evaluating different interventions are needed to provide reliable evidence to inform clinical decisions.

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Citation: Kiran Kumar Krishanappa  S, Eachempati  P, Kumbargere Nagraj  S, Shetty  NY, Moe  S, Aggarwal  H, Mathew  RJ. Interventions for treating oro‐antral communications and fistulae due to dental procedures. Cochrane Database of Systematic Reviews 2018, Issue 8. Art. No.: CD011784. DOI: 10.1002/14651858.CD011784.pub3.