CLOSURE OF SINUS OPENINGS RESULTING FROM DENTAL EXTRACTIONS (Oral Antral Fistulas; Sinus Fistula; OA Fistula)
Upper back teeth often have roots that extend up into the sinuses. When these teeth need to be removed, healing with a persistent sinus opening can occur. there are a number of factors that can contribute to this and these include cigarette smoking, healing problems such as autoimmune disease, presence of sinus disease, periodontal issues, and ankylosis to name a few. Cigarette smoking has been the one greatest risk factor in my experience.
We have used many different procedures over the years for treatment of an oral sinus fistula and the closure using native fat tissue derived from the cheek fat (buccal fat pad) has been the best and most reliable procedure for this. (J Oral Maxillofac Surg 74:1718-1722, 2016).
There may be reasons to use a variety of techniques. Patients who have undergone chemotherapy or radiation therapy are often at a greater risk for developing the opening. these same patients often have compromised tissue including the buccal fat tissue. In those cases, we may have to resort to other tissues or materials.
Some of the benefits of the fat flap is that it is native tissue, right there (immediately next to the site), relatively easy to access, a low risk procedure, less painful than the palatal flap, and these tissues usually have an excellent blood supply. As with so many surgical procedures, prevention is a much better solution. Careful and thoughtful tooth extraction technique will often avoid the problem in the first place. In an area where we expect a concern the use of PRGF or other grafting techniques can have a proactive effect on healing from a natural standpoint. The risk of having such a problem is one more reason to have an experienced and well trained individual providing you extractions and oral surgery care.
If you have questions, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 to learn more.
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