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Existence of and Predisposing Factors for Implant Periapical Lesions

DISCUSSION Oroantral communication is an unnatural communication between the oral cavity and maxillary sinus, and when it fails to close spontaneously, it remains patent and is epithelialized so that oroantral fistula develops, as occurred in the case presented. Surgical closure of an antral perforation is indicated if the opening is greater than 4 to 5 mm at the time of injury, if a sinus disease is present whatever the size of the opening, and if the communication is persistent. As presented in this case, the formation of the fistula was confirmed by the latency and chronicity of constant communication with purulent depth, beyond the patient's pain complaints. Numerous surgical techniques have been described in the literature, mostly based on mobilizing the tissue and advancing the resultant flap into the defect. Techniques, from soft tissue–only closure to the use of composite closures involving alloplastic materials such as gold, acrylic, or bone grafts, have been described. Soft tissue– only flaps include the buccal advancement flap, buccal fat pad flap, a combination of the buccal fat pad and advancement flap, the buccinator myomucosal flap, and the vascularized palatal island flap. The authors decided to use the Bichat fat pad because of its reliability, ease of harvest, low complication rate, rich blood supply, simple procedure, and minimal discomfort to patient in association an advancement flap. The main disadvantage observed in this form of treatment was reported in a case displaying loss of the oral vestibule, wherein the patient would need to undergo sulcoplasty technique. However, because of the initial clinical status of the patient, this disadvantage becomes easily minimized for the restoration of homeostatic oroantral balance. Amazingly, this technique also improves the physiologic functions of the cheek, for example, suppleness and elasticity. Therefore, as observed in the clinical case, there is the possibility of obtaining successful use of buccal fat for closing oroantral fistula, even the most unfavorable ones. The use of pedicle of the buccal fat pad for reconstruction of defects including oroantral communications is already more than consolidated in the literature, being easy to perform and convenient for both the patient and the operator. Furthermore, it is located in the same surgical field as the defect to cover, therefore diminishing the risk of infection.