Closure of an Oral Antral Opening using Preshaped Collagen Membrane?

Dear Doctor, for closing oro-antral fistula we succesfuly use the method as was suggested by dr. Wassmund We need to mobilize buccal trapezoide flap with periosteum releasing cut and perform 1-1,5mmexcision on the palatal.when the flap is released enough you can suture it without tension.After 2 month approximately you can continue with sinus fluore augmentation. Good luck

We use the Zimmer CurV to close these openings. Reflect the oral mucosa about 7 mm on the palatal side and on the buccal develop a large flap and score the periosteium to gain enough tissue to come close to primary closure. Place the CurV and secure with one screw on the buccal. Close with 3-0 Vicryl . The collagen is replacement for the traditional gold plate technique.

In attempt to close fresh post extraction oro-antral fistula we can use buccal flap with releasing periosteal incision,but we'll lost keratinize gingiva,wich will compromise implant placement or over conventional prosthetic rehabilitation.What about nailing non-resorbable PTFE on both sides(bucal and palatal) plus some approachin buccal part towards palatal without tight suturing purposely to have healing with secondary intention( this will give us extra amount of keratinized tissue) and I hope isolation of clot from oral environment wich will subsequently transform in to bone

Without an xray I don't know what the bone height is in the premolar,second molar area. I'd avoid placing an implant in the o-a repair site, bridge over it. So place a resorbable(long resorption time) membrane over bony defect and close primarily. You don't get a nice regenerated membrane but a scarred one that is difficult to lift, could a lift be done at the time of repair? You could attempt a Pikos repair of large antral tears but you don't have a floor for closure, so I'd get the floor back first then punt and stay away from the OA site.

All coments are all right, but some times to reflect a a flap is not enough I hardly reccommend to use ALLODERM which is an avascular tissue and works as a connective. You can cover the defect using alloderm under the gingiva and cover it with a flap. Remember than this defect is three layers, sinus membrane, bone and mucosa.

Any thoughts to using PRF for a membrane cover?

Dr Mario if we will tightly close OA we will have deficiensy of keratinized tissue in this site.Is it possible not to close tightly.My foughts about this is conservation of clot wich will in the future transform in the bone

The problem with recommending a single repair approach for oro-antral closure is that sites can vary in their degree of anatomical defect. The object here is twofold: closure of the defect to allow regeneration of the membrane and de-epithelialization of the fistulous tract to prevent regrowth. In an ectraction site with considerable bone height from the defect, an ideal material is PRF. It will allow rapid regrowth of the membrane at the level of the sinus floor, prevent infection, prevent epthelialization into the defect from the crest, and result in rapid regrowth of bone. You do not need to advance flaps in these types of cases. The sites that are more difficult to close are where the sinus floor is congruent with the alveolar crest. These types of cases require complete soft tissue closure with an advanced flap and de-epthelialization. RJM

A foreign body at an o/a fistula, doesn't make much sense to me. Just as the gold foil, went out of favor, I would suggest closing this with traditional surgical technique . This patient's poor oh., can't help. Bv