Treating communications between the oral cavity and maxillary sinus: insufficient evidence

dental examThe 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.

What was the research?

A systematic review of the evidence on the safe and effective treatment of openings between the mouth and main sinus caused by dental procedures

Who conducted the research?

The research was conducted by a team led by Salian Kiran Kumar Krishanappa from Melaka-Manipal Medical College, Melaka, Malaysia, on behalf of Cochrane Oral Health. Prashanti Eachempati, Sumanth Kumbargere Nagraj, Naresh Yedthare Shetty, Soe Moe, Himanshi Aggarwal and Rebecca J Mathew were also on the team.

What evidence was included in the review?

One randomised controlled trial, which was conducted in Iran, is included in this 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).

What did the evidence say?

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.

How good was the evidence?

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. We are uncertain about which interventions are effective.

What are the implications for dentists and the general public?

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.

What should researchers look at in the future?

Further research should be done in interventions for treating oro-antral communications and fistulae due to dental procedures by conducting well-planned RCTs with more clarity. Researchers should design trials which evaluate all the outcomes mentioned in this review. Future research on adverse effects of different interventions should include longer follow-up. Furthermore, reports on clinical trials would be improved by following CONSORT group guidelines.


Kiran Kumar Krishanappa, Prashanti E, Sumanth KN, Naresh S, Moe S, Aggarwal H, Mathew RJ. Interventions for treating oro-antral communications and fistulae due to dental procedures. Cochrane Database of Systematic Reviews, 2016, Issue 5. Art. No.: CD011784. DOI: 10.1002/14651858.CD011784.pub2.

This post is an extended version of the review’s plain language summary, compiled by Anne Littlewood at the Cochrane Oral Health Group Editorial Base.