Clinical protocols for treatment of oroantral defects

Introduction: Oroantral communication (OAC) is an abnormal connection between the oral cavity and the maxillary sinus, most commonly arising as a complication following maxillary posterior tooth extractions. If left untreated, it may progress to chronic oroantral fistula (OAF) and maxillary sinusitis, significantly compromising patient health and quality of life. Aim: Having clinical protocol aims to provide a standardized approach for the diagnosis, classification, and management of OAC, emphasizing evidence-based decision-making and surgical techniques tailored to defect size and duration for repair. Material and Methods: Research was done exploring specialized databases PubMed, MEDLINE, EBSCO, Science Direct, Scopus for the period January 2015 to January 2025, by use of MeSH terms: “oroantral communication”, “oroantral fistula”, “maxillary sinus”, “surgical closure” and “clinical protocol”. Included were English-language papers only, review articles, clinical studies and guidelines relating to the diagnosis, indications and choice of surgical technique for the treatment of oroantral communication and fistula. Results: Of the 106 articles generated, 47 were included in the review as exclusively surgical techniques without the additional use of graft materials. The protocol integrates current best practices in clinical assessment, radiographic imaging, and treatment planning. It outlines criteria for choosing among primary closure techniques, such as buccal advancement flaps and palatal rotation flaps, as well as comparison in success rate among them. Conclusion: Implementation of a structured clinical protocol ensures timely diagnosis and effective management of OAC, reducing the risk of chronic complications and improving surgical outcomes. This highlights the need of such guideline for support of the clinicians in delivering predictable and patient-centered care. Keywords: Oroantral communication, oroantral fistula, maxillary sinus, surgical closure, clinical protocol.