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Evaluation of Vestibular depth with
Inverted Periosteal Flap vs. Buccal Advancement Flap
for Closure of Oroantral Communication

Dr. Sajeel Ahmad
BDS, FCPS II Resident (Oral and Maxillofacial Surgery)

Supervised by:
Prof. Dr. Muhammad Usman Akhtar
BSc, BDS (Hons), MCPS, MDS
De’Montmorency Institute of Dental Sciences/
Punjab Dental Hospital, Lahore, Pakistan

DHA. MDS Designation: Professor Department: Oral and Maxillofacial Surgery Name of training institution: De’Montmorency College of Dentistry/ Punjab Dental Hospital. BDS (Hons). Buccal Advancement Flap for Closure of Oroantral Communication” Prepared by: Dr. Sajeel Ahmad Name of specialty: Oral and Maxillofacial Surgery RTMC Reg.75500 SUBJECT: Submission of Synopsis for Dissertation Dear Sir/Madam. no: DSG-2016-077-1827 CPSP ID: 2016-1739 Trainee’s signature: _________________________________ Name of supervisor: Prof. Research and Training Monitoring Cell. MCPS. Pakistan. Muhammad Usman Akhtar Qualification: BSc. Lahore Signature of Supervisor: ______________________________ . Karachi. Dr. 7th Central Street Phase II.The Director. College of Physicians and Surgeons. Enclosed herewith please find research study titled “Evaluation of Vestibular depth with Inverted Periosteal Flap vs.

College of Physicians and Surgeons. Signature of Supervisor: _____________________________ Prof. Buccal Advancement Flap for Closure of Oroantral Communication” of my candidate has not been conducted in the Department of Oral & Maxillofacial Surgery at de’Montmorency College of Dentistry/ Punjab Dental Hospital. Muhammad Usman Akhtar BDS. It is further explained that ethical issues regarding the topic have been discussed and found to have no objection regarding study by the ethical committee. Dr. MCPS. Research and Training Monitoring Cell. DHA. Furthermore this study is not currently being duplicated in this institute.The Director. Karachi. Pakistan. Phase II. 7th Central Street. MDS Department of Oral and Maxillofacial Surgery Punjab Dental Hospital/ De’Montmorency College of Dentistry .75500 This is to certify that the FCPS II synopsis topic “Evaluation of Vestibular depth with Inverted Periosteal Flap vs.

autogenous bone graft as well as allogenic.1 Extraction of maxillary posterior teeth is the most common cause of an oroantral communication as the thickness of the sinus floor in that region ranges from 1 to 7 mm. The Buccal advancement flap described by Rehrmann is the most commonly used method for closure of oroantral communications. palatal flaps. Advantages The rationale of this study is to suggest the inverted periosteal flap as a beneficial alternative treatment for closure of oroantral communications. Surgical options include the buccal advancement flap. OBJECTIVE To evaluate the change in vestibular depth using two different methods of surgical closure of oroantral communications. Despite the existence of numerous alternative techniques.3 The most common sequelae of such a communication are postoperative maxillary sinusitis and the formation of a chronic oroantral fistula. benign or malignant tumors and trauma. (Reference master article) The compromised sulcus depth also leads to limitation in the future restorative options of patients planned for removable prosthesis requiring adequate vestibular depth. 1. (reference batra) Intro of inverted periosteal flap. While the procedure carries a high success rate of up to 93%. time since creation of communication etc. leading to a level of discomfort that is described by patients as a sensation that their Buccal mucosa has been sutured to their alveolar mucosa. in terms of better conservation of vestibular depth as compared to other surgical options. The advancement of the Buccal flap crestally and medially causes a significant reduction in the vestibular depth. 2 Other less common causes includes maxillary cysts. The management of an oroantral communication depends on a number of factors including size of the communication. the Moczair flap. site. resulting in an anatomically close relationship between the root apices of the premolar and molar teeth and the maxillary antrum. the buccal fat pad.INTRODUCTION: An oroantral communication (OAC) is an open connection between the oral cavity and the maxillary sinus. surgical closure still remains the treatment of choice. xenografts and synthetic graft materials. the Buccal sulcus depth is almost invariably compromised. tongue flaps. OPERATIONAL DEFINITIONS .

DATA COLLECTION PROCEDURE All the patients fulfilling the inclusion criteria will be selected from the outpatient department of oral and maxillofacial surgery.5mm. The maxillary buccal vestibule is the area bounded by the alveolar gingiva. Patients who are unable to attend follow up visits and unwilling to give informed consent. Lahore. . Patients ages 18-65 years of both genders. 3.5mm. Size of oroantral communication between 2-10 mm on clinical examination Exclusion Criteria 1. Sample size: The calculated sample size is ?????????????? Sampling technique: Non-probability purposive sample SAMPLE SELECTION Inclusion Criteria 1. blunted instrument which is used to measure the depth of the maxillary vestibule. 2. Periodontal probe It is a long. Oral and Maxillofacial Surgery.5mm. Punjab Dental Hospital on the basis of history. The fornix is the highest part of the vestibule next to the maxilla. the buccal frenum.5mm ball at the tip and millimeter markings are present at 3. Punjab Dental Hospital/ de’Montmorency College of Dentistry. Duration of study: Six months after approval of synopsis. the buccal mucosa. Oroantral communication is an open connection between the oral cavity and the maxillary sinus. Presence of post extraction oroantral communication as revealed by history 3. 1. 5. It has 0. Vestibular depth The distance from the crest of the residual alveolar ridge to the fornix of the buccal vestibule. 8.5mm interval and colour coding at 3. 2. MATERIAL AND METHODS Study design: Descriptive case series Setting: Outdoor Patient Department. and the hamular notch. Patients who are regular smokers. 3. Medically compromised patients like Diabetes mellitus (DM) assessed on history.5mm and 11. thin. 2.5mm to 5.

Effect modifiers like age and gender will be controlled through stratification. Qualitative variables like gender and sensation will be calculated as frequency and percentage. DATA ANALYSIS PROCEDURE Data will be entered and analyzed by using Statistical Package for Social Sciences (SPSS) version 17. Study protocol use of data for research and risk benefit ratio will be explained to the patients and a written informed consent will be taken. middle and posterior) adjacent to the oroantral communication will be made using a periodontal probe. Mean and standard deviation will be calculated for quantitative variables like age and duration. a crestal incision will be made with a no. the dissection will be stopped at least 3mm short of the crestal edge of the flap. and clipped with a small hemostat. All patients will be instructed to avoid blowing their nose. The wound will be then irrigated with saline and the buccal flap approximated and closed with resorbable sutures. playing any wind instruments etc. with anterior and posterior releasing incisions and a full thickness mucoperiosteal flap will be raised. A structured proforma will be used to record the patient’s demographic details like name. A preoperative recording of the maxillary buccal vestibular depth at three points (anterior. The surgical procedure will be performed under local anesthesia. Post stratification Chi square test will be applied by taking P=0.clinical and radiographic examination.000 adrenaline).05 as a significant. The procedure described will be carried out by the researcher himself. two sutures will be passed through each of the two corners of the full thickness flap at its crestal aspect. while applying traction on the hemostats. Oral antibiotics Amoxicillin 500 mg and NSAIDS three times daily for 5 days will be prescribed to all patients. To retract the flap. A sharp scissor or blade will then be used to dissect the periosteum in a split-thickness manner from the underlying submucosal tissue in an apical to crestal direction. All patients will be invited to return for follow up after 3 weeks. One suture each will then passed through both apical corners of the flap through the periosteal layer only. gender. .15 blade. using a separate needle for each corner. The periosteal free edge will then be approximated to the palatal or lingual tissues using the two sutures already passed at the apical edges. and any additional sutures will be placed if required. The ethical committee of de’ Montmorency College of Dentistry shall review ethical aspect of synopsis. drinking with a straw. Postoperative recording of the maxillary buccal vestibular depth at the three locations will be taken with a periodontal probe.0. age. To avoid unintentional separation of the periosteal layer. After the injection of sufficient local anesthetic (lignocaine 2% with 1:100.

Rosenfeld E. . Watertight Closure. International Journal of Oral and Maxillofacial Surgery. 2006. Abuabara A. van Minnen B. Bos R. 2. Oroantral communications. 5. Cortez A. 4. Closure of Oroantral Communications: A Review of the Literature. Evaluation of different treatments for oroantral/oronasal communications: experience of 112 cases. 2011. van Roon M. Hernando J. Medicina Oral Patología Oral y Cirugia Bucal. Villarreal P.35(2):155-158.72(7):1244- 1250. de Moraes M. Passeri L. Sluiter W.:e499-e503. A retrospective analysis. 2010. Bos R. 2010. Visscher S. Inverted Periosteal Flap: An Alternative to the Buccal Advancement Flap for Tension-Free. Journal of Oral and Maxillofacial Surgery. van Minnen B. 3. 2014. 6. Gallego L. Journal of Oral and Maxillofacial Surgery. Journal of Oral and Maxillofacial Surgery. Visscher S.REFERENCES 1. Junquera L.69(12):2956-2961. Moreira R. Retrospective Study on the Treatment Outcome of Surgical Closure of Oroantral Communications.68(6):1384-1391.

: _________________________________ Clinical Data .(Pre Op and Immediate Post Op) Site of OAC: ________________________________________________________________________ Duration of OAC: ___________________________________________________________________ Removal method: Simple Extraction ☐ Surgical Extraction ☐ Treatment Strategy: Inverted Periosteal Flap ☐ Buccal Advancement Flap ☐ Vestibular depth (in mm) Pre-Op Post-Op Reading 1 Reading 2 Reading 3 Mean Follow Up Closure of communication: Yes ☐ No ☐ Presence of Maxillary Sinusitis at follow up: Yes ☐ No ☐ Satisfactory wound healing: Yes ☐ No ☐ Vestibular depth (in mm) Follow Up (3 weeks) Reading 1 Reading 2 Reading 3 Mean Decrease in Vestibular Depth: Yes ☐ No ☐ Informed Consent: _____________________________________________________ Doctor’s Signature: _____________________________________________________ . PROFORMA Evaluation of Vestibular depth with Inverted Periosteal Flap vs. Buccal Advancement Flap for Closure of Oroantral Communication Name _______________________________ Age ______________ Gender: Male ☐ Female ☐ Address: ____________________________ Contact No.