CLINICAL AND RADIOGRAPHIC

ASSESSMENT OF CYANOACRYLATES
OPPOSING BUCCAL SLIDING FLAP FOR
THE IMMEDIATE REPAIR OF ORO-ANTRAL
COMMUNICATION
Maggie A Khairy and Inas A Abulmag
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, October 6 University,
Department of Oral radiology, Faculty of Dentistry, AlFayoum University, Egypt

Egyptian Journal Of Oral and Maxillofacial surgery, September 2020

PRESENTED BY: DR. SANJITI MADAN
GUIDED BY: DR. ARATI NEELI
ABSTRACT
 INTRODUCTION
Oro-antral communication (OAC) is the inevitable connection between the oral cavity and the
maxillary sinus.

CAUSES OF THE OAC:

• Extraction of maxillary molars (due to the close proximity of their roots to the antral floor which is
very thin in this area)
• Periapical infection
• Large cysts
• Tumors
• Trauma
DIAGNOSIS OF OAC:
• Valsalva test, Cheek blowing test and probing of the perforation site
• Radiological: IOPA, OPG, PNS, CT/CBCT
MANAGEMENT OF AOC:
• Several articles recommend the closure of this communication within 24
hours of the incident.
• Several treatment options are postulated for the immediate closure of OAC,
these are either conservative or surgical maneuvers.
• It is commonly agreed that a defect within 2 mm can heal spontaneously
providing the stability of blood clot is secured and total absence of infection
throughout the healing period.
• On the other hand, larger defects are managed in a different way; they were
for long treated using local flaps.
• One of the oldest surgical procedures to treat Oroantral communication is
the buccal sliding flap. Rehramnn was the first to introduce this flap in 1945
and since then it gained wide popularity owing to its ease of technique,
reliability and versatility.
CYNOACRYLATE
• Cyanoacrylates were first introduced to the medical field in the 1940s, the
widely used forms were polymers of N-butyl cyanoacrylate, and 2-octyl
cyanoacrylate.
• These polymers activate in the presence of moisture forming a tight chain
between the two surfaces to be bonded in a hasty process lasting only 10 - 15
seconds.
• These structural properties permitted boosting of the coagulation process and
building a mechanical barrier at the site of tissue breakdown.
• The process of activation of cyanoacrylates is exothermic which can cause
tissue damage. In order to attenuate the harmful effects of heat generation,
long chains of methyl group were added to prolong the polymerization process
thus decreasing the rate of heat generation.
IN ORAL AND MAXILLOFACIAL SURGERY CYANOACRYLATES ARE USED IN:
• Osteosynthesis of mandibular fractures
• bone grafts
• alveolar and palatal clefts
Also, Cyanoacrylates are proved to accelerate the healing process within
lacerations and perforations, to possess an antibacterial effect, decreases
incidence of infection.
To promote healing and maintain hemostasis within sockets after tooth
extraction.
Moreover, Cyanoacrylates were related to decrease scarring in extraoral
wounds.
• There is a lack of adequate evidence regarding effects of
cyanoacrylate on the healing process of the sinus membrane.
• Therefore, the present study aimed to assess clinical and radiological
efficacy of cyanoacrylates in flapless closure of acute oro-antral
communication.
PATIENTS AND METHODS
The present study was carried out in the Oral surgery and
Maxillofacial Department, Faculty of Dentistry, October 6 University.
 A total of 20 patients suffering from instant oro-antral
communication during inadvertent extraction of upper molars were
incorporated in the study.
Diagnosis and confirmation of the presence of OAC was based on
clinical and radiological examinations.
CLINICAL EXAMINATION WAS BASED ON:
1. Clinical inspection
2. Valsalva test: Asking patients to exhale air while pressing their
nostrils, air bubbles were seen getting out of the socket.
RADIOLOGICAL EXAMINATION: After confirmation of clinical
examination immediate CBCT scans were arranged for all patients to
verify the following findings:-
1. Communication between the maxillary sinus and oral cavity with
size range 5 - 8 mm.
2. Preserved intact buccal and palatal lamellar bone.
3. Absence of any tooth fragment or foreign body within the sinus
PATIENTS WERE EXCLUDED FROM THE STUDY IF:-
1. They suffered from any chronic systemic disease or on regular medication.
2. Presence of any foreign material within the sinus
3. Presence of periapical infection.
4. Smokers.
Patients who fitted the inclusion criteria were 12 males and 8 females with
age range 29 - 62 years.
Patients were randomly divided into two equivalent groups where Group I
patients had their OAC closed using collagen sponge soaked with periacryl
HV 901 (cyanoacrylate) while Group II patients were treated using buccal
advancement flap.
GROUP 1:
A: irrigation of the socket, B: collagen cone cut and soaked with periacryl, C: collagen cone inserted in the socket, D: socket
is completely soaked with periacryl
GROUP 2:
A: Socket after irrigation
B: buccal advancement flap
C: repositioning and suturing of the flap
• Postoperative instructions and medications were the same for both
groups.
• All patients were warned to avoid consuming hot food or drinks, nose
blowing, sneezing with closed mouth or any form of negative or
positive pressure for 1 week postoperative.
• All patients were prescribed Augmentin 1 gm/12hrs for one week,
Paracetamol 500 mg/12hrs for one week and were advised to use it
whenever necessary.
• Nasal decongestants were also prescribed Qid/ 7 days. Sutures were
removed after 10 days in Group II patients
 POST OPERATIVE
EVALUATION(CLINICAL FOLLOW-UP)
Pain was assessed using a visual analogue scale (VAS) of 10 units in combination
with a graphic rating scale.
• On the VAS, the left most end represented the absence of pain (score 0) and the
right most end indicated the most severe pain (score 10).
Facial swelling was assessed using the modified Gabka and Matsamura technique .
• Using a soft tape three measurements were recorded, tragus to the outer corner of
the nose, tragus to the outer corner of the mouth, and lateral corner of the eye to
the angle of the mandible. The sum of the 3 preoperative measurements was taken
as the baseline.
• The difference between the maximum postoperative measurement and the
baseline gave the value of facial swelling for each patient
Vestibular depth: was assessed using graded periodontal probe.
 Persistence of the communication was evaluated through asking the
patient about signs of OAC and by clinical examination.

Clinical data were collected at 1, 3, 7, 15 days and 1 month

postoperatively
RADIOLOGICAL EVALUATION
CBCTs were done for each patient preoperatively and at 1 month and 3
months postoperative to evaluate the following:
 The defect size was measured both buccolingually and mesiodistally
by taking average of three readings from three different planes.
The bone density at the site of the defect was measured using
software of Planmeca (Romexis Planmeca, Planmeca, Finland).
RESULTS
PAIN:
SWELLING:
• Results collected showed increase in facial dimensions in both groups. Yet it is to be noted that group I
revealed mild increase within facial measurements at day 1 and 3 days postoperative followed by a marked
decline at day 7 and 15 postoperative.
• In contrast Group II demonstrated a significant increase in facial dimensions at day 1, 3, 7 and 15
consecutively.
• Data collected from both groups at 1 month postoperative were showed complete resolution of the swelling
with facial measurements were similar to the immediate postoperative.
VESTIBULAR DEPTH:
• There was no preoperative significant difference between mean vestibular depths in the two groups.
• In contrast, at day 1, 3, 7, 15 days as well as 1 month. Group I showed statistically significant higher mean
vestibular depth than Group II which experienced a significant decrease in mean vestibular depth.
• This reduction started at day 1 and continues decreasing till 1month postoperative .
DEFECT SIZE AND BONE DENSITY:
DISCUSSION
• Cyanoacrylates proved effective in various surgical maneuvers due to
its ability to potentiate healing by establishing a strong bond to skin or
mucosa via swift polymerization once in contact with blood or tissue
fluid.
• These properties allowed cyanoacrylates to provide hemostasis within
the surgical field, efficiency in closure of incisions in delicate areas e.g
eyelids with better esthetics, its aptness to stabilize fresh bone grafts
in place till the entire healing process is completed and to decrease
incidence of infection within the surgical site by forming an intact
barrier against bacterial ingress.
Cone beam CT was the method of assessment in this study following
the recommendations of previous articles where they advocated the
ability of CBCT to assess the size of the defect and to characterize the
bone density and the mucosa surrounding the perforation.
Thus CBCT can be a beneficial modality to confirm the presence of the
defect and to evaluate the healing process by measuring the size and
bone density within the defect.
• Regarding the final outcome of the present study and comparing it to
previous researches it is apparent that the buccal sliding flap and the
flapless application of cyanoacrylate are both reliable treatment
procedures for immediate Oro-antral communication.
• However, the flapless cyanoacrylate offers an easy, reliable treatment
method bypassing all comorbidities associated with surgical
intervention.
• This is followed by the previously mentioned pain and swelling in the
immediate postoperative phase while on the long run emerges the
decreased sulcular depth.
CONCLUSION
• Cyanoacrylates provide a simple reliable procedure for closure of
immediate Oro-antral communications.
 CRITICAL APPRAISAL
• TITLE
Type of the study is not mentioned.

• ABSTRACT
Abstract is Well structured.

• TEXT
Text is well written.

• DATA ANALYSIS
Data analysis was done using appropriate statistical tests.
• DISCUSSION
Discussion is well structured.

• CONCLUSION
Conclusion is complete.

• REFERENCING
Authors followed VANCOUVER style.
Number of references were judicious and appropriate.
THANK YOU