Kiran Kumar Krishanappa Salian, Eachempati Prashanti, Kumbargere Nagraj Sumanth, Shetty Naresh Yedthare, Moe Soe, Aggarwal Himanshi, Mathew Rebecca J
Department of Prosthodontics, Faculty of Dentistry, Melaka-Manipal Medical College, Manipal Academy of Higher Education (MAHE), Jalan Batu Hampar, Melaka, Malaysia, 75150.
Cochrane Database Syst Rev. 2018 Aug 16;8(8):CD011784. doi: 10.1002/14651858.CD011784.pub3.
An oro-antral communication is an unnatural opening between the oral cavity and maxillary sinus. When it fails to close spontaneously, it remains patent and is epithelialized to develop into an oro-antral fistula. Various surgical and non-surgical techniques have been used for treating the condition. Surgical procedures include flaps, grafts and other techniques like re-implantation of third molars. Non-surgical techniques include allogenic materials and xenografts. This is an update of a review first published in May 2016.
To assess the effectiveness and safety of various interventions for the treatment of oro-antral communications and fistulae due to dental procedures.
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 23 May 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2018, Issue 4), MEDLINE Ovid (1946 to 23 May 2018), and Embase Ovid (1980 to 23 May 2018). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. We also searched the reference lists of included and excluded trials for any randomised controlled trials (RCTs).
We included RCTs evaluating any intervention for treating oro-antral communications or oro-antral fistulae due to dental procedures. We excluded quasi-RCTs and cross-over trials. We excluded studies on participants who had oro-antral communications, fistulae or both related to Caldwell-Luc procedure or surgical excision of tumours.
Two review authors independently selected trials. Two review authors assessed trial risk of bias and extracted data independently. We estimated risk ratios (RR) for dichotomous data, with 95% confidence intervals (CI). We assessed the overall quality of the evidence using the GRADE approach.
We included only one study in this review, which compared two surgical interventions: pedicled buccal fat pad flap and buccal flap for the treatment of oro-antral communications. The study involved 20 participants. The risk of bias was unclear. The relevant outcome reported in this trial was successful (complete) closure of oro-antral communication.The quality of the evidence for the primary outcome was very low. The study did not find evidence of a difference between interventions for the successful (complete) closure of an oro-antral communication (RR 1.00, 95% Cl 0.83 to 1.20) one month after the surgery. All oro-antral communications in both groups were successfully closed so there were no adverse effects due to treatment failure.We did not find trials evaluating any other intervention for treating oro-antral communications or fistulae due to dental procedures.
AUTHORS' CONCLUSIONS: We found very low quality evidence from a single small study that compared pedicled buccal fat pad and buccal flap. The evidence was insufficient to judge whether there is a difference in the effectiveness of these interventions as all oro-antral communications in the study were successfully closed by one month after surgery. Large, well-conducted RCTs investigating different interventions for the treatment of oro-antral communications and fistulae caused by dental procedures are needed to inform clinical practice.
口腔上颌窦交通是口腔与上颌窦之间的非自然开口。若不能自行闭合，开口会持续存在并被上皮化，进而发展为口腔上颌窦瘘。已采用多种手术和非手术技术来治疗该病症。手术方法包括皮瓣、移植及其他技术，如第三磨牙再植。非手术技术包括同种异体材料和异种移植物。这是对2016年5月首次发表的一篇综述的更新。
评估各种干预措施治疗因牙科手术导致的口腔上颌窦交通和瘘管的有效性和安全性。
Cochrane口腔健康信息专家检索了以下数据库：Cochrane口腔健康试验注册库（截至2018年5月23日）、Cochrane对照试验中心注册库（CENTRAL）（Cochrane图书馆，2018年第4期）、MEDLINE Ovid（1946年至2018年5月23日）以及Embase Ovid（1980年至2018年5月23日）。检索了美国国立卫生研究院试验注册库（ClinicalTrials.gov）和世界卫生组织国际临床试验注册平台以查找正在进行的试验。检索电子数据库时对语言或出版日期无限制。我们还检索了纳入和排除试验的参考文献列表以查找任何随机对照试验（RCT）。
我们纳入了评估任何治疗因牙科手术导致的口腔上颌窦交通或口腔上颌窦瘘的干预措施的RCT。我们排除了半随机对照试验和交叉试验。我们排除了关于因Caldwell-Luc手术或肿瘤手术切除导致口腔上颌窦交通、瘘管或两者皆有的参与者的研究。
两位综述作者独立选择试验。两位综述作者独立评估试验偏倚风险并提取数据。我们估计二分数据的风险比（RR）及95%置信区间（CI）。我们采用GRADE方法评估证据的总体质量。
本综述仅纳入一项研究，该研究比较了两种手术干预措施：带蒂颊脂垫瓣和颊瓣治疗口腔上颌窦交通。该研究涉及20名参与者。偏倚风险尚不清楚。该试验报告的相关结局为口腔上颌窦交通成功（完全）闭合。主要结局的证据质量极低。该研究未发现手术后1个月时两种干预措施在口腔上颌窦交通成功（完全）闭合方面存在差异的证据（RR 1.00，95%CI 0.83至1.20）。两组的所有口腔上颌窦交通均成功闭合，因此未出现因治疗失败导致的不良反应。我们未找到评估任何其他治疗因牙科手术导致的口腔上颌窦交通或瘘管的干预措施的试验。
我们从一项比较带蒂颊脂垫瓣和颊瓣的单一小型研究中发现了质量极低的证据。由于研究中的所有口腔上颌窦交通在手术后1个月均成功闭合，该证据不足以判断这些干预措施的有效性是否存在差异。需要开展大型、实施良好的RCT来研究治疗因牙科手术导致的口腔上颌窦交通和瘘管的不同干预措施，以为临床实践提供参考。
