FLAP-FREE TREATMENT OF AN

OROANTRAL COMMUNICATION
WITH PLATELET-RICH FIBRIN

PRESENTED BY :
DR.K.VISHNU PRIYATHAM
PG IST YEAR
 INTRODUCTION

 Oroantral communications can complicate dental surgery, particularly during extraction of

a posterior maxillary root, but they do heal spontaneously when the perforation is less

than 5mm in diameter.

 However, larger perforations need treatment, often with a mucoperiosteal buccal sliding

flap or buccal fat pad.

 There are other options, but these have disadvantages such as

postoperative swelling and pain, and loss of vestibular depth.

 A platelet- rich fibrin clot, first described by Chouckroun et al., is formed by

platelets, white cells, cytokines, and circulating stem cells enmeshed in a

fibrin matrix, and is a natural biomaterial that permits optimal healing.

 It can be sutured to tissue because of its 3- dimensional fibrinous

architecture. Here, they have used plugs of platelet-rich fibrin clots for flap-

free treatment of oroantral perforations after tooth extraction.

• TECHNIQUE:

 They treated new perforations of more than 5 mm in diameter in 20

patients who were non-smokers, had no systemic diseases, and no signs of
sinus disease.

 The diagnosis of oroantral communication was confirmed by blowing

through the nose and mouth.

 Granulation tissue was carefully removed and the socket rinsed with sterile
saline.
 Six x 10ml blood was taken into anticoagulant tubes and immediately

centrifuged at 400g for 10 minutes( nuve 200 centrifuge, Beckman coulter).

 Platelet-rich fibrin clots were sutured to the gingiva with 3-0 silk non-

resorbable sutures and the extraction cavity was filled with platelet-rich

fibrin.
 Suturing the clots prevents them from migrating to the sinus, and stabilizes
them.

 After the cavity has been filled with clots, the gingival margins were closed
with horizontal matrix sutures.

 Post-operative analgesic ( paracetamol) and mouth rinse(isotonic saline)

were prescribed 2-3 times daily.

 Antibiotics and nasal decongestants were not used.

 Patients were recommended to eat a soft diet and not to blow the nose
during the first week, and sutures were removed 10 days later.
 At the end of a week the platelet-rich fibrin had been transformed into
healthy granulation tissue.

 Three weeks postoperatively healing and epithelization of oral mucosa

was apparent.
 There is no need to raise a flap and the vestibular depth was protected,

which are the main advantages of using platelet-rich fibrin clots to close

oroantral communications after extraction.

 Wound
healing

Bone
hemostasis
regeneration

Wound Graft
sealing stabilization
• PRF contains more growth factors and is more biocompatible than PRP. It
possesses an additional favourable impact on wound healing due to its three
dimensional fibrin architecture and antimicrobial activity.

• PRF is a fibrin meshwork, in which platelet cytokines, growth factors and cells
are entrapped and discharged after a period and can serve as a resorbable
film.

• Fibrin is essential for blood clot contraction( retraction) that is, spontaneous
shrinkage of the clot, which plays a role in hemostasis, wound healing, and
restoring the flow of blood post obstructive thrombi.
• Mechanisms governing platelet- mediated tissue repair.

 They release cytokines, chemokines, and growth factors such as SDF-1 and

HGF that control recruitment, proliferation and activation of fibroblasts,

neutrophils, monocytes, SMCs, MSCs and other cell types critically involved in

wound healing.
• Stages of healing with PRP :

 Hemostasis

 Inflammation

 Cellular and matrix proliferation( most important phase of healing).

 Wound remodelling ( longest phase, which may involve scar tissue

formation).
• Advantages :

 Cost effective and safe.

 Minimally invasive technique with low risks and satisfactory clinical results
such as preventing complications or implant failure.
• A retrospective study was conducted in the maxillofacial surgery unit of the
Federico university of naples from April 2017 to December 2020.

• A total of 102 OAC patients with a lesion of a diameter of 5mm or more

were enrolled in the study and surgically treated, 63 patients were treated
with PRF alone; 39 patients were treated with a buccal flap or buccal fat
pad.
• Results: Locoregional healing of the surgical area was observed between 3 and
4 weeks in all patients, no recurrences were recorded. At 6 months the mucous
membrane of the maxillary sinus is completely regenerated and resumes
normal mucociliary functions.

• Conclusion : surgical treatment of OAC with PRF is less invasive surgical

technique than using mucous flaps or buccal fat pad. PRF is an autologous
material that contains growth factors and allows to preserve the height of the
vestibular height.
• This study shows that PRF is a viable alternative technique for immediate
closure of acute OACs. In addition, PRF can be used for tissue wound healing
and regeneration without any side effects.

• Clinically, the main advantage of this technique is protection of the depth of

the vestibular sulcus, because it is not necessary to raise a flap. Therefore
this technique enables the closure of OACs without primary flap closure or
any other surgical interventions.
• Moreover, this technique is cheap and easily accessible.

• The use of PRF for immediate closure of acute OACs will make the treatment
of OACs less traumatic and easier and will eliminate the need for special
surgical expertise.