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1 One stage operation of large oroantral fistula closure, sinus lifting for dental implant installation Bu-Kyu Lee Department of Oral and Maxillofacial Surgery, Asan Medical Center, College of Medicine, Ulsan University Abstract Bone grafts at the maxillary sinus are often required after closure of an oroantral fistula (OAF) to allow for subsequent implant installation. The present report describes a single procedure that provides large OAF closure and bone grafting at the involved sinus. This technique involves sinus mucosal lifting via elevating the sinus membrane, which is recovered as a continuous layer by combining the residual sinus membranes with a flipped part of the oral mucosa around the OAF. This technique involves sinus mucosal lifting via elevating the sinus membrane, which is recovered as a continuous layer by combining the residual sinus membranes with a flipped part of the oral mucosa around the OAF. Autogenous bone from the Ileum was grafted into the prepared sinus space, and the oral side of the graft was covered by a rotated palatal flap. This technique was used to treat 3 patients who had large OAFs in the atrophied posterior maxillay region due to previous multiple implant failures after sinus lifting. The treatment was successful in all cases. This technique appears to be suitable for large OAFs where implants are subsequently required. Keywords; bone graft, dental implant, OAF, oroantral fistula, sinus lifting 26 Implantology Vol. 12, No

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3 original article 28 Implantology Vol. 12, No

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골편의 구강내 노출된 부위를 덮기 위 전하여 재위치 시킨 후 주변의 점막과 봉합을 하였다.

portion은 합성 collagen(terudermis, al palatal pedicled flap)을

5 original article (a) (b) Fig 5. Corticocancellous block bone으로 다리를 만들고, particulated marrow bone particle로주변을 채워 이식한다. 4. 구개회전피판을 이용한 구강부의 폐쇄 cle의 혈류에 영향을 주지 않도록 하면서 주의 깊게 피판을 회 OAF부위에 이식된 골편의 구강내 노출된 부위를 덮기 위 전하여 재위치 시킨 후 주변의 점막과 봉합을 하였다. Donor 하여, 전층(Full thickness)의 회전 구개유경 피판(rotation- site의 denuded portion은 합성 collagen(terudermis, al palatal pedicled flap)을 이용하였다(figure 1, 6). pedi- Terumo, Japan)으로 덮어주어 점막의 치유를 촉진 시켰다 Fig 6. 구개유경 피판을 회전시켜 이식부의 구강부를 덮어 Fig 7. 술 후 resin splint를 장착한 모습. 준 모습. 30 Implantology Vol. 12, No

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7 original article 32 Implantology Vol. 12, No

8 1. Boyne PJ, James RA. Grafting of the maxillary sinus floor with autogenous marrow and bone. J Oral Surg 1980;38(8): Raghoebar GM, Timmenga NM, Reintsema H, et al. Maxillary bone grafting for insertion of endosseous implants: results after months. Clinical oral implants research 2001;12(3): Dolanmaz D, Tuz H, Bayraktar S et al. Use of pedicled buccal fat pad in the closure of oroantral communication: analysis of 75 cases. Quintessence Int 2004;35(3): Haas R, Watzak G, Baron M et al. A preliminary study of monocortical bone grafts for oroantral fistula closure. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96(3): Anavi Y, Gal G, Silfen R, Calderon S. Palatal rotation-advancement flap for delayed repair of oroantral fistula: a retrospective evaluation of 63 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96(5): Kraut RA, Smith RV. Team approach for closure of oroantral and oronasal fistulae. Atlas Oral Maxillofac Surg Clin North Am 2000;8(1): el-hakim IE, el-fakharany AM. The use of the pedicled buccal fat pad (BFP) and palatal rotating flaps in closure of oroantral communication and palatal defects. J Laryngol Otol 1999;113(9): Awang MN. Closure of oroantral fistula. Int J Oral Maxillofac Surg 1988;17(2): Abuabara A, Cortez AL, Passeri LA et al. Evaluation of different treatments for oroantral/oronasal communications: experience of 112 cases. Int J Oral Maxillofac Surg 2006;35(2):

9 original article 10. Al-Qattan MM. A modified technique of using the tongue tip for closure of large anterior palatal fistula. Ann Plast Surg 2001;47(4): Proctor B. Bone graft closure of large or persistent oromaxillary fistula. Laryngoscope 1969;79(5): Watzak G, Tepper G, Zechner W et al. Bony press-fit closure of oroantral fistulas: a technique for pre-sinus lift repair and secondary closure. J Oral Maxillofac Surg 2005;63(9): Jensen OT. Sinus bone grafting for oral antral fistulae. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology & Endodontics 2004;97(1): Ficking, B.W. Oral surgery involving the maxillary sinus. Ann R Coll Surg 1957;20(1): Ogunsalu C. A new surgical management for oro-antral communication: the resorbable guided tissue regeneration membrane--bone substitute sandwich technique. West Indian Med J 2005;54(4): Jung JH, Choi BH, Jeong SM et al. A retrospective study of the effects on sinus complications of exposing dental implants to the maxillary sinus cavity. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics 2007;103(5): Kurien M, Raman R, Job A. Roentgen examination of maxillary sinus, antral puncture and irrigation--a comparative study. Singapore medical journal 1989;30(6): Sjostrom M, Sennerby L, Nilson H et al. Reconstruction of the atrophic edentulous maxilla with free iliac crest grafts and implants: a 3-year report of a prospective clinical study. Clinical implant dentistry and related research 2007 ;9(1): Nelson K, Ozyuvaci H, Bilgic B et al. Histomorphometric evaluation and clinical assessment of endosseous implants in iliac bone grafts with shortened healing periods. The International journal of oral & maxillofacial implants 2006;21(3): James RB. Surgical closure of large oroantral fistulas using a palatal island flap. J Oral Surg 1980;38(8): Hwang D, Wang HL. Medical contraindications to implant therapy: Part II: Relative contraindications. Implant dentistry 2007;16(1): Chung DM, Oh TJ, Lee J et al. Factors affecting late implant bone loss: a retrospective analysis. The International journal of oral & maxillofacial implants 2007;22(1): Strietzel FP, Reichart PA, Kale A et al. Smoking interferes with the prognosis of dental implant treatment: a systematic review and metaanalysis. Journal of clinical periodontology 2007;34(6): DeLuca S, Zarb G. The effect of smoking on osseointegrated dental implants. Part II: Peri-implant bone loss. The International journal of prosthodontics 2006;19(6): Bain CA. Smoking and implant failure--benefits of a smoking cessation protocol. The International journal of oral & maxillofacial implants 1996;11(6): Gorman LM, Lambert PM, Morris HF et al. The effect of smoking on implant survival at second-stage surgery: DICRG Interim Report No. 5. Dental Implant Clinical Research Group. Implant dentistry 1994;3(3): Bain CA, Moy PK. The association between the failure of dental implants and cigarette smoking. The International journal of oral & maxillofacial implants 1993;8(6): DeLuca S, Habsha E, Zarb GA. The effect of smoking on osseointegrated dental implants. Part I: implant survival. The International journal of prosthodontics 2006;19(5): van den Bergh JP, ten Bruggenkate CM, Krekeler G, Tuinzing DB. Sinusfloor elevation and grafting with autogenous iliac crest bone. Clin Oral Implants Res 1998;9(6): Jensen OT, Shulman LB, Block MS et al. Report of the Sinus Consensus Conference of Int J Oral Maxillofac Implants 1998;13 Suppl: Implantology Vol. 12, No

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