Management strategies and determinants of clinical decision-making in oroantral communication among dental practitioners

TL;DR

This study explores how U.S. dental practitioners manage oroantral communications, finding that treatment varies by defect size and practitioner experience, but lacks standardization.

Contribution

The study identifies key factors influencing OAC management and highlights the need for standardized guidelines and training.

Findings

Collagen-based materials are commonly used for small OACs, while larger defects often require specialist referral or flap techniques.

Specialization and experience are strongly associated with management approach and material selection.

Timing of repair is relatively consistent across practitioner characteristics, but technique and material selection vary.

Abstract

Oroantral communication (OAC) represents an abnormal connection between the oral cavity and the maxillary sinus, often arising after posterior maxillary extractions. Unmanaged OACs can lead to chronic sinusitis and fistula formation. Despite various treatment options, standardized guidelines are lacking. This study examined current management strategies, influencing factors, and practitioner confidence in treating OACs among dental professionals in the United States (U.S.).

A nationwide, cross-sectional online survey was conducted among 193 dental practitioners. The survey assessed demographics, management preferences by perforation size, timing of repair, material selection factors, and self-reported comfort levels. Associations between practitioner characteristics and management choices were analyzed using Cramer’s V. Multivariate logistic regressions were also performed to evaluate independent predictors of (1) management choice, and (2) timing of repair.

Most respondents were male (72.8%) and mid-career practitioners. Management approaches varied by perforation size: collagen-based materials were common for small defects (0–2 mm), while specialist referral and flap techniques predominated for larger perforations (> 7 mm). 81% performed closure on the same day. Ease of use was the main factor guiding material choice (33.7%). Specialization showed a strong association with management approach (Cramer’s V = 0.654, p < 0.001), and experience with OAC cases was moderately to strongly related (Cramer’s V = 0.403, p = 0.007). In multivariate analyses, experience managing sinus perforations and self-rated confidence were associated with management choice, while no practitioner characteristics were independently associated with timing of repair.

Respondents demonstrated size-dependent escalation in OAC management, but variability persisted in technique and material selection. Adjusted analyses suggest that experience-related factors are more closely linked to material selection for moderate defects, whereas timing of repair appears relatively consistent across practitioner characteristics. These findings highlight the need for standardized, outcomes-informed guidance and targeted training to improve consistency and optimize patient outcomes.