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Abordagens integradas das fístulas oro-antrais : estratégias de prevenção, diagnóstico, técnicas de fechamento e reabilitação dentária
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Advisor(s)
Abstract(s)
As fístulas oro-antrais (FOA) correspondem a comunicações patológicas entre a cavidade oral e o seio maxilar, geralmente resultantes de extrações dentárias, traumas, infeções ou complicações relacionadas com implantes. A sua ocorrência compromete a integridade da barreira anatómica e funcional entre os dois compartimentos, favorecendo a sinusite, a má cicatrização e a falência da reabilitação oral. Esta revisão narrativa propõe uma análise integrada dos aspetos anatómicos, clínicos, terapêuticos e reabilitadores envolvidos na prevenção, diagnóstico, encerramento cirúrgico e reabilitação dentária das FOA. Apresenta-se uma revisão pormenorizada da anatomia funcional do seio maxilar, com destaque para as variações anatómicas que influenciam tanto o risco de ocorrência como a estratégia terapêutica. São discutidas as abordagens diagnósticas, com a avaliação clínica, nas provas funcionais e na imagiologia tridimensional por tomografia computorizada de feixe cónico (CBCT). As técnicas cirúrgicas são analisadas em função da cronicidade e da dimensão do defeito, incluindo retalhos locais, retalho palatino, enxertos com gordura bucal, membranas de regeneração tecidular e o uso de fibrina rica em plaquetas. São ainda abordadas tecnologias emergentes como a impressão 3D e os implantes personalizados.
A revisão contempla igualmente os princípios da reabilitação dentária após o encerramento, incluindo reconstruções ósseas, planificação implantar e uso de próteses
obturadoras. A seleção terapêutica deve basear-se numa avaliação individualizada da complexidade anatómica e dos objetivos funcionais, integrando uma abordagem
multidisciplinar centrada no doente
Oroantral fistulas (OAF) are pathological communications between the oral cavity and the maxillary sinus, most often caused by dental extractions, trauma, infections, or implant-related complications. Their occurrence poses risks of sinusitis, impaired healing, and compromise of future oral rehabilitation. This narrative review provides an integrated analysis of the anatomical, clinical, and therapeutic aspects involved in the prevention, diagnosis, surgical closure, and dental rehabilitation of OAF. It begins with a detailed review of the functional anatomy of the maxillary sinus, emphasizing anatomical variations such as sinus floor pneumatization, root proximity, and septa that influence both the occurrence and management of OAF. Diagnostic strategies are discussed, with particular focus on clinical signs, functional tests, and imaging techniques, notably cone-beam computed tomography (CBCT), which enables precise assessment of the communication and sinus condition. Surgical techniques are presented according to defect size, chronicity, and sinus health. These include local mucosal flaps, palatal flaps, buccal fat pad grafts, use of platelet-rich fibrin (PRF), and guided tissue regeneration membranes. Technological innovations such as 3D printing and custom implants are also addressed in complex cases. The review also considers dental rehabilitation following closure, including the role of bone reconstruction and implant planning, with emphasis on long-term functional and aesthetic integration. Clinical decision-making should be guided by anatomical complexity and rehabilitation goals, within an integrated and patient-centered approach.
Oroantral fistulas (OAF) are pathological communications between the oral cavity and the maxillary sinus, most often caused by dental extractions, trauma, infections, or implant-related complications. Their occurrence poses risks of sinusitis, impaired healing, and compromise of future oral rehabilitation. This narrative review provides an integrated analysis of the anatomical, clinical, and therapeutic aspects involved in the prevention, diagnosis, surgical closure, and dental rehabilitation of OAF. It begins with a detailed review of the functional anatomy of the maxillary sinus, emphasizing anatomical variations such as sinus floor pneumatization, root proximity, and septa that influence both the occurrence and management of OAF. Diagnostic strategies are discussed, with particular focus on clinical signs, functional tests, and imaging techniques, notably cone-beam computed tomography (CBCT), which enables precise assessment of the communication and sinus condition. Surgical techniques are presented according to defect size, chronicity, and sinus health. These include local mucosal flaps, palatal flaps, buccal fat pad grafts, use of platelet-rich fibrin (PRF), and guided tissue regeneration membranes. Technological innovations such as 3D printing and custom implants are also addressed in complex cases. The review also considers dental rehabilitation following closure, including the role of bone reconstruction and implant planning, with emphasis on long-term functional and aesthetic integration. Clinical decision-making should be guided by anatomical complexity and rehabilitation goals, within an integrated and patient-centered approach.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Fístulas oroantrais Surgical technique Closure OAF Oroantral communication