Comparison of Inverted Periosteal Flap Versus Buccal Advancement Flap for Closure of Post-Extraction Maxillary Sinus Perforation: A Randomized Controlled Trial
Sponsor study identifier
interventional
24
1 country
1
Study Start
September 15, 2024
Actual (reported)Primary Completion
August 8, 2025
Actual (reported)Study Completion
December 10, 2025
Actual (reported)This randomized controlled clinical study will evaluate the effectiveness of the inverted buccal periosteal flap in closing recent post-extraction oroantral communications and compare it with the conventional buccal advancement flap. The study will include 24 patients who develop an oroantral communication measuring 3-6 mm after non-surgical extraction of maxillary posterior teeth. Participants will be randomly allocated into two groups: the test group treated with the inverted buccal periosteal flap, and the control group treated with the buccal advancement flap. The primary outcome will be successful clinical closure of the communication, assessed by absence of oroantral fistula, nasal fluid leakage, and air leakage during the Valsalva test. Secondary outcomes will include postoperative pain, facial edema. Patients will be followed for up to 45 days after surgery.
Registry-reported information. Elapsed time and enrollment totals alone do not measure study progress or recruitment pace.
December 10, 2025
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Dates and qualifiers reported by the registry. Estimated dates do not confirm that a milestone has occurred.
September 15, 2024
Actual (reported)August 8, 2025
Actual (reported)December 10, 2025
Actual (reported)June 2, 2026
Actual (reported)June 5, 2026
Actual (reported)Successful Closure of Oroantral Communication
Successful closure will be assessed clinically by confirming the absence of oroantral fistula formation, absence of fluid leakage through the nose, and absence of air leakage or air bubbles during the Valsalva test.
1 week, 15 days, and 45 days after surgery.
Postoperative Pain
Postoperative days 1, 3, 5, and 7.
Postoperative Facial Edema
Postoperative days 1, 3, and 5.
Participants in this arm will receive surgical closure of the post-extraction oroantral communication using the inverted buccal periosteal flap. A full-thickness mucoperiosteal flap will be elevated, the periosteal layer will be dissected and inverted over the defect, then sutured to the palatal tissue to achieve tension-free closure.
Participants in this arm will receive surgical closure of the post-extraction oroantral communication using the conventional buccal advancement flap. A buccal mucoperiosteal flap will be elevated, advanced palatally, and sutured to the palatal mucosa to cover the communication.
Surgical closure of post-extraction oroantral communication using an inverted buccal periosteal flap. A full-thickness mucoperiosteal flap will be elevated, followed by dissection of the periosteal layer from the overlying mucosa. The periosteal flap will then be inverted over the defect and sutured to the palatal tissue to achieve tension-free closure.
Surgical closure of post-extraction oroantral communication using the conventional buccal advancement flap. A buccal full-thickness mucoperiosteal flap will be elevated, released by periosteal scoring, advanced palatally, and sutured to the palatal mucosa to cover the communication.
School of Dental Medicine
Damascus, Syria
Visscher SH, van Minnen B, Bos RR. Closure of oroantral communications: a review of the literature. J Oral Maxillofac Surg. 2010 Jun;68(6):1384-91. doi: 10.1016/j.joms.2009.07.044. Epub 2010 Mar 12. No abstract available.
Parvini P, Obreja K, Begic A, Schwarz F, Becker J, Sader R, Salti L. Decision-making in closure of oroantral communication and fistula. Int J Implant Dent. 2019 Apr 1;5(1):13. doi: 10.1186/s40729-019-0165-7.
Majd S Mohammad, DDs
Damascus University
Omar A Heshmeh, PhD
Damascus University
Saleh Al Kurdi, PhD
Arab International University
24 participants (actual enrollment reported by the registry).
First Submitted
June 2, 2026
First Posted
June 5, 2026
Study Start
September 15, 2024
Actual (reported)Acute Oroantral Communication Closure: Resorbable Collagen Membrane vs. Buccal Advancement Flap Outcomes
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Lago-Mendez L, Diniz-Freitas M, Senra-Rivera C, Gude-Sampedro F, Gandara Rey JM, Garcia-Garcia A. Relationships between surgical difficulty and postoperative pain in lower third molar extractions. J Oral Maxillofac Surg. 2007 May;65(5):979-83. doi: 10.1016/j.joms.2006.06.281.
Rosenfeld EA. Inverted periosteal flap: an alternative to the buccal advancement flap for tension-free, watertight closure. J Oral Maxillofac Surg. 2014 Jul;72(7):1244-50. doi: 10.1016/j.joms.2014.03.006. Epub 2014 Mar 20.
Ibrahim MT, Gharieb EA, Sheta MS. A pedicled buccal periosteal flap for the closure of oro-antral fistula. BMC Oral Health. 2024 Apr 10;24(1):440. doi: 10.1186/s12903-024-04217-6.
Primary Completion
August 8, 2025
Actual (reported)Study Completion
December 10, 2025
Actual (reported)Last Updated
June 5, 2026
Record last verified: 2026-06
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