Which treatments are best for oro-antral fistulae?

Data sources Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Oral Health's Trials Register, the US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organisation International Clinical Trials Registry Platform. There were no restrictions on language or date of publication selected.Study selection Randomised controlled trials (RCTs) of interventions for the management of oro-antral fistulae or communications as a result of dental procedures only were considered. Crossover trials and quasi-randomised studies were excluded. Data extraction and synthesis Two reviewers independently elected studies, extracted data and assessed risk of bias. The main outcome of closure of the oro-antral fistulae or communications was dichotomous and expressed as a risk ratio (RR) 95% confidence intervals (CI). The GRADE approach was used to assess the overall quality of the evidence.Results Only one study with unclear risk of bias was included. This involved 20 patients and compared two surgical interventions: pedicled buccal fat pad flap and buccal flap. There was successful closure of all oro-antral communications in both groups, so no difference was reported between the interventions one month after surgery (RR 1.00, 95% Cl 0.83 to 1.20). The quality of the evidence was very low (GRADE). Conclusions As all the interventions in the one small study were effective there is insufficient evidence to assess any difference. Further research including large well-conducted and reported RCTs on treating oro-antral communications and fistulae caused by dental procedures is needed to inform clinical practice.