Systematic Review of Case Reports and Case Series Published Between 2015 and 2025 on the Use of Biomaterials for Closure of Oroantral Fistula
Clinical Snapshot
PICO Framework
| P — Population | Patients with oroantral fistulas (age range 20-77 years) from various etiologies including infections and tooth extractions |
| I — Intervention | Biomaterials for oroantral fistula closure including platelet-rich fibrin (PRF), advanced PRF, collagen membranes, and other grafts |
| C — Comparator | No specific comparator - descriptive synthesis of case reports and series |
| O — Outcomes | Oroantral fistula closure, symptom relief, healing outcomes, and complications |
Bottom Line
This systematic review of 18 case reports and series suggests that various biomaterials, particularly platelet-rich fibrin and collagen membranes, show promise for oroantral fistula closure. However, the evidence quality is limited by the study design - case reports provide the lowest level of clinical evidence without control groups or standardised outcome measures. While outcomes appear consistently positive across different biomaterials and patient populations, the lack of comparative data makes it impossible to recommend one approach over another. The significant variability in reporting standards and short follow-up periods further limit clinical applicability. Australian oral surgeons should interpret these findings cautiously, considering them as preliminary evidence that may inform treatment decisions alongside clinical experience, but should not rely on this evidence alone for practice changes. Higher-quality comparative studies are needed before definitive treatment recommendations can be made.
Key Findings
P Value: Not applicable - no statistical testing performed
Effect Size: Not quantifiable - descriptive synthesis only
Primary Outcome: Consistent oroantral fistula closure across all biomaterial types
Nnt Or Sensitivity: Success rate appears high but not quantified with confidence intervals
Confidence Interval: Not applicable for case series synthesis
Clinical Application
Biomaterials like PRF and collagen membranes are readily available in Australian oral surgery practices Relevant to Australian oral surgeons and dental specialists; biomaterials generally available through TGA-approved suppliers; technique training may be required for optimal outcomes Adult patients (20-77 years) with oroantral fistulas requiring surgical closure in oral and maxillofacial surgery practice
Abstract
Oroantral fistulas (OAFs) challenge the clinical decision-making of oral surgeons, requiring selection of an effective biomaterial for successful closure. This systematic review aims to evaluate recent biomaterials and techniques for closing oroantral fistulas, as reported in case reports and series. The goal of this review was to assess how different biomaterials affect the clinical closure of OAFs and oroantral communication. This systematic review followed PRISMA guidelines. Multiple scientific databases (Scopus, Web of Science, Cochrane Library) were comprehensively searched using relevant MeSH terms and Boolean operators. Inclusion criteria were case series, reports, and presentations using biomaterials for OAF closure published between 2015 and 2025, with visibly defined outcomes. Reviews, animal studies, and case series and reports without biomaterial use were excluded. Two independent reviewers performed title/abstract and full-text screening. Data extraction included patient demographics, OAF characteristics, biomaterials used, and outcomes. Narrative synthesis was performed after assessing quality using the Joanna Briggs Institute tool. The final assessment of 189 records yielded 18 eligible studies, having patients (age range 20-77 years) with varied etiologies, such as infections and extraction, OAF dimensions, and follow-up periods (9 days to 13 months). Commonly used biomaterials included platelet-rich fibrin (PRF), advanced PRF, collagen membranes, and other grafts. Patient outcomes showed consistent OAF closure, symptom relief, and uneventful healing. Studies represented 12 countries. Variability in reporting OAF characteristics was noted. Diverse biomaterials are effective for OAF closure, with frequent use of PRF and advanced PRF. Consistent reporting of OAF characteristics is essential for future research and improved comparability.
References
- 1.Ali, F. M., Alqahtani, A. S., Makrami, A. M., Odabi, N. I., Derbishi, A. A., Hakami, S. H., Jali, A., Alamir, A. M., & Mattoo, K. (2026). Systematic review of case reports and case series published between 2015 and 2025 on the use of biomaterials for closure of oroantral fistula. Medical Science Monitor, 32, Article MSM.952194. https://doi.org/10.12659/MSM.952194
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