case_images: PMC6233470_01
case_images: The fistula is clinically examined with a wide, blunt instrument to detect the site of the opening in relation to the adjacent structure.. Note: Clinically, the opening looks more posterior than that shown on the radiograph.
case_images: ccide-10-245Fig1.jpg
case_images: PMC6233470_01_ccide-10-245Fig1.jpg
case_images: f1-ccide-10-245
case_images: A 32-year-old, nonsmoker, systemically healthy man presents to our clinic with the chief complaint of an opening at the extraction site of the upper right first molar (Figure 1).
case_images: A preoperative panoramic radiograph was taken to detect the site of the fistula and the vertical bone height of the extracted tooth.. Note: The radiograph shows insufficient bone height to support clot formation and that the lining membrane is open directly to the crestal bone.
case_images: ccide-10-245Fig2.jpg
case_images: PMC6233470_01_ccide-10-245Fig2.jpg
case_images: f2-ccide-10-245
case_images: Radiographs were taken, and a diagnosis of chronic OAF was acquired (Figure 2).
case_images: At the site of the first molar, a large bony defect was found after the flap was raised and the bone was exposed.. Note: The defect exhibited a very shallow bone height, which made stabilization of the blood clot difficult.
case_images: ccide-10-245Fig3.jpg
case_images: PMC6233470_01_ccide-10-245Fig3.jpg
case_images: f3-ccide-10-245
case_images: Under local anesthesia, a three-sided flap was created; the bone was then exposed, and a large bone defect (greater than 5 mm) was found (Figure 3).
case_images: Slowly resorbable collagen membrane was placed as a first layer to close the bone opening and fixed in place with sutures to prevent dislodgment or being aspirated into the sinus.
case_images: ccide-10-245Fig4.jpg
case_images: PMC6233470_01_ccide-10-245Fig4.jpg
case_images: f4-ccide-10-245
case_images: Slow-resorption collagen membrane extracted from bovine tendon containing collagen type I (Genoss, Gyeonggi-do, South Korea) was used to cover the bone defect and was fixed in place with nylon suture (Figure 4).
case_images: Multiple platelet-rich fibrin clots (more than one clot layered above each other) were placed as a second layer to cover the bony defect and enhance soft-tissue healing.
case_images: ccide-10-245Fig5.jpg
case_images: PMC6233470_01_ccide-10-245Fig5.jpg
case_images: f5-ccide-10-245
case_images: PRF clot was placed above the collagen membrane in two layers (Figure 5).
case_images: The double-layer flap was closed using mattress and single interrupted sutures with a free-tension flap and eversion to avoid wound dehiscence.
case_images: ccide-10-245Fig6.jpg
case_images: PMC6233470_01_ccide-10-245Fig6.jpg
case_images: f6-ccide-10-245
case_images: Horizontal and vertical mattress suturing was performed with interrupted stitches between layers (Figure 6).
case_images: Wound healing was evident after 2 weeks, and the sutures were partially removed.. Note: The fistula was closed, with no communication between the oral and nasal cavities.
case_images: ccide-10-245Fig7.jpg
case_images: PMC6233470_01_ccide-10-245Fig7.jpg
case_images: f7-ccide-10-245
case_images: At 2 weeks, the wound matured, and signs of inflammation had disappeared; the sutures were partially removed (Figure 7).
case_images: Six weeks after surgery, complete wound healing with obvious hypertrophy of the soft tissue was observed.
case_images: ccide-10-245Fig8.jpg
case_images: PMC6233470_01_ccide-10-245Fig8.jpg
case_images: f8-ccide-10-245
case_images: Gingival overgrowth and an increase in thickness were observed when the patient returned for further follow-up at 6 weeks after surgery (Figure 8).