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. 2025 Apr 23;29(5):263.
doi: 10.1007/s00784-025-06335-z.

Using panoramic radiographs to assess the probability of causing oroantral communication following tooth removal. A retrospective cross-sectional study

M M Bakacak #  1   2 , R C Hoogeveen #  3 , W E R Berkhout  2 , E M Van Cann  1   4
Affiliations

Using panoramic radiographs to assess the probability of causing oroantral communication following tooth removal. A retrospective cross-sectional study

M M Bakacak et al. Clin Oral Investig. .

Abstract

Objectives: To preoperatively assess the probability of oroantral communication (OAC) following the removal of maxillary (pre)molars using panoramic radiographs (PAN) and to assess the OAC-rate.

Materials and methods: During a 4,5-year period, patient characteristics of removals of maxillary (pre-)molars were recorded: 'sex', age, 'sidedness', 'type of tooth', 'reason for removal'' and 'occurrence of OAC'. On the PAN of OAC-cases and of 100 control cases, the 'Fraction of the Root Overlapping the Maxillary Sinus' (FROMS) was calculated. The OAC-rate was reported overall, per tooth type and for four diagnostic classes: A: no overlap, B: 0.1-25%, C: 25.1-50% and D > 50% overlap. Univariate tests and regression analysis were performed to test the association between OAC-rate and 'FROMS', 'sex', age, 'sidedness', 'type of tooth', 'reason for removal'.

Results: Of 2340 maxillary (pre-)molars removed, 112 resulted in OAC (OAC-rate of 4.8% (95%CI 3.9%-5.7%)) The FROMS diagnostic class was significantly associated with the OAC-rate (χ2 = 42.90 df3, p < 0.0001). For the four diagnostic classes the risk of OAC was (A) 1.0%, (B) 3.3%. (C) 10.1% and (D) 17.7%. The first molar showed highest OAC-rate with 7.0%. No association between OAC-rate and 'sex', age, 'sidedness', 'type of tooth', 'reason for removal' was found.

Conclusions: FROMS is a valid indicator of OAC probability. The overall OAC-rate was 4.8% and was highest in first molar removal.

Clinical relevance: Dentists and oral surgeons using PAN to assess OAC probability, can anticipate possible OAC and counsel patients.

Keywords: Adverse Effects; Oroantral Fistula; Panoramic Radiography; Peroperative Complications; Tooth Extraction.

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Conflict of interest statement

Declarations. This study was granted the approval of the Board of Directors of the Diakonessenhuis following the recommendation of its Research Bureau (Appendix 1). The approval of the Ethical Review Board of the Academic Center for Dentistry Amsterdam (ACTA) was also obtained, under number 2022–35410. The study was ruled not to be subject to the Medical Research Involving Human Subjects Act (WMO) (Appendix 2). Informed consent: No Informed consent was applicable for this study. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Examples of diagnostic classes of Fraction of Root Overlapping the Maxillay Sinus (FROMS) Upper left: No overlap of root with contour of maxillary sinus: diagnostic class A Upper right: FROMS 0.1% < 25%: diagnostic class B. Lower left:: FROMS 25.01%– 50%: diagnostic class C. Lower right: FROMS < 50%: diagnostic class D. (A) length of the root projected over the maxillary sinus (measured from apex to floor of the maxillary sinus) and (B) length of the root projected outside the maxillary sinus (measured between the line connecting the mesial and distal cemento-enamel junction and the sinus floor)
Fig. 2
Fig. 2
Graphical presentation of distribution of number of patients over the classes and OAC-rate per class based on Table 1. (OAC + oroantral communication; OAC- no oroantral communication)
See this image and copyright information in PMC

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