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Oro-Antral Communication — ORE Part 1 MCQ

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ModerateOral SurgeryOro-Antral CommunicationORE Part 1

An oro-antral communication is noted after extraction of the upper left first molar. It is approximately 4 mm in diameter. What is the most appropriate immediate management?

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Correct answer: EPlace a figure-of-eight suture over the socket without raising a buccal flap

A 4 mm oro-antral communication falls into the category of small defects suitable for conservative management. UK NHS guidance confirms that small holes can be treated with simple sutures over the socket without raising a flap. This is supported by recent systematic review evidence (2025) which categorises defects <5 mm as amenable to conservative management with hemostatic measures, while larger defects (>5 mm) require flap-based surgical closure. A figure-of-eight suture provides secure closure and maintains primary healing. Option A (buccal advancement flap) is typically reserved for larger defects (>5 mm) or when conservative measures have failed. Option D (packing alone) lacks the definitive closure offered by suturing. Option B (antibiotics without closure) is inadequate as it does not address the defect itself. Option C (immediate OMFS referral) is unnecessary for a 4 mm defect manageable in primary care by an experienced dentist.

Reference: Oro-Antral Communication (OAC) Advice Leaflet, Chesterfield Royal Hospital NHS Trust, and Dipalma G, et al. (2025) Management of Oro-Antral Communication: A Systematic Review of Diagnostic and Therapeutic Strategies. Diagnostics 15(2):194. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11765130/