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user report _ oroantral communications I Fig. 4_Bone graft substitute in the defect. Fig. 5_The defect is filled up to the ginigival level. Fig. 6_Sligth expansion of the aug- mentate one day after the operation. Fig. 7_Superficial degradation of the bone graft substitute in the height of the biological with after two weeks. Figs. 8a & b_Complete soft tissue closure, occlusal view after 3 (left) and 8 months (right). Tab. 1_Localization of the OACs after tooth extraction. I 33implants4_2010 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8a Fig. 8b these techniques are also intricate and invasive, and there is always a risk for dislocation of graft material intothesinuscavity(Thomaetal.2006). Frequently,theoccurrenceofanoroantralcommu- nication is not anticipated and therefore the interven- tion to close the perforation was not scheduled in ad- vance.Aneasy,efficientandminimallyinvasivemethod would represent a benefit for both patients and clini- cians alike. Communication closure by insertion of root analogs made chair-side from a porous -tricalcium phosphate ( -TCP) composite fulfills these criteria (Thoma et al. 2006). The technique was shown to be fast and easy. Furthermore, less pain and swelling were observed compared to the patients that weretreatedwithabuccalflap(Gacicetal.2009).How- ever,thefabricationofrootanalogsisonlypossiblewith unfracturedrootsastemplates(Thomaetal.2006). Here, we present a template-independent tech- niquefororoantralcommunicationclosurethatusesa moldable polylactide-coated -TCP. The initially soft bone substitute hardens in the defect and thereby formsabarrierbetweentheoralandthenasalcavities. In this pilot study, we addressed the question whether thenovelmethodissuccessfulinclosingtheoroantral communications that have occurred in nine patients aftertoothextraction.Thesafeestablishmentofabar- rier, healing and regeneration of hard and soft tissue structureswereevaluated. _Materials and methods Subjectpopulationandclinicalsituation Allpatientswithanoroantralcommunicationafter tooth extraction between June 18, 2007, and October 17,2008,inaprivatedentalpracticeweretreatedwith thedescribedmethod.Thestudyincluded5femaleand 4malepatientswhowerebetween21and86yearsold. Theoccurrenceoforoantralcommunicationswasrou- tinelycheckedbyaskingthepatienttopressurizehisor hernasalcavity.Positivefindingswereverifiedvisually and with a blunt probe. Subjects were excluded from the study if the anamnesis or mucous nasal discharge indicatedanacuteinfectionofthemaxillarysinusorif theresidualheightofthebuccalplatewasbelow3mm, which may interfere with stable fixation of the graft material. Based on these criteria, no patient had to be excluded. The dimensions of the extraction sockets were measured by probing, radiographically and on clinical pictures (Figs. 1 & 2). The extraction defects measured 6 to 14 mm in the mesio-distal and 8 to 12 mm in the bucco-oral direction. The height of the buccalplateinthesocketwasbetween3and11mm.All extractionsocketsweresurroundedbyintactgingiva. Closureoftheoroantralcommunication Inafirststep,thesiteoftheperforationatthebot- tom of the extraction socket was covered with of oxy- genizedcellulose(Tabotamp,Johnson&JohnsonMed- ical,Gargrave,UnitedKingdom)(Fig.2)inordertopre- Region 18 17 16 15 14 24 25 26 27 28 OAC 1 – 1 1 – 1 – 3 2 –