A comparing the efficacy of Flapless Closure using Collagen sponge and Platelet-rich fibrin membrane with Buccal Advancement flap Closure in cases of Acute Oro-antral Communication

INTERVENTION: Intervention1: Flapless Closure of Acute Oro Antral Communication using Collagen Sponge and Platelet‐Rich Fibrin PRF Membrane: Patients in the intervention group will undergo flapless closure of acute Oro antral communication under local Anaesthesia using 2% lignocaine hydrochloride with 1:80000 adrenaline under aseptic conditions. After irrigation and decontamination of the socket the size of the Oro‐antral communication will be clinically assessed followed by placement of a resorbable collagen sponge within the defect to act as a scaffold for stabilization and healing. A platelet‐rich fibrin membrane prepared from autologous venous blood using Choukroun s protocol centrifugation at 3000 rpm for 10 minutes will then be placed over the collagen scaffold and secured to the surrounding mucoperiosteal tissues using 4‐0 vicryl sutures. Postoperative care will include antibiotics analgesics and standard sinus precautions with instructions to avoid nose blowing sneezing and use of straws. Patients will be followed up on the 7th and 14th postoperative days for assessment of pain using the Visual Analog Scale wound healing using Landry Turnbull and Howley Healing Inde Xand evaluation of postoperative complications including infection sinusitis and wound dehiscence. Control Intervention1: Buccal advancement flap closure: Patients in the comparator group will undergo conventional closure of acute Oro antral communication using the buccal advancement flap technique under local Anaesthesia with 2% lignocaine hydrochloride containing 1:80000 adrenaline under aseptic conditions. After thorough irrigation and debridement of the socket a broad‐based trapezoidal mucoperiosteal flap will be raised from the margin of the extraction socket extending into the buccal sulcus. The flap will be carefully reflected and advanced to achieve tension‐free closure of the Oro antral communication and secured over the defect using 4‐0 vicryl sutures. Postoperative management will include antibiotics analgesics and standard sinus precautions including avoidance of nose blowing sneezing and use of straws. Patients will be advised soft diet and instructed regarding oral hygiene maintenance. Sutures will be removed after 7 days and follow‐up will be done on the 7th and 14th postoperative days for evaluation of pain using Visual Analog Scale wound healing using Landry Turnbull and Howley Healing Inde Xand assessment of complications such as infection sinusitis and flap dehiscence. CONDITION: Health Condition 1: K088‐ Other specified disorders of teethand supporting structures PRIMARY OUTCOME: Comparison of clinical success rate of closure of acute Oro antral communication OAC between the two treatment groups collagen sponge + PRF membrane flapless closure vs buccal advancement flap closure assessed as complete closure of OAC without clinical or radiographic evidence of persistent communication or sinus‐related complications.Timepoint: 7th and 14th postoperative day. SECONDARY OUTCOME: Postoperative pain assessment measured using the Visual Analog Scale in both intervention and comparator groups ; ; Wound healing status evaluated using Landry Turnbull and Howley Healing Inde X; ; Incidence of postoperative complications including infection sinusitis and wound dehiscence recorded during follow‐up period ; ; Comparison of soft tissue healing response between both groups over the follow‐up periodTimepoint: 7th and 14th postoperative days INCLUSION CRITERIA: Acute OAC of 4 to 9 mm diameter following maxillary molar extraction