الفهرس 
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Abstract
The extraction of the maxillary teeth is a challenge to any dentist due to close relation between the roots of the maxillary teeth (especially upper molars) and the maxillary sinus floor, which in some cases the extraction lead to
oro-antral communication which need intervention by Caldwell-Luc procedure.
Pain, bleeding and infection are the most annoying postoperative complications occurring due to Caldwell-Luc approach and closure of the
oro-antral fistula so this study is carried out to evaluate the Ankaferd Blood Stopper after closure of the oro-antral communication.
This study was carried out on 14 adult patients with age ranged from 27 to 50 years old suffering from oro-antral fistula needed to be treated by Caldwell-Luc approach.They were selected from the outpatient Clinic of Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University. They were non-smokers, did not suffer from bilateral chronic maxillary sinus diseases and free from any systemic diseases make general anesthesia contraindicated.
Patients were divided into two groups:
• Group A (study group): seven patients had undergone closure of oro-antral fistula by buccal advanced flap through Caldwell-Luc approach with placement of Surgicel® soaked with Ankaferd Blood Stopper® inside the maxillary sinus.
• Group B (control group): seven patients had undergone closure of oro-antral fistula by buccal advanced flap through Caldwell-Luc approach with placement of Surgicel® inside the maxillary sinus.
All operations were carried out under general anesthesia in the operating theatre of Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University after taking history from all patients and clinical examination is done introrally, extraorally and radiographically by CBCT.
All patients undergone irrigation by normal warm saline and using nasal decongestant drops, plain chest radiograph and blood analysis.
In both groups, the pain was at maximum immediately after the operation and decreased by time with statically significant difference in each group independently and with no statically significant difference by comparing them together.
Regarding the swelling, it was at maximum after three days and subsided by time in the two groups and there was statically significance difference in the second follow-up.
In study group no cases suffered from postoperative bleeding from nostril, while in the control group about 30% of patients had bleeding from nostril immediately postoperatively and 15% of the patients had bleeding from the nostril after three days.
Regarding the infection, in study group, no cases showed neither infection nor pus formation at the site of OAF. While in control group, pus was observed in one case after two weeks and this case was eliminated from the sample and undergone another operation later. Also, another case showed pus after three months.
By using CBCT to evaluate the fluid level preoperatively and postoperatively after three months the Ankaferd Blood Stopper helped in accelerating subsided of fluid level accumulation rather than Surgicel alone with statically significant difference.
Microbiological test is done by using intraoperative swap from the maxillary sinus and postoperatively after one week by taking a swap from the post nasal discharge and comparing the two results and decrease the Staphylococcus and streptococcus bacteria.