Oroantral communications (OACs) most commonly occur following tooth extraction in the posterior maxilla and require prompt surgical closure to prevent chronic oroantral fistula and maxillary sinusitis. Although numerous flap techniques have been described, evidence regarding the optimal suturing technique for OAC closure remains limited. This study aimed to compare the burst pressure resistance of different suturing techniques using an ex vivo porcine skin model.

An experimental biomechanical study was performed using unfixed porcine donor skin. Standardized 1-cm and 2-cm incisions were closed using simple interrupted, horizontal mattress, cross-stitch, or continuous sutures (continuous sutures were evaluated only for 2-cm incisions). Burst pressure at suture failure was measured using a custom-designed 3D-printed pressure chamber (n = 140). As most data were not normally distributed, non-parametric statistical analyses (Kruskal–Wallis test with Bonferroni-adjusted post hoc comparisons) were performed.

No statistically significant differences were observed among the suturing techniques for 1-cm incisions. For 2-cm incisions, simple interrupted sutures demonstrated significantly higher burst pressure resistance than continuous sutures (adjusted p < 0.001) and cross-stitch sutures (adjusted p = 0.015). No significant difference was observed between simple interrupted and horizontal mattress sutures.

Within the limitations of this ex vivo biomechanical model, simple interrupted sutures demonstrated greater resistance to burst pressure than continuous and cross-stitch sutures in 2-cm incisions. These findings may support the selection of suturing techniques during OAC closure; however, further studies using oral mucosa and in vivo models are required before direct clinical recommendations can be made.