## 1 Introduction  
Extraction of the third molars is the most common procedure performed by oral and maxillofacial surgeons [1]. In addition to traditional surgical complications such as bleeding, postoperative pain, infection, and nerve damage, oro-antral communication (OAC) may occur following the extraction of a maxillary molar. In OAC, the soft tissue and the bony barrier between the maxillary sinus and the oral cavity, which is partly only 0.5 mm thick, are perforated, leading to a communication between the oral cavity and the maxillary sinus [2]. Consequently, the fistula may undergo connective tissue epithelialization, which may lead to chronic sinusitis [3]. Research indicates that the surgical removal of the upper third molar in the maxilla may result in the opening of the maxillary sinus in as many as 13% of cases, whereas completely displaced teeth could increase the likelihood of sinus opening by up to 25% [4]. The incidence of OAC is estimated to be between 10% to 23% on average, depending on the surgical procedure and the extent of the impaction [4]. In particular, the prevalence of displaced third molars approaches 24%, which implies a substantial risk of OAC in clinics [5]. On average, it takes 48 to 72 h for epithelial tissue to migrate into OAC. A fistula may become chronic if surgical intervention is not performed within this time [6]. Typically, patients complain of fluid leakage from the nose, altered phonation, reduced suction build-up through the mouth when drinking, unpleasant taste sensations, and pain in the OAC region [7; 8; 9]. A common complication is maxillary sinusitis. The occurrence is associated with a polymicrobial infection that includes both aerobic and anaerobic bacteria. A combination of antibiotics and surgical intervention may be required to treat this condition [10]. Several methods can be used to diagnose OAC. In order to plan for extraction of the third molar in the maxilla, most commonly, a 2D panoramic slice image is obtained (referred to as panoramic radiography or orthopantomogram) [11]. Along with its high availability, it stands out for its good resolution, low radiation, and low cost, especially when compared to other 3D imaging technologies. Intraoral assessment may provide insight into the presence of a large OAC. In addition, other possibilities include the presence of a visible polyp in the secretory duct of the OAC; the Valsalva test, in which the patient exerts pressure on the maxillary sinus through exhalation, which then results in air leakage through the OAC; the use of imaging techniques (panoramic radiography and CT) to assess any bony defects; and finally probing or insertion of radiopoaure materials [3; 12]. There are concerns regarding the spread of germs and the potential for atrogenic extension of an OAC in the latter approach [13]. Low sensitivity and specificity are associated with the low invasive option, while germ spread and potential attorogenic complications are associated with the invasive option. Therefore, it is important to carefully consider which procedure is the most appropriate. With advanced artificial intelligence (AI)-based approaches, decision making and problem solving can be automated [14]. The clinical decision process is generated by algorithms using the patterns found in the input data points. The incorporation of artificial intelligence into everyday clinical practice is becoming increasingly important in many medical specialties, as well as dentistry and oral and maxillofacial surgery [15]. A review by [PERSON] et al. revealed an increasing interest in AI research in dentistry and oral and maxillofacial surgery [15]. Most of the papers listed in the review focused on the diagnosis of dental caries and other oral pathologies. Alveolar bone loss, the proximity of the third lower molar to the alveolar nerve, or the prediction of orthodontic extractions could be investigated for similar questions as in the present work [15].