Background: Surgical repair of the oroantral fistula is one among the controversial things revolving around the surgeons working in the oral and maxillofacial region. This review article aimed to discuss the concepts and consensus revolving around the surgical management of oro antral fistula. The multiple techniques described in various literatures over the last 4 to 5 decades to arrive at the uniformly successful procedure for the closure of the oro antral fistula. In simplest terms, treatment modalities to repair the oroantral fistula include local or distant soft tissue flaps, with or without autogenous grafts or alloplastic implants. Immediate repairs of the acute oroantral defect have a uniformly high success rate, but the success rate of secondary closure of the chronic oroantral fistula is reported to be as low comparatively. Conclusion: The long-term closure of the oroantral fistula challenges all surgeons working in the oral and maxillofacial region. A historical review of the more valid techniques has been presented. A protocol for oroantral fistula closure is offered ie; the buccal sliding flap for little (5 to 10 mm) lateral or midalveolar defects; the palatal rotation flap for little (5 to 10 mm) palatal or midalveolar defects; the anterior-based dorsal tongue flap for moderate (10 to20 mm) anterior defects; and the temporalis flap is reserved for larger (>2 cm) posterior defects. Thus with the advancing trends in oral and maxillofacial surgery the techniques are evolving more and more to achieve desired result with much higher prognosis.