Comparative Evaluation of Buccal Fat Pad and Subepithelial Connective Tissue Graft in the Treatment of Localized Recession (Randomized Clinical Trial)

Abstract

The main goal nowadays in periodontal plastic surgery is to achieve maximal root coverage in the treatment of gingival recession with minimal invasive procedure, provide the patient good esthetic and protect teeth from any dentinal hypersensitivity and root caries. Several surgical techniques have been suggested for the treatment of dental root exposure in form of free or pedicle graft, based on soft tissue reposition like (pedicle flap techniques; It has been reported that pedicle flaps provide high success in achieving root coverage or on grafting like (free gingival graft or SCTG). The coronally advanced flap procedure involves a coronal reposition of the gingiva located apically to the recession to cover root exposure. In 1926, Norberg was the first to introduce this procedure to periodontology literature. In 1975, Bernimoulin described the exact technique of performing the coronally advanced flap in two situations; which are single and multiple recessions. Bernimoulin et al. performed CAF subsequent to free gingival graft augmentation. Pini Prato et al. combined the CAF procedure with nonresorbable membranes. Several regenerative materials have been combined with coronally Advanced Flap (CAF) such as, platelet rich fibrin (PRF), platelet rich plasma (PRP). In 1997, Egyedi was the first to describe the use of the pedicled buccal fat pad flap for the closure of oroantral communications after surgical ablative resections. Then in 1983 Neder was the first to use buccal fat pad (BFP) as a free graft in oral cavity reconstruction procedure. Back in 1986, Tideman noticed that the pedicled buccal fat pad flap gets epithelialized in a period of 3–4 weeks; consequently, coverage with a skin graft is not mandatory. Many studies have conducted the use of buccal pad of fat for closure of delayed oroantral fistula, immediate oronantral communication and oronasal communications secondary to traumatic extraction of upper molars and premolars. Rapidis used pedicled BFP flaps for surgical reconstruction and closure of medium sized post-resection acquired surgical defects. Moreover, Amin showed how effectively a buccal fat pad can be used to close a large surgical defect as partial maxillectomy defects acquired prior to surgical resection of neoplastic diseases. The simplicity of procedure with its low complication rates and excellent functional outcome; was the reason encouraging us to use a BFP as a way of surgical reconstruction of defects. The buccal pad of fat is a specialized fatty tissue which can be considered as a novel source of mesenchymal cells (MSC). It contains an abundant population of stem cells. These cells have high potential for regeneration of different specialized periodontal tissues. Therefore, BFP can be considered as a convenient promising source for tissue engineering in oral and craniofacial areas; since it is simple to harvest and offers a good amount and quantity of tissues.