الفهرس 
Review of the LiteratureOnly 14 pages are availabe for public view
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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.
Moreover, it has a rich blood supply and can be simply harvested by an intraoral flap with minimal invasion and complications for patients. BFP is formed of three lobes, anterior, intermediate and posterior. The BFP is fixed by six ligaments and supplied by many nutritional vessels. Its function is to occupy the deep masticatory spaces during muscle contraction by slippage and to protect the facial nerves and vessels from harm caused by extrusion of muscle contraction and external force impulsion.
Agrawal et al. used pedicle buccal pad of fat management of gingival recession. Agrawal et al. claimed that the currently used procedures mentioned previously in this review of literature for root coverage procedures in Miller’s Class III and IV gingival recession have a poor prognosis.
In 2014, Agrawal introduced a new predictable technique; which is the pedicled buccal fat pad (PBFP) in cases of severe gingival recession. He also found that it can serve as a well vascularized and easily obtainable local flap for regenerative purposes and to increase keratinized gingiva dimensions. However, he restricted this technique to upper posterior teeth because the pedicle cannot reach the anterior teeth.
Consequently, we aim in our research to use it as free graft rather than pedicled graft which will eliminate the limitation of use in posterior teeth as what was described by Agrwal. The BFP will be compared here in this research with the CTG as the latest can be considered nowadays as the gold standard method in the correction of recession.
10 patients from outpatient Oral Diagnosis dental clinic participated in this study. In study group the buccal vestibule was anesthetized in vicinity of the first and second maxillary molar. The cheek was retracted laterally and a mucosal incision was made while leaving a cuff of non- attached mucosa for closure. The incision was done throughout the mucosa and muscle meanwhile an external pressure was applied on the skin in the area of the buccal fat pad.
After BFP exposure, the fascia was pierced with scissors. With a continuous external pressure on the cheek a long hemostat was used to spread and manipulate the fat. With minimal delicate traction, the protruding portion of the fat pad was gently grasped and pulled outside of the incision then the fat was clamped at the base and the required amount was harvested and excised to be used in donor site. The incision was closed with suture.
In control group the patient received SCTG from the palate with a single incision technique. The recipient site was prepared with a split-thickness flap which was reflected by a horizontal incision made at the papilla base, mesial and distal to the recession defects. Two slightly divergent incisions were released from the end of the previous horizontal incisions with a full-thickness flap starting from margin of the gingiva reaching 3-4 mm after the exposed bone then continued with a split-thickness extending to the alveolar mucosa. After flap elevation scaling, subgingival debridement of the exposed root followed by root conditioning with a tetracycline solution (125 mg tetracycline/ml of saline). In the study group sites, previously prepared BFP or a SCTG in control group was applied over the exposed root using a single sling suture to fix the flap just coronal to the CEJ.
The results of the following study showed that the classical SCTG is more stable and successful in treatment of GR specially in long-term follow ups. The BFP was only successful in increasing soft tissue thickness and improved the recession in all the other parameters for just one month. Gradual relapse of the results in the study group took place until the final follow-up at 6 months.
The results showed that the BFP failed in achieving a reliable result in comparison to the gold standard used in control group in combination with CAF