Comparative Evaluation of Buccal Fat Pad and Subepithelial Connective Tissue Graft
Condition: Gingival Recession
MeSH terms: Gingival Recession
Study type: Interventional
Phase: Early Phase 1

Summary: 
      Compare between Buccal fat pad and subepithelial connective tissue graft in treatment of
      localized recession.

      Primary objective: to evaluate root coverage in terms of gingival thickness and esthetic.

      Secondary objective: to evaluate patient satisfaction and postoperative pain.
    

Detailed description: 
      Material and Methods

      16 patients from outpatient Oral Diagnosis dental clinic will participate in this study.

      Patient selection and hospitalization

      Prospective randomized clinical trial will be conducted on patients requiring correction of
      gingival recession. The research will be reviewed by the ethical committee of Faculty of
      Dentistry Ain Shams University.

      Patient Grouping

      Patient will be randomly allocated into one of the two groups:

      control group (8 patients): will be treated with coronally advanced flap combined with
      subepithelial Connective tissue graft (SCTG).

      Study group(8 patients): will be treated with coronally advanced flap combined with buccal
      fat pad (BFP).

      Preoperative Assessment

      For all patients routine radiographic investigations are required. The first phase of therapy
      formed of oral hygiene measures, scaling, subgingival debridement and correction of any
      disturbance in occlusion needed. A periodontal evaluation should be done two weeks after
      phase I therapy.

      A stent will be made for each defect with vertical groove located at the mid-labial region to
      standardize the placement and angulation of probe while taking measurement. All measurements
      will be taken with a standardized Williams graduated periodontal probe (Hu-Friedy).

      Surgical procedure:

        -  Oral antiseptic mouthwash will be used before anaesthetizing the surgical area. A field
           block anesthesia at the surgical area is given with a lidocaine and
           epinephrine-containing solution.

           a) Recipient site preparation

        -  A split-thickness flap will be reflected by a horizontal incision made at the papilla
           base, mesial and distal to the recession defects. Two slightly divergent incisions will
           be 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 continue
           with a split-thickness extending to the alveolar mucosa .

        -  After flap elevation scaling, planing 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 subepihelial CT graft in control group will be
           applied over the exposed root a single sling suture will fix the flap just coronal to
           the Cemento-enamel junction (CEJ). Flaps will also be coronally positioned.

           b) Donor site:

        -  In study group the buccal vestibule is anesthetized in vicinity of the first and second
           maxillary molar. The cheek will be retracted laterally and a mucosal incision will be
           made while leaving a cuff of non- attached mucosa for closure. The incision will be done
           throughout the mucosa and muscle meanwhile an external pressure will be applied on the
           skin in the area of the buccal fat pad. After the buccal fat pad exposure, the fascia is
           pierced with scissors. With a continuous external pressure on the cheeck a long hemostat
           is used to spread and manipulate the fat. With minimal delicate traction, the protruding
           portion of the fat pad is gently grasped and pulled outside of the incision then the fat
           is clamped at the base and the required amount is harvested and excised to be used in
           donor site. The incision is closed with suture .

        -  The control group will receive SCTG from the palate with a single incision technique .

      Postoperatively patients will be covered by Augmentine 1 gm tablets every 12 hours and flagyl
      500 mg every eight hours. Analgesics are given in a combined protocol; where ibuprofen 600mg
      and paracetamol 1gm are alternating. The patient is instructed to use 0.12% chlorhexidine
      mouthwash three times daily for two weeks.

      Methods of assessment

      The parameters which should be measured at baseline, 3 and 6 months after surgery:

        1. Plaque index (PI) will be recorded according to Silness and Loe .

        2. Gingival index (GI) will be recorded according to Loe and Silness .

        3. Probing depth (PD).

        4. Clinical attachment level (CAL).

        5. Recession depth (RD).

        6. Recession width (RW).

        7. Percentage of mean root coverage (MRC %) will be calculated as ([RD preoperative - RD
           postoperative]/RD preoperative) × 100%.

        8. Width of keratinized tissue (WKT).

        9. Gingival thickness (GTH).

       10. Root coverage esthetic score (RES).

       11. Pain level will be assessed by verbal, numeric scale and by recording amount of
           analgesic intake postoperatively.

      Result presentation and statistics

      Results will be tabulated and statistically analyzed.
    

Intervention name(s): free fat graft; subepithelial graft
Intervention type(s): Biological; Biological
Intervention description(s): fat harvested from patient will be used to cover exposed root; subepitheial graft harvested from palate
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Treatment