Pedicled Buccal Fat Pad Research Articles

Titanium mesh and pedicled buccal fat pad for the reconstruction of maxillary defect: case report

BackgroundPedicled buccal fat pad (PBFP) has been used for the reconstruction of small-sized maxillary defects but cannot be used without hard tissue support on the defect larger than 4 cm × 4 cm × 3 cm.Case presentationA 64-year-old man had a history of squamous cell carcinoma of the left maxilla. After removal of the posterior maxilla, a complex bone defect (size, 5 cm × 4 cm × 3 cm) was immediately reconstructed using PBFP combined with a titanium mesh. A pinpoint fistula was found in the left palatal region 1 month after the surgery and was treated with a palatal sliding flap. There were no further complications during the follow-up.ConclusionThe present technique demonstrated that PBFP combined with a titanium mesh could be used for the reconstruction of complex maxillary defect (size, 5 cm × 4 cm × 3 cm) without additional bone graft.

New Tunneled Buccal Fat Pad Flap for Palatal Reconstruction.

In the palatal defects due to surgical resection, flap selection is very important for a correct reconstruction. Different methods have been suggested over the time, however the pedicled buccal fat pad is a simple, effective, reliable flap for reconstruction after palate tumor resection. The aim of the present study is to introduce a new surgical technique for palate reconstruction with pedicled buccal fat pad flap exposing the advantages. The Authors performed this procedure in 17 patients in order to treat medium-sized oncologic surgical defect of palate region in the period between 2016 and 2019. Complete wound healing after only 4 weeks without complication after 12 months follow-up was observed. This is the first cases series described with this new technique.

Buccal abscess derived from subcutaneous emphysema caused by the Valsalva maneuver after oral surgery with pedicled buccal fat pad grafting

AbstractPedicled buccal fat pad grafting is applied in a variety of oral surgeries, including the reconstruction of oral defects or the closure of oroantral communication. Pedicled buccal fat pad grafting is a well‐established and relatively safe procedure; however, it may cause complications such as swelling, hematoma and/or infection. There are few reports on the detailed cause and clinical course of these complications. This report discusses the Valsalva maneuver as a cause of complications after oral surgery with pedicled buccal fat pad grafting. A 77‐year‐old man underwent pedicled buccal fat pad grafting for oroantral communication after sequestrectomy for medication‐related osteonecrosis of the maxilla. Postoperatively, the performance of the Valsalva maneuver during defecation caused facial subcutaneous emphysema, hematoma and buccal abscess formation. The abscess could not be treated by antibiotics alone, and required surgical drainage. Prominent subcutaneous emphysema is associated with bleeding due to blood vessel damage, and may cause a large hematoma, especially in patients receiving antithrombotic therapy. Hematomas are susceptible to infection, and infections in the buccal space are often severe due to the tissue continuity in deep spaces. Therefore, buccal abscesses after pedicled buccal fat pad grafting require surgical drainage. This case report suggests that performing the Valsalva maneuver during defecation may cause complications after pedicled buccal fat pad grafting. Patients should be informed that the Valsalva maneuver could lead to serious complications, and that all types of the Valsalva maneuver should be avoided postoperatively.

Study Of The Efficacy Of Pedicled Buccal Fat Pad Graft Technique In The Management Of Oro-Antral Communications

Background of the study: Oro-antral communication is a complication associated with extraction of maxillary posterior teeth, surgeries of the maxillary sinus or pathologies associated with the sinus or the posterior maxilla. Such abnormal communications need to be repaired at the earliest, to maintain oral and nasal complex harmony and to prevent undue complications thereafter. These communications can be repaired by various methods, one of those being buccal fat pad pedicled graft technique which will be clinically evaluated and critically discussed in this paper. The pre-operative, immediate and post-operative measures followed, the eligibility criteria chosen and the duration of follow up period will formulate the outline for the study. A careful assessment of the criteria, clinical signs and healing is noted, to establish the outcome of the technique. Aim: The aim of this clinical study is to evaluate the effectiveness of buccal fat pad pedicled graft technique for closure of Oro-antral communications. The purpose of choosing this method is easy availability of the graft near to the recipient site, ease of technique for the surgeon, reliable technique and predictable outcome of the treatment. The effectiveness of the procedure and its predictability, in comparison to other methods is dealt in detail below. Methods: An observational study to evaluate the effectiveness of a surgical technique to repair oro-antral communications wherein the pedicled buccal fat pad is used as a graft material. 20 patients with OAC, who were presented to the department of Oral & Maxillofacial surgery, VS Dental College & Hospital, Bangalore were recruited for the study. The clinical study was conducted in accordance with the protocol and the results were evaluated on the basis of patient’s comfort towards the procedure, ease of the technique, healing time, post-operative complications and recurrence rate of the communication. The details of the technique and a review of the previous studies published were discussed in detail, to form a relevant summary. Results: The technique was found to be more effective and convenient to both the patient and operator, owing to its ease of performing, minimal risk of complications from the grafted site and the harvest site and predictable healing. Conclusions: The technique is easiest among the various methods recommended so far, pertaining to the procedure and predictability. Although, the training and experience of a skilled operator is equally important in achieving the best results.

Long-Term Outcomes of Zygomaticomaxillary Reconstruction With Autologous Bone Grafts Supported by Pedicled Buccal Fat Pad Flap.

The purpose of this study was to investigate the effectiveness of the pedicle buccal fat pad flap combined with autogenous bone grafts to reconstruct zygomaticomaxillary defects after tumor resection. A retrospective case series analysis of 11 patients that underwent zygomaticomaxillary reconstruction after tumor resection with autologous bone grafts supported by pedicle buccal fat pad flap as the lining of the maxillary sinus from January 2009 to December 2015 was performed. All the patients underwent computed tomography to measure the aesthetic appearance, bone graft formation, mucosa of the maxillary sinus, and their response to treatment, including complications. With a mean follow-up period of 4.7 years, all patients were pleased with the symmetrical contours of zygomaticomaxillary and symptom improvements of the maxillary sinus except for one patient who complained of transient infraorbital numbness. Recurrence, bone infection or necrosis, and other complications were not observed in the follow-up period. Pedicled buccal fat pad flap promotes wound healing and prevents the exposure of bone grafts to the maxillary sinus. This technique may be a promising treatment option when reconstructing complicated zygomaticomaxillary defects.

A patient who underwent bone gap arthroplasty and mobilization of the temporomandibular joint using a pedicled buccal fat pad via an intra-oral approach

A patient who underwent bone gap arthroplasty and mobilization of the temporomandibular joint using a pedicled buccal fat pad via an intra-oral approach

Is There a Difference in Volumetric Change and Effectiveness Comparing Pedicled Buccal Fat Pad and Abdominal Fat When Used as Interpositional Arthroplasty in the Treatment of Temporomandibular Joint Ankylosis?

There is limited evidence in the literature about fat grafting in the management of temporomandibular joint ankylosis (TMJA). The purpose was to investigate which interpositional fat grafting technique is superior in the operative management of TMJA. The specific aim was to compare the volumetric change and maximal mouth opening (MIO) when pedicled buccal fat or abdominal fat is interposed in patients being treated for TMJA. A randomized controlled trial was conducted on TMJA patients divided into 2 groups: Pedicled buccal fat pad was used for interposition in group A, whereas abdominal fat was used in group B. At the end of 1year, the volumetric change in fat was analyzed by comparing immediate postoperative and 1-year follow-up magnetic resonance imaging (MRI). MIO and re-ankylosis were recorded. Categorical variables were analyzed by the χ2 test or Fisher exact test. Continuous variables were compared using the t test and Wilcoxon signed rank test. Linear regression analysis was performed. A total of 36 patients (51 joints [15 bilateral and 21 unilateral]) were included, comprising 18 in group A and 18 in group B. The mean preoperative MIO measured 6.8mm in group A and 4.2mm in group B. The mean immediate postoperative MRI fat volume was 4.3cm3 in group A and 10.8cm3 in group B. One-year follow-up MRI showed a fat retention rate of 32.44% in group A and 58.17% in group B. The rate of volumetric shrinkage was 67.5% in group A and 41.9% in group B (P<.001). Analysis of variance showed a statistically significant difference between volumetric shrinkage and both treatment groups (P<.001). MIO improved to 30.6mm in the pedicled buccal fat pad group (group A) and 41.9mm in the abdominal fat group (group B) (P<.001). No re-ankylosis occurred in either group at 1-year follow-up. Our study results suggest that the percentage of retention of interposed abdominal fat at 1year is more than that of pedicled buccal fat pad. Volumetric shrinkage is greater with buccal fat pad, which is a paradox considering the pedicled blood supply. Abdominal fat is better than pedicled buccal fat pad when used for interposition in TMJA treatment.

Use of autogenous bone graft of the anterior wall of the maxillary sinus in the management of oroantral fistula

Introduction: The oroantral fistula consists of a persistent communication between the maxillary sinus and the buccal cavity, being a complication resulting from traumas, pathologies or dental extractions. Objective: To present a clinical case of oroantral fistula closure using autogenous bone graft from the anterior sinus wall as a treatment option. Materials and Methods: Patient with a history of traumatic extraction of the upper left molars about 4 months ago. During the clinical examination, there was an orifice in the left maxillary alveolar crest, suggestive of oroantral fistula, responding positively to the Valsalva maneuver. Panoramic radiographic examination evidenced continuity between the oral cavity and the left maxillary sinus, which presented with opacification, suggestive of acute maxillary sinusitis on the left side. Sinusitis was treated within 15 days. After treatment, we evaluated the patient who was asymptomatic and, at that moment, the surgical procedure for the oroantral fistula closure was planned, removing a bone block from the anterior wall of the left maxillary sinus presenting the sinus membrane and grafting with fixation using System 1.5 mm with an "L" plate and four bolts. Conclusion: This surgical technique is useful for the closure of chronic oroantral fistulas in patients with oroantral fistulas.Descriptors: Oroantral Fistula; Bone Transplantation; Maxillary Sinus.ReferencesMartín-Granizo R, Naval L, Costas A, Goizueta C, Rodriguez F, Monje F, Muñoz M, Diaz F. Use of buccal fat pad to repair intraoral defects: review of 30 cases. Br J Oral Maxillofac Surg. 1997;35(2):81-4.Yilmaz T, Suslu AE, Gursel B. Treatment of oroantral fistula:experience with 27 cases. Am J Otolaryngol. 2003;24(4):221-23.Anavi Y, Gal G, Silfen R, Calderon S. Palatal rotation-advancement flap for delayed repair of oroantral fistula: a retrospective evaluation of 63 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96(5):527-34.Haas R, Watzak G, Baron M. A preliminary study of monocortical bone grafts for oroantral fistula closure. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96(3):263-66Zide MF, Karas ND. Hydroxylapatite block closure of oroantral fistulas: report of cases. J Oral Maxillofac Surg. 1992;50(1):71-5.Poeschl PW, Baumann A, Russmueller G, Poeschl E, Klug C, Ewers R. Closure of oroantral communications with Bichat's buccal fat pad. J Oral Maxillofac Surg. 2009;67(7):1460-6.Jain MK, Ramesh C, Sankar K, Lokesh Babu KT. Pedicled buccal fat pad in the management of oroantral fistula: a clinical study of 15 cases. Int J Oral Maxillofac Surg. 2012;41(8):1025-29.Amaratunga NA. Oro-antral fistulae--a study of clinical, radiological and treatment aspects. Br J Oral Maxillofac Surg. 1986;24(6):433-37.Proctor B. Bone graft closure of large or persistent oromaxillary fistula. Laryngoscope 1969;79(5):822-26.Visscher SH, van Minnen B, Bos RR. Closure of oroantral communications: a review of the literature. J Oral Maxillofac Surg. 2010;68(6):1384-91.Visscher SH, van Roon MR, Sluiter WJ, van Minnen B, Bos RR. Retrospective study on the treatment outcome of surgical closure of oroantral communications. J Oral Maxillofac Surg. 2011;69(12):2956-61.Hanazawa Y, Itoh K, Mabashi T, Sato K. Closure of oroantral communications using a pedicled buccal fat pad graft. J Oral Maxillofac Surg. 1995;53(7):771-75.

Coverage of mucosal defects after oral cancer resection by the combination of the pedicled buccal fat pad flap and the “mucosal defect covered with fibrin glue and polyglycolic acid sheet （MCFP）” method

Coverage of mucosal defects after oral cancer resection by the combination of the pedicled buccal fat pad flap and the “mucosal defect covered with fibrin glue and polyglycolic acid sheet （MCFP）” method

Versatility of the pedicled buccal fat pad flap for the management of oroantral fistula: a retrospective study of 25 cases

PurposeMaxillary bone grafts and implantations have increased over recent years despite a lack of maxillary bone quality and quantity. The number of patients referred for oroantral fistula (OAF) due to implant or bone graft failure has increased, and in patients with an oroantral fistula, the pedicled buccal fat pad is viewed as a robust, reliable option. This study was conducted to document the usefulness of buccal fat pad grafts for oroantral fistula closure.Materials and methodsWe retrospectively studied 25 patients with OAF treated with a buccal fat pad graft from 2015 to 2018. Sex, age, OAF location, cause, duration, presence of systemic disease, smoking, previous dental surgery, and side effects were investigated.ResultsA total of 25 patients were studied. Mean patient age was 54.8 years, and the male to female ratio was 19:6. Causes of oroantral fistula were cyst enucleation, tumor resection, implant removal, bone graft failure, and extraction. Excellent results were obtained in 23 (92%) of the 25 patients. In the other two patients that both smoked, a small fistula was observed during follow-up. No recurrence of oroantral fistula was observed after 2 months to 1 year of follow-up.ConclusionsThe incidence of oroantral fistula is increasing due to implant and bone graft failures. Oroantral fistula closure using a pedicled buccal fat pad was found to have a high success rate.

Which treatments are best for oro-antral fistulae?

Data sources Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Oral Health's Trials Register, the US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organisation International Clinical Trials Registry Platform. There were no restrictions on language or date of publication selected.Study selection Randomised controlled trials (RCTs) of interventions for the management of oro-antral fistulae or communications as a result of dental procedures only were considered. Crossover trials and quasi-randomised studies were excluded. Data extraction and synthesis Two reviewers independently elected studies, extracted data and assessed risk of bias. The main outcome of closure of the oro-antral fistulae or communications was dichotomous and expressed as a risk ratio (RR) 95% confidence intervals (CI). The GRADE approach was used to assess the overall quality of the evidence.Results Only one study with unclear risk of bias was included. This involved 20 patients and compared two surgical interventions: pedicled buccal fat pad flap and buccal flap. There was successful closure of all oro-antral communications in both groups, so no difference was reported between the interventions one month after surgery (RR 1.00, 95% Cl 0.83 to 1.20). The quality of the evidence was very low (GRADE). Conclusions As all the interventions in the one small study were effective there is insufficient evidence to assess any difference. Further research including large well-conducted and reported RCTs on treating oro-antral communications and fistulae caused by dental procedures is needed to inform clinical practice.

Prophylactic Use of Buccal Fat Flaps to Improve Oral Mucosal Healing following Furlow Palatoplasty.

Furlow palatoplasty is increasingly used both for primary palatoplasty and for secondary correction of velopharyngeal insufficiency. Although Furlow palatoplasty offers the advantage of lengthening the palate, the most tenuous component of the oral mucosal repair is anterior transposition of the oral mucosal Z-plasty flap, with superficial separation of the oral mucosa observed in up to 53 percent of cases of secondary Furlow palatoplasty. To mitigate this problem, the authors prophylactically placed pedicled buccal fat pad flaps to provide an additional vascular layer to promote healing of the overlying oral mucosal Z-plasty flap. The authors report their experience comprising seven patients who underwent Furlow palatoplasty with buccal fat flap augmentation. Four of these patients had secondary Furlow palatoplasty procedures; one of them experienced oral mucosal separation that healed uneventfully. No patients developed an oronasal fistula. The authors' experience suggests that buccal fat flaps may minimize vascular compromise and dehiscence of the oral mucosal Z-plasty following Furlow palatoplasty. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.

Abstract: Prophylactic Use of Buccal Fat Flaps to Improve Oral Mucosal Healing Following Furlow Palatoplasty

BACKGROUND: Furlow palatoplasty (FP) is increasingly used both for primary palatoplasty and secondary correction of VPI. While FP offers the advantage of lengthening the palate, the most tenuous component of the oral mucosal repair is anterior transposition of the oral mucosal z-plasty flap. When a secondary FP was done to correct VPI following primary FP, the senior author found oral mucosal separation in 53% of cases. To mitigate this problem, we prophylactically placed pedicled buccal fat pad flaps to provide an additional vascular layer to promote healing of the overlying oral mucosal z-plasty flap. METHODS: A retrospective chart review identified patients who underwent pedicled buccal fat pad flaps with FP performed by the senior author (A.G.). Cleft palate diagnosis, Veau classification, primary and secondary palate repair surgeries, surgical technique and post-operative complications were extracted. The need for buccal fat flap augmentation was determined if the oral mucosal z-plasty flap showed duskiness during transposition or was under tension at the time of closure. Unilateral versus bilateral buccal fat flaps were chosen based on expected areas of tension in the final repair. On the buccal mucosa, a longitudinal incision just lateral to the most posterior aspect of the alveolar ridge was made, from which buccal fat was gently teased out. This was tunneled submucosally to the palatal repair site, where it was secured just posterior to the hard palate and anterior to the transposed levator veli palatine muscle. The oral side of the Furlow palatoplasty was then brought together over these pedicled buccal fat flaps. RESULTS: We identified six patients who underwent FP with buccal fat flap augmentation. Two patients (33%) were primary FP while four patients (67%) were secondary FP. Three patients had unilateral cleft lip and palate, two had submucosal cleft palate and one had cleft palate only. The youngest patient was 11 months old, and the oldest was 7 years and 9 months. Half of the procedures used bilateral buccal fat pad flaps while the remainder were unilateral. All patients were seen at two weeks postoperatively and followed up regularly, with average follow-up time of 21 months (range 8–41 months). Post-operatively, one patient demonstrated a 1 cm area of mucosal dehiscence at the tip of the posterior triangular flap, which healed uneventfully. There were no other post-operative complications observed, including donor-site complications, complications relating to the buccal fat pad flap. No patient developed an oronasal fistula. DISCUSSION: Our experience suggests that the buccal fat pad flap may minimize vascular compromise and dehiscence of the oral mucosal z-plasty following FP. This separation rate decreased from 8/15 (53%) patients in our prior series of secondary FP procedures to 1/4 (25%) patients undergoing secondary FP with buccal fat flaps. Cleft palate surgeons should consider adding this low-risk technique to their repertoire, as it provides an additional vascular layer beneath the most tenuous part of the oral mucosal closure in a FP, and may improve vascularity to the overlying oral mucosa so as to minimize dehiscence at this closure.

Interventions for treating oro-antral communications and fistulae due to dental procedures.

An oro-antral communication is an unnatural opening between the oral cavity and maxillary sinus. When it fails to close spontaneously, it remains patent and is epithelialized to develop into an oro-antral fistula. Various surgical and non-surgical techniques have been used for treating the condition. Surgical procedures include flaps, grafts and other techniques like re-implantation of third molars. Non-surgical techniques include allogenic materials and xenografts. This is an update of a review first published in May 2016. To assess the effectiveness and safety of various interventions for the treatment of oro-antral communications and fistulae due to dental procedures. Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 23 May 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2018, Issue 4), MEDLINE Ovid (1946 to 23 May 2018), and Embase Ovid (1980 to 23 May 2018). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. We also searched the reference lists of included and excluded trials for any randomised controlled trials (RCTs). We included RCTs evaluating any intervention for treating oro-antral communications or oro-antral fistulae due to dental procedures. We excluded quasi-RCTs and cross-over trials. We excluded studies on participants who had oro-antral communications, fistulae or both related to Caldwell-Luc procedure or surgical excision of tumours. Two review authors independently selected trials. Two review authors assessed trial risk of bias and extracted data independently. We estimated risk ratios (RR) for dichotomous data, with 95% confidence intervals (CI). We assessed the overall quality of the evidence using the GRADE approach. We included only one study in this review, which compared two surgical interventions: pedicled buccal fat pad flap and buccal flap for the treatment of oro-antral communications. The study involved 20 participants. The risk of bias was unclear. The relevant outcome reported in this trial was successful (complete) closure of oro-antral communication.The quality of the evidence for the primary outcome was very low. The study did not find evidence of a difference between interventions for the successful (complete) closure of an oro-antral communication (RR 1.00, 95% Cl 0.83 to 1.20) one month after the surgery. All oro-antral communications in both groups were successfully closed so there were no adverse effects due to treatment failure.We did not find trials evaluating any other intervention for treating oro-antral communications or fistulae due to dental procedures. We found very low quality evidence from a single small study that compared pedicled buccal fat pad and buccal flap. The evidence was insufficient to judge whether there is a difference in the effectiveness of these interventions as all oro-antral communications in the study were successfully closed by one month after surgery. Large, well-conducted RCTs investigating different interventions for the treatment of oro-antral communications and fistulae caused by dental procedures are needed to inform clinical practice.

Reconstruction of large oroantral defects using a pedicled buccal fat pad

BackgroundOroantral communicating defects, characterized by a connection between the maxillary sinus and the oral cavity, are often induced by tooth extraction, removal of cysts and benign tumors, and resection of malignant tumors. The surgical defect may develop into an oroantral fistula, with resultant patient discomfort and chronic maxillary sinusitis. Small defects may close spontaneously; however, large oroantral defects generally require reconstruction. These large defects can be reconstructed with skin grafts and vascularized free flaps with or without bone graft. However, such surgical techniques are complex and technically difficult. A buccal fat pad is an effective, reliable, and straightforward material for reconstruction.Case presentationThis report describes three cases of reconstruction of large oroantral defects, all of which were covered by a pedicled buccal fat pad. Follow-up photography and radiologic imaging showed successful closure of the oroantral defects. Furthermore, there were no operative site complications, and no patient reported postsurgical discomfort.ConclusionIn conclusion, the use of the pedicled buccal fat pad is a reliable, safe, and successful method for the reconstruction of large oroantral defects.

Clinical evaluation of Class II and Class III gingival recession defects of maxillary posterior teeth treated with pedicled buccal fat pad: A pilot study

Buccal fat pad (BFP) is a specialized vascular tissue adequately present in buccal space and is close to the maxillary posterior quadrant. The aim of this clinical study was to evaluate the utility of pedicled BFP (PBFP) in the treatment of Class II and III gingival recession. Ten systemically healthy patients with age ranging from 35 to 55 years with Class II and Class III gingival recession in the maxillary molars were selected. Before the surgical phase, patients were enrolled in a strict maintenance program including oral hygiene instructions and scaling and root planing. A horizontal incision of 1-1.5 cm was made in the buccal sulcus of the maxillary molar region; buccinator muscle was separated bluntly to expose the BFP. The fat was then teased out from its bed and spread to cover defects adequately. It was then secured and sutured without tension. Clinical parameters such as probing depth, recession width, recession length (RL), and width of keratinized gingiva were recorded at baseline and at 6 months postoperatively, and weekly assessment was done at 1 week, 2 weeks, 3 weeks, and after 4 weeks for observations during the postoperative healing. Treated recession defects healed successfully without any significant postoperative complications. Decreased gingival recession horizontal width values from 4.65 ± 0.4327 to 0.94 ± 1.350 and RL from 6.4 ± 1.075 to 0.7 ± 0.6750 were observed postoperatively (P < 0.05). Percentage of root coverage average was 89.3%. There was a statistically significant decrease in the width and depth of recession. Pedicled buccal fat showed promising results as the treatment modality in the management of Class II and Class III gingival recession of maxillary posterior teeth.

The Reliability of Free Buccal Fat Graft for Treatment of Severe Gingival Recessions at Mandibular and Maxillary Exposed Roots.

Introduction:The occurrence of gingival recessions (GRs) is multifactorial, mainly due to trauma induced by traumatic toothbrushing, orthodontic tooth movement, as well as anatomical factors such as bone dehiscence, teeth malposition, and muscle pull. Fat tissue in the oral cavity is widely available and easily accessed. The use of pedicled buccal fat pad (BFP) graft is well known in maxillofacial surgery and has been shown promising results, becoming safe and effective graft for several clinical applications. However the use of fat tissue harvested from the buccal fat pad as a free graft (BFFP) is less common, but recently, it has been described by the author for different intraoral clinical applications. The aim of this study is to present additional application using the BFFG for coverage of severe muco-GRs and to discuss the promising outcomes of this procedure.Patients and Methods:A technique for harvesting intraoral BFFG for the use in mucogingival surgery is presented. A total of 10 patients (age: 38.3 ± 6.8 years) with 17 teeth presenting severe GRs (4.8 ± 1.8 mm) were included in the study. Recessions treated using BFFGs were recorded at baseline and 12 months after surgery.Results:A total of 17 GRs were treated using BFFG. At 12 months, significant reduction of recession occurred. Initial recession was reduced from 4.8 ± 1.8 mm to 1.7 ± 0.9 mm. A mean of 3.1-mm reduction in GR was achieved compared to baseline.Conclusions:The new, simple, technique for treatment of severe GRs using BFFG resulted in significant reduction of GRs.

Two-Year Clinical Evaluation of Pedicled Buccal Fat Pad Alone and with Emdogain for Root Coverage of Severe Gingival Recession Defects: A Case Series.

Gingival recession is defined as an apical displacement of the gingival margin beyond the cementoenamel junction leading to serious consequences, including exposure of the root surface, loss of periodontal attachment, root sensitivity to hot and cold air, and esthetic problems. The aim of this study was to evaluate the long-term effect of pedicled buccal fat pad (PBFP) alone and with Emdogain in covering severe gingival recession defects and restoring tooth function. A total of 10 severe buccal recession defects in maxillary first molars were selected to be treated with PBFP, with Emdogain (group I; n = 5) or alone (group II; n = 5). Probing depth, clinical attachment level, depth of the gingival recession, width of the keratinized gingiva, and tooth mobility were recorded and statistically analyzed at baseline and during follow-up recalls until 2 years postoperatively. At 2 years, the percentage of root coverage was 60.18% and 59.07% for group I and group II, respectively, with significant differences compared to baseline and all follow-up times for each group but with statistically significant differences between groups (P > .05). Emdogain with PBFP did not show significant improvement compared to PBFP alone in terms of root coverage percentage. PBFP alone may be the better treatment for severe gingival recession defects.

Use of Pedicled Buccal Fat Pad for Midface Augmentation.

The pedicled buccal fat pad has occasionally been used for the closure of oroantral and oronasal fistulae. However, this versatile and convenient technique has not been used widely in the field of esthetic surgery. The main cosmetic interest in the buccal fat pads was to surgically extract them to reduce cheek prominence. Here, the authors introduce a novel operative technique using the pedicled buccal fat pad for midface augmentation in patients with deficient soft-tissue volume, particularly in the anterior malar or paranasal region. This rather simple surgical method can be performed either individually or concomitantly with reduction malarplasty. The surgical outcomes include a natural appearance with reliable long-term stability.

Low quality evidence for treatment approaches for oro-antral communications.

Data sourcesCochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline via Ovid, Embase via Ovid, US National Institutes of Health Trials Registry and the World Health Organisation (WHO) International Clinical Trials Registry Platform were searched until July 2015 followed by hand searching of relevant references.Study selectionUsing no language restrictions, two authors independently assessed for inclusion of randomised controlled trials (RCTs) evaluating any intervention for treating oro-antral communications (OAC) and oro-antral fistulae (OAF) due to dental procedures. Quasi-RCTs and crossover trials were excluded.Data extraction and synthesisTwo authors independently assessed for inclusion, resolved disagreement by discussion and a third reviewer was consulted if necessary.Qualitywas determined independently by using GRADE 2004.For the dichotomous outcome complete closure, they expressed the estimate effect as risk ratio (RR) with 95% confidence interval (CI).ResultsA single study that started with 22 participants was included in the review where the overall risk of bias was judged as unclear. The main outcome was complete closure. The study compared pedicled buccal fat pad flap (PBFPF) with buccal flap (BF) and showed no difference in the closure of OAC, with a calculated RR of 1.00, 95% CI 0.83 to 1.20.ConclusionsVery low quality evidence from a small single study provided insufficient proof to judge if there is a difference in the effectiveness of the interventions.