الفهرس 
The evaluation of recession depth after treating miller class i and ii gingival recession using non- pedicled buccal fat pad graft compared to subepithelial connective tissue graft: A randomized controlled clinical trial
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Abstract
Gingival recession is a common periodontal disease that affects a significant percentage of the human population. Gingival recession is defined as the apical displacement of the gingival margin below the cementoenamel junction level. The etiology of this condition is multifactorial. This problem may affect the quality of life as it compromises the aesthetic and commonly causes dentin hypersensitivity.
Various surgical techniques have been used to treat areas with recession. The predictability of complete root coverage depends on the integrity of interdental periodontal supporting tissues. Therefore, complete root coverage can be reached in Miller class I and II, while class III shows usually partial root coverage and class IV usually shows no complete root coverage.
The subepithelial connective tissue graft (SCTG) with the coronally advanced flap technique (CAF) showed the best clinical outcomes in cases with Miller I and II gingival recessions. This technique is considered the gold standard as it is highly predictable in terms of providing a significant amount of root coverage and keratinized tissue gain in short and long term evaluation studies.
The hard palatal mucosa is the commonly used donor site to collect SCTG. However, previous studies reported patients’ discomfort, postoperative morbidity, and some postoperative complications following the harvesting process. Also, some palatal anatomical variations may limit the amount of the harvested SCTG or endanger the greater palatine artery.
Therefore, a new alternative autogenous grafting material such as the buccal fat pad (BFP) was introduced. BFP showed promising benefits as it is rich in adipose-tissue-derived stem cells (ADSCs). BFP has been reported to contain a thousand times the number of stem cells per gram in comparison to that from the bone marrow. They induce the expression and secretion of multiple growth factors such as insulin-like growth factor (IGF), vascular endothelial growth factor (VEGF), and transforming growth factor-beta 1(TGF-β1).
Moreover, the ADSCs own angiogenic characteristics and the ability to differentiate into vascular endothelial cells. Furthermore, the technique used to collect BFP is easy, simple to perform and practice on, and non-invasive. The healing of the donor site is fast and with low reported postoperative complications. The BFP is an organized type of tissue with different lipolysis kinetics and not subjected to lipid metabolism. So it retains its structure for a certain time.
Accordingly, the present randomized clinical trial was conducted to assess the amount of gingival recession depth reduction after using the non-pedicled buccal fat pad graft with the coronally advanced flap to sites with Miller Class I or II gingival recessions (GRs) in comparison to subepithelial connective tissue graft with the CAF which is considered the gold standard. twenty-four patients with Millar class I and II gingival recession were enrolled. 12 patients were randomly assigned to the control group SCTG+CAF, and the other 12 patients to be in the study group BFP+CAF. Clinical outcomes such as recession depth RD, percentage of root coverage RC%, recession width RW, keratinized tissue thickness KTT, keratinized tissue width KTW, pocket depth PD, clinical attachment level CAL, gingival index GI, and plaque index PI were evaluated at baseline, three month and six month follow-ups. Patient-reported postoperative pain was recorded for 14 days with VAS score.
The study revealed that the two groups showed a statistically significant reduction in recession depth from baseline to 6months follow-up. The median RD and RC% showed no significant difference between the two treatments at 3 months and 6 months. The BFP group showed a statistically significantly lower mean KTT and KTW than the SCTG at 3 and 6 months follow-up. No statistically significant difference was detected in patient-reported postoperative pain score between the two groups at all postoperative fourteen days.