Treatment of Miller Class I Gingival Recession with Using No
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Gingival recession is the apical displacement of the gingival tissue in relation to the cementoenamel junction resulting in the root surface being exposed to the oral environment. This exposure may lead to dentin sensitivity, pain, risk of root caries, abrasion, and erosion lesions, in addition to not being esthetic. Its etiology is associated with several factors such as biofilm accumulation, chemical and mechanical trauma, orthodontic treatment, quantity and quality of keratinized gingiva, and occlusal trauma.

Success in the treatment of gingival recessions is directly related to its severity. In Miller Class I and Class II recessions, there is no interproximal tissue loss; thus, complete root coverage is feasible

A female, presented to the Dentistry Clinic reporting a lack of gingival symmetry between the maxillary left and right canines and with the desire to eliminate oral mucosa biting. The clinical exam confirmed the face rounded and cheek biting and revealed a Miller Class I gingival recession on the maxillary left canine . The removal of the Bichat fat pad was suggested to the patient with the objective of eliminating the oral mucosa biting and using the tissue for the root coverage.

The surgical procedure was initiated by harvesting the buccal fat pad. The incision location is at the vestibule fundus, at the distal caries of the second molar with a 30 mm distance from the vestibule and above the Parotid duct . The incision is made, initially, by perforating the alveolar mucosa, buccinator muscle, and connective tissue capsule that surrounds the Bichat buccal fat pad. Then, the incision is extended about 1.5 cm until it reaches the mesial caries of the first molar . A curved hemostat was used to enlarge the tissues. The buccal extension of the Bichat ball is completely removed by careful circular movements . 4 ml of buccal fat pad was removed. The donor site was immediately sutured with a 4.0 silk thread with a simple suture .

The preparation of the recipient site (gingival recession on the maxillary left canine) was performed with an intrasulcular incision and two divergent vertical incisions toward the vestibule bottom. A partial thickness flap was then raised, and a periosteal releasing incision was made so the flap could be loosened and slid to cover the graft. The canine root was then scaled and planned with 5-6 Gracey curettes and irrigated with sterile saline solution. A portion of the buccal fat pad was cut into a size that was sufficient to cover the recipient site, its surface was macerated with a scalpel blade, and the graft was positioned. The graft was stabilized with an X suture using a 5.0 resorbable suture thread, and the flap was then coronally positioned and anchored with simple and suspension sutures.
As postoperative medications, amoxicillin 500 mg and ibuprofen 400 mg were prescribed. The patient was instructed to rinse the surgical site with 0.12% 58 chlorhexidine digluconate solution twice a day, for 1 week. The suture was removed 15 days post surgery.

The patient reported that the oral mucosa biting was completely eliminated and that she was satisfied with the esthetic and functional results of the buccal fat pad removal surgery. Additionally, she was satisfied with the root coverage of the maxillary left canine, which favored smile esthetics and reduced dentin sensitivity.

In conclusion non pedicled buccal fat pad graft is an effective technique in the treatment of Miller Class I gingival recessions and may be considered a treatment option. The technique is safe and easy to perform, presents excellent esthetic and therapeutic results, and can also be applied in areas distant from the donor site or even in the lower arch.

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