Şiddetli Dişeti Çekilmesinin Saplı Bukkal Yağ Dokusu Kullanılarak Tedavisi: Histolojik ve Klinik Bulgular

Year 2016, Volume: 6 Issue: 4, 187 - 190, 15.12.2016

Esra Ercan Celal Çandırlı Cihan Uysal Bilge Cansu Uzun Engin Yenilmez

Abstract

Dişeti çekilmelerinin tedavisinde pek çok yöntem vardır. Ancak Miller III ve Miller IV tip dişeti çekilmeleri zayıf prognoza sahiptir. Bukkal Yağ Dokusu (BYD), kemik, kıkırdak, yağ veya kasa dönüşebilen özel bir yağ dokusudur. Bu vaka raporunda şiddetli dişeti çekilmesi olan 2 hastanın saplı BYD kullanılarak tedavisi anlatılmıştır. Uygulama esnasında cerrahi aşamada alıcı alanda tam kalınlık flep kaldırılmıştır. Saplı BYD uygun cerrahi teknikle açığa çıkarılmıştır. BYD’nin gövdesi hareketlendirilerek mukozaya yakın şekilde dikilmiştir. Küçük bir parça yağ dokusu histolojik inceleme için ayrılmıştır. Damarlı flep üst 1. büyük azı dişinin bukkal yüzeyine sıkıca yerleştirilerek dikilmiştir. Bukkal flep de koronal şekilde pozisyonlandırılarak dikilmiştir. On iki hafta sonunda her iki vakada da dişeti çekilmesi azalmıştır. Klinik periodontal parametrelerde ve mobilitede iyileşme görülmüş; her iki vakada da keratinize dişeti dokusu belirgin şekilde izlenmiştir. Üç ay sonraki gingivoplasti aşamasında elde edilen küçük bir parça dişeti, histolojik inceleme için ayrılmış ve ilk histolojik örnekte damarlı yağ dokusu izlenmiştir. Elde edilen 2. örnekte ise Tip I kollajen lifler ve fibroblastlarla birlikte epitelizasyon ve epitel içinde papilla oluşumu izlenmiştir. BYD kullanımı, üst çene azı ve küçük azı dişlerinde, dişeti sağlığına olumlu etki ederek, kök yüzeyi örtülmesini sağlayabilir. Bu konuda ileri dönük, kontrollü, klinik çalışmalara ihtiyaç vardır.

Keywords

Bukkal yağ dokusu, dişeti çekilmesi, kök yüzeyi örtülmesi

Treatment of Severe Gingival Recession Using Pedicled Buccal Fat Pad: Histological and Clinical Findings

Abstract

There are a lot of techniques for treatment of gingival recessions. However, Miller class III and IV type recession defects have poor prognosis. The Buccal Fat Pad (BFP) is a specialized tissue that can be able to transform into bone, cartilage, fat and muscle. In this case report, the treatment of two cases with severe gingival recessions using pedicled BFP,  was introduced. During surgery, full thickness flap was elevated at recipient site. The pedicled BFP was exposed using proper surgical technique. The body mass of BFP was removed over and sutured to mucosa. Small amount of fat tissue was obtained for histological analysis. Vascularized flap was placed at buccal surface of 1st molar tooth and sutured. The buccal flep also was coronally positioned and sutured.  The gingival recessions were decreased fot both of the cases at the end of 12 weeks. The clinical periodontal parameters and mobility were improved, the keratinized gingival tissues were observed clearly. A small amount of gingival tissue that had been obtained during gingivoplasty after 3 months, was kept for histological analysis. The vascularized fat tissue was seen at the first histological sample. Type 1 collagen fibers and fibroblasts with epithelization and papilla formation in epithelium, was observed at the second sample.  The BFP may provide root covarage for the treatment of gingival recessions at maxillary molars and premolars by positive affecting the gingival health.  The prospective, controlled clinic trials are needed at this area.

Keywords

Buccal fat pad, gingival recession, root coverage

References

• 1. Sullivan HC, Atkins JH. Free autogenous gingival grafts. III. Utilization of graft in the treatment of gingival recession. Periodont 1968; 6: 152-60. 2. Wennström J, Pini Prato G. Mucogingival theraphy: Periodontal plastic surgery. In: Lindhe J, Karring T, Lang N, eds. Clinical Periodontology and Implant Dentisry, 4th ed. Copenhagen: Munksgaard; 2003. p.576-649. 3. Miller PD Jr. A classification of marginal tissue recession. Int J Periodontics Restorative Dent 1985; 5: 8-13. 4. Carter TG, Egbert M. Traumatic prolapse of the buccal fat pad (traumatic pseudolipoma): A case report and literature review. J Oral Maxillofac Surg 2005; 63: 1029-32. [CrossRef] 5. Farré-Guasch E, Martí-Pagès C, Hernández-Alfaro F, Klein-Nulend J, Casals N. Buccal fat pad, an oral access source of human adipose stem cells with potential for osteochondral tissue engineering: an ın vitro study. Tissue Engineering Part C Methods 2010; 16: 1083-94. [CrossRef] 6. Kumari BN, Thiagarajan R, Narayanan V, Devadoss P, Mammen B, Emmadi P. A new technique for root coverage using buccal fat pad. Quintessence Int 2010; 7: 547-9. 7. Babu HM, Gujjari SK, Prasad D, Sehgal PK, Srinivasan A. Comparative evaluation of a bioabsorbable collagen membrane and connective tissue graft in the treatment of localized gingival recession: A clinical study. J Indian Soc Periodontol 2011; 15: 353-8. [CrossRef] 8. Vijayendra R, Suchetha A, Jaganath S, Gurfan K. Two-step procedure for root coverage using a free gingival graft and a subepthelial connective tissue graft. Indian J Dent Res 2011; 22: 478-81. [CrossRef] 9. Singh J, Prasad K, Lalitha RM, Ranganath K. Buccal fat pad and its applications in oral and maxillofacial surgery: a review of published literature (february) 2004 to (July) 2009. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 110: 698-705. [CrossRef] 10. Dean A, Allomillos F, Garcia-Lopez A, Sanchez J, Penalba M. The buccal fat pad in oral reconstruction. Head Neck 2001; 23: 383-8. [CrossRef] 11. Agarwal C, Gayathri GV, Mehta DS. An innovative technique for root coverage using pedicled buccal fat pad. Contemporary Clinical Dent 2014; 5: 386-8. [CrossRef]