Evaluation of pedicled buccal pad of fat with zygomatic implants in reducing vestibular gingival recession: a pilot study

Background: The rehabilitation of severely atrophic maxillae with extra-maxillary zygomatic implants often poses challenges due to insufficient soft tissue volume, resulting in implant body exposure and increased risk of gingival recession, peri-implant mucositis, and chronic inflammation, which can potentially compromise implant survival. Objective: This prospective clinical split-mouth study aimed to evaluate the effectiveness of the buccal fat pad flap (BFPF) in minimizing gingival recession and improving peri-implant soft tissue outcomes in patients receiving extra-maxillary zygomatic placement for severe maxillary atrophy. Methods: Four patients presenting with Cawood and Howell Class IV–VI maxillary atrophy were rehabilitated using the quad-zygomatic implant technique. Each patient received bilateral zygomatic implants; on one side, the implant was covered with a buccal fat pad (BFP) over the externalized implant, while the contralateral side served as a control and underwent conventional mucoperiosteal soft-tissue closure. Gingival recession, peri-implant tissue conditions, modified bleeding index (mBI), presence of suppuration, and implant survival were assessed at 3, 6, and 12 months postoperatively. Results: The BFPF group demonstrated significantly less gingival recession at all follow-up intervals (P < 0.05) and lower mBI scores. Suppuration was absent in both groups. Although harvesting time for the BFPF was slightly longer, it did not significantly prolong the overall surgery. Conclusion: The pedicled buccal fat pad flap is a promising adjunct for enhancing soft tissue outcomes in atrophic maxillae rehabilitation, reducing gingival recession, and reducing peri-implant soft tissue complications.