PMC6955123_01
PMC6955123_02
The clinical exam confirmed the face rounded and the indication for Bichectomy technique.
CRID2019-1049453.001.jpg
PMC6955123_02_CRID2019-1049453.001.jpg
fig1
The clinical exam confirmed the face rounded (Figure 1) and cheek biting and revealed a Miller Class I gingival recession on the maxillary left canine (Figure 2).
Miller Class I gingival recession on the maxillary left canine (recipient site).
CRID2019-1049453.002.jpg
PMC6955123_02_CRID2019-1049453.002.jpg
fig2
The clinical exam confirmed the face rounded (Figure 1) and cheek biting and revealed a Miller Class I gingival recession on the maxillary left canine (Figure 2).
The incision location in donor site: vestibule fundus, at the distal caries of the second molar with a 30 mm distance from the vestibule and above the parotid duct.
CRID2019-1049453.003.jpg
PMC6955123_02_CRID2019-1049453.003.jpg
fig3
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 (Figure 3).
Extension of the incision: from the distal caries of the second molar to the mesial caries of the first molar.
CRID2019-1049453.004.jpg
PMC6955123_02_CRID2019-1049453.004.jpg
fig4
Then, the incision is extended about 1.5 cm until it reaches the mesial caries of the first molar (Figure 4).
Removal of the buccal extension of the Bichat ball.
CRID2019-1049453.005.jpg
PMC6955123_02_CRID2019-1049453.005.jpg
fig5
The buccal extension of the Bichat ball is completely removed by careful circular movements (Figure 5). 4 ml of buccal fat pad was removed.
Simple suture in donor site with 4.0 silk thread.
CRID2019-1049453.006.jpg
PMC6955123_02_CRID2019-1049453.006.jpg
fig6
The donor site was immediately sutured with a 4.0 silk thread (braided black silk, Technofio, Goiania, GO, Brazil) with a simple suture (Figure 6).
Preparation of the recipient site: with an intrasulcular incision and two diverging vertical incisions up to the alveolar mucosa.
CRID2019-1049453.007.jpg
PMC6955123_02_CRID2019-1049453.007.jpg
fig7
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 (Figure 7).
Scaled and planned with 5-6 Gracey curettes in canine root prior to receiving graft of adipose tissue.
CRID2019-1049453.008.jpg
PMC6955123_02_CRID2019-1049453.008.jpg
fig8
The canine root was then scaled and planned with 5-6 Gracey curettes (Figure 8) (Hu-Friedy, Chicago, IL, USA) and irrigated with sterile saline solution.
Macerated portion of the buccal fat pad cover of the recipient site.
CRID2019-1049453.009.jpg
PMC6955123_02_CRID2019-1049453.009.jpg
fig9
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 (Figure 9).
Flap coronally positioned and anchored with simple and suspension sutures.
CRID2019-1049453.010.jpg
PMC6955123_02_CRID2019-1049453.010.jpg
fig10
The graft was stabilized with an X suture using a 5.0 resorbable suture thread (polyglycolic acid suture, Technofio, Goiania, GO, Brazil), and the flap was then coronally positioned and anchored with simple and suspension sutures (Figure 10).
PMC6955123_03
Removal of sutures 15 days postoperatively.
CRID2019-1049453.011.jpg
PMC6955123_03_CRID2019-1049453.011.jpg
fig11
The suture was removed 15 days postsurgery (Figure 11), and follow-up visits were scheduled at 30 (Figure 12), 60 (Figure 13), and 365 (Figure 14) days.
30-day postoperative follow-up.
CRID2019-1049453.012.jpg
PMC6955123_03_CRID2019-1049453.012.jpg
fig12
The suture was removed 15 days postsurgery (Figure 11), and follow-up visits were scheduled at 30 (Figure 12), 60 (Figure 13), and 365 (Figure 14) days.
60-day postoperative follow-up.
CRID2019-1049453.013.jpg
PMC6955123_03_CRID2019-1049453.013.jpg
fig13
The suture was removed 15 days postsurgery (Figure 11), and follow-up visits were scheduled at 30 (Figure 12), 60 (Figure 13), and 365 (Figure 14) days.
1-year postoperative follow-up.
CRID2019-1049453.014.jpg
PMC6955123_03_CRID2019-1049453.014.jpg
fig14
The suture was removed 15 days postsurgery (Figure 11), and follow-up visits were scheduled at 30 (Figure 12), 60 (Figure 13), and 365 (Figure 14) days.
PMC6955123_04