Assessment of Soft Tissue Thickness Over Zygomatic Implants in Atrophied Maxilla Covered With Buccal Fat Pad vs. Palatal Pedicle Flap

Background and Rationale The rehabilitation of the severely atrophied maxilla utilizingzygomatic implants is a highly predictable and effective treatment modality. However,managing the peri‐implant soft tissue in these complex cases remains a significantclinical challenge. Because zygomatic implants frequently emerge through thin,non‐keratinized, and mobile alveolar mucosa rather than thick, attached gingiva, theperi‐implant environment is highly susceptible to complications. Inadequate soft tissuethickness can lead to mucosal recession, exposure of the implant collar, plaqueaccumulation, and ultimately peri‐implantitis, which threatens the long‐term success ofthe prosthesis.To mitigate these risks and achieve an optimal permucosal seal, soft tissue augmentationis often required. Vascularized soft tissue grafts are preferred in these compromisedanatomical sites due to their robust blood supply and enhanced healing capacity. TheBuccal Fat Pad (BFP) flap is a well‐documented and frequently utilized technique for thispurpose; however, its volume can be unpredictable, and it may be unavailable due to priorsurgeries or anatomical deficiencies. Therefore, evaluating robust alternatives, such asthe Palatal Pedicle Flap (PPF)‐which utilizes the thick, keratinized palatal mucosa‐iscritical for optimizing surgical outcomes.Study Design and Methodology This study is structured as a prospective, randomizedcontrolled clinical trial utilizing a split‐mouth design. The split‐mouth approach isstrategically chosen to eliminate inter‐subject biological and immunological variability,allowing each patient to effectively serve as their own control. Patients presenting witha severely resorbed maxilla requiring bilateral zygomatic implant placement will beenrolled.Following successful implant placement, the right and left maxillary quadrants will berandomized. One side will be assigned to receive soft tissue augmentation using thestandard Buccal Fat Pad (BFP) flap, while the contralateral side will be assigned toreceive the Palatal Pedicle Flap (PPF).Surgical Intervention Overview All surgical procedures will be performed underappropriate anesthesia following standard sterile protocols.For the BFP side: The buccal fat pad will be accessed via a vestibular mucosal incision,carefully bluntly dissected, mobilized, and advanced over the zygomatic implant collarwithout tension.For the PPF side: A palatal pedicle flap will be meticulously outlined, elevated with itsvascular supply intact, rotated, and adapted around the contralateral implant collar.Both flaps will be secured using appropriate resorbable sutures to ensure tension‐freeprimary closure and optimal tissue adaptation around the implant abutment interface.Post‐operative care will adhere to standard institutional guidelines, including theprescription of appropriate analgesics, antibiotics, and antimicrobial mouth rinses.Clinical Significance By systematically comparing the healing trajectories, tissuestability, and functional outcomes of the BFP and PPF techniques over a 6‐month period,this trial aims to provide definitive, evidence‐based guidance for soft tissue managementin zygomatic implantology. Furthermore, it seeks to validate the PPF as a reliable andpredictable reconstructive alternative in clinical scenarios where the buccal fat pad isdeemed insufficient or inaccessible.