We wish to thank the commenter for his view on our paper. We have already discussed the two important factors when using the buccal fat pad (BFP) in osteoradionecrosis (ORN) lesions—the extent (stage III mand/max ) and size of the lesion. While staging would show either extension of ORN into the maxillary sinus or the mandibular lower border, which would definitely complicate the treatment, the size of the lesion might not correlate directly with the staging of the lesion. The orthopantomogram discussed by the commenter showed a thin alveolus/floor of sinus in the area of the lesion (the site of tooth 28), thus the staging would be III max , while the size of the ORN lesion appeared to be less than 9 cm 2 . We would therefore re-iterate our findings that the use of the BFP would be reliable and would achieve a consistent positive outcome when applied in stage I mand/max or stage II mand/max and also when the size of the lesion is less than 9 cm 2 . We agree that the vascularity of the recipient size is a critical factor, but we think the ability of the BFP to compensate for this hypovascular state is highly dependent on the extension and size of the lesion. The larger the lesion, the more revascularization is needed.
Another factor that we wish to highlight here is the duration of follow-up. Due to the nature of extremely compromised wound healing, treatment is only considered a success if there is no sign of ORN at 6 months following BFP.
Finally, the commenter correctly stated the difficulty in deciding the exact cause of osteonecrosis when patients undergo both radiation therapy to the head and neck region and bisphosphonate therapy. A significant number of patients have both risk factors and we agree that the use of BFP could be extended to bisphosphonate-related osteonecrosis, as recently reported by Gallego et al.