Modified Vestibular Incision Supraperiosteal Tunnel Access in Recession Type 2 with Thin Phenotype: A Report of Two Cases

Abstract

Gingival Recession Type 2 (RT2) presents complexity in achieving complete Root Coverage (RC) and associated parameters such as interproximal attachment loss and bone loss further have a negative influence on the stability of achieved RC. Complete RC might be attainable in RT2, though certain factors like tooth malposition, avascular root surface area, frenal pull, and thin Periodontal Phenotype (PP) may limit the amount of RC. Vestibular Incision Subperiosteal Tunnel Access (VISTA) technique proposed in the last decade has been promising in the maxillary anterior region in the management of Miller Class I/ RT1 and even some RT2 gingival recession. In this case report, two systemically healthy female patients, having RT2 gingival recession in mandibular incisors labially positioned/rotated with thin PP were treated with Modified-vestibular incision supraperiosteal tunnel access (m-VISTA) along with Subepithelial Connective Tissue Graft (SCTG). Fifty percent RC was achieved in case-1 and 100% in case 2. The results were maintained during the follow-up period of nine months in case 1, and one year in case 2. Gingival RT2 with malpositioned tooth may be successfully treated with m-VISTA and SCTG as demonstrated in achieving stability of percentage RC and patients’ satisfaction in terms of aesthetics and resolution of hypersensitivity in the present case report.