Vestibular Incision Subperiosteal Tunnel Access Research Articles

Management of Miller’s Class-III multiple recession defects in mandibular anterior teeth using vista technique and PRF membrane: A case report

Gingival recession, characterized by the displacement of gingival tissue towards the root surface, poses challenges like compromised aesthetics and heightened vulnerability to dental issues such as root caries and sensitivity. Various surgical techniques have been developed to address these concerns, with recent advancements like the Vestibular Incision Subperiosteal Tunnel Access (VISTA) technique showing promise, especially for multiple recession defects in the esthetic zone. VISTA reduces tissue trauma and promotes optimal healing by minimizing micromotion, thus enhancing the overall success of root coverage procedures. Integrating Platelet-rich fibrin (PRF) membranes aids in soft tissue healing and graft integration, offering a cost-effective and immune-friendly option to bolster procedure success.In a 31-year-old female patient with receding gums and mobile teeth, vestibuloplasty was performed after oral prophylaxis and stabilization of mobile teeth to address the inadequate vestibular depth and mucogingival deformity. Post-operative care included antibiotics and pain relief medications. Subsequently, a Miller’s Class-III multiple gingival defect (MRD) was corrected using the VISTA technique combined with Platelet-rich fibrin (PRF) membrane application. PRF was inserted into the tunnel to cover the denuded roots and to improve the gingival phenotype and the surgical site was sutured. One month later, successful healing was evident with increased vestibular depth, demonstrating effective treatment outcomes.

Comparative Evaluation of Vestibular Incision Subperiosteal Tunnel Access (VISTA) Technique with other Tunneling Techniques: Protocol for a Systematic Review and Meta-analysis

Introduction: Gingival recession is defined as the displacement of the gingival margin apical to the Cementoenamel Junction (CEJ). The aim is to achieve complete root coverage. The increasing demand for aesthetics by patients has led dentists to adopt newer and more novel techniques. Since Allen first introduced the tunneling technique in 1994, several procedural adjustments have been suggested. The “Vestibular Incision SubperiostealPeriosteal Tunnel Access (VISTA)” technique was introduced by Zadeh HH and offers the benefit of being minimally invasive. Need for the study: This systematic review aims to guide clinicians in selecting the best possible root coverage procedure for better patient-centered outcomes. Aim: The aim is to compare the “VISTA technique” with other tunneling techniques in the treatment of multiple gingival recession defects. Materials and Methods: Up until December 2023, the authors will search PubMed, the Cochrane Library, and Embase without any language constraints. Additionally, reviewers will handsearch and examine the bibliographies of relevant publications, search trial registries for active trials, and look for potentially relevant research. The keywords to be used for the search include VISTA technique, tunneling technique, root coverage procedure, and multiple gingival recession. Randomised Controlled Trials (RCTs) using an open or blinded assessment of outcomes will be included. Full journal publications will also be included. Exclusions will be made for brief abstracts (typically meeting reports), non randomised studies, research on experimental pain, studies based on animal models, and observational studies. The eligibility of each study will be independently determined by three review authors (SS, PD, RO). They will then extract the data and independently assess the Risk of Bias (RoB) for each study using the established Cochrane methodology. The evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE), and a summary of findings will be tabulated. The Preferred Reporting Items for Synthematic Reviews and Meta-Analyses (PRISMA) guidelines will be followed for present review.

Need for additional research on vestibular incision subperiosteal tunnel access (VISTA) technique in India

Need for additional research on vestibular incision subperiosteal tunnel access (VISTA) technique in India

Clinical efficacy of Vestibular Incision Subperiosteal Tunnel Access (VISTA) for treatment of multiple gingival recession defects: a systematic review, meta-analysis and meta-regression.

This study investigated the efficacy of Vestibular Incision Subperiosteal Tunnel Access (VISTA) compared to other methods for treating multiple adjacent gingival recessions (MAGRs) through a systematic review and meta-analysis. A systematic literature search was performed through June 2023, to identify clinical trials investigating VISTA for root coverage on MAGRs. A meta-analysis with meta-regression model was employed on the primary outcomes of mean and complete root coverages (MRC, CRC), comparing VISTA with other techniques. Clinical efficacy of various graft materials was assessed. Fourteen studies were included, 8 of which met the criteria for quantitative assessment. The cumulative MRC (88.15% ± 20.79%) and CRC (67.85% ± 21.72%) of VISTA were significantly higher compared to the tunneling technique (SMD = 0.83 (95% CI [0.36, 1.30], p < 0.01). The baseline recession depth showed a negative correlation with CRC, whereas baseline keratinized gingiva width exhibited a positive correlation with this outcome. The VISTA technique, particularly with acellular dermal matrix (ADM) or connective tissue graft (CTG) materials, offers superior outcomes compared to the tunneling technique. The capacity of platelet-rich fibrin (PRF) to substitute for connective tissue graft (CTG) in VISTA-root coverage was noteworthy, provided there is adequate keratinized tissue width. VISTA in concert with acellular dermal matrix or CTG resulted in improved root coverage, surpassing the outcomes achieved through tunneling. PRF emerged as a viable alternative to CTG, when used in conjunction with VISTA, demonstrating comparable mean root coverage. This is particularly evident in situations where sufficient keratinized gingiva is available and when patient comfort is taken into consideration.

Comparative Evaluation of Vestibular Incision Subperiosteal Tunnel Access (VISTA) Technique With and Without Advanced Platelet Rich Fibrin for Treatment of Maxillary Anterior Gingival Recessions.

Gingival recession is an apical shift of the gingival margin with exposure of the root surface to the oral cavity which creates an aesthetic problem. The present study was attempted to compare Vestibular incision subperiosteal tunnel access (VISTA) with and without Advanced platelet rich fibrin(A-PRF) in the treatment of Miller's class I gingival recessions. 24 patients were assigned randomly either to test (VISTA with A-PRF) or control (VISTA alone) group. Clinical parameters like recession depth (RD), recession width (RW), clinical attachment loss (CAL), width of keratinized gingiva (WKG), gingival thickness (GT) and probing depth (PD) were recorded at baseline,3 and 6 months post operatively. Inter group comparison of mean RC in mm, %RC, ΔWKG and CAG revealed no statistically significant difference (p>0.05). Change in GT showed statistically significant improvement in test group. Within the limitations of this study, both treatment options (VISTA with A-PRF and VISTA alone) have resulted in predictable and comparable root coverage with increased gingival thickness in the test group.

VISTA approach in conjunction with enamel matrix derivative, cortico-cancellous bone, and connective tissue graft for periodontal defect surgery: A case series.

The biggest challenge during periodontal regeneration in the anterior region is the prevention of soft-tissue recession. Minimally invasive surgeries, particularly papilla preservation techniques and soft-tissue augmentation, may significantly reduce such postoperative soft-tissue recession. This article presents the vestibular incision subperiosteal tunnel access approach for periodontal regeneration in the anterior region. A subperiosteal tunnel prepared from a single vertical vestibular incision adjacent to the defect is used for debridement, enamel matrix derivative application, defect grafting with cortico-cancellous tuberosity bone, and insertion of the connective tissue graft. Evaluation of six cases with up to 6 years of follow-up showed improvements in all clinical parameters. The probing pocket depth improved from 8.2±0.75 mm initially to 2.7±0.52 mm at follow-up, clinical attachment level improved from 8.5±0.83 mm initially to 2.7±0.52 mm at follow-up, and midfacial gingival recession of 1 mm at two sites was corrected. The papillae were stable at all sites, with an average distance of 4.8 mm from the incisal edge to the papilla tip. This technique seems to be a promising approach for achieving both esthetic and functional goals of periodontal regenerative surgery. However, experience in performing microsurgeries and harvesting tuberosity tissues may be a limitation.

Modified Coronally Advanced Tunnel (MCAT) Technique with or without Vestibular Incision for the Treatment of Multiple Gingival Recessions: A Case Series and Literature Review

&lt;p&gt;Treatment of multiple gingival recessions with periodontal plastic surgery is challenging due to several factors that needed to be considered in one surgical session. The success and stability of root-coverage outcomes depend on gingival thickness (GT), defect characteristics and anatomical limitations addressing hard and soft tissue relationships and periodontal structures. Root coverage is less predictable in the presence of interproximal attachment loss. Evidence on the treatment of multiple recession-type defects, particularly Miller Classes III and IV, is scarce. The modified coronally advanced tunnel technique (MCAT) has been report-ed to exert root-coverage effects in Miller Class III cases via partial papilla elevation. To gain surgical access in challenging anatomies, the use of additional vestibular incisions (vestibular incision subperiosteal tunnel access, [VISTA]) has been proposed. In this case report, two patients who underwent surgeries for Miller Class II-III recessions with thin phenotypes are described. After non-surgical periodontal treatment, creeping attachment of 0.5-1 mm was observed in some teeth in case 1. Both patients underwent the treatment of MCAT technique combined with connective tissue grafting, whereas only the patient in case 2 underwent VIS-TA. Complete root coverage, increased GT and aesthetic outcomes with a follow-up period of at least 5 months were achieved in multiple teeth in both cases. The report and the literature review suggested that MCAT w/wo VISTA can predict root coverage and modify phenotypes for the treatment of multiple recessions.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Minimally Invasive Gingival Recession Treatment by Using Vista Combined With PRF and Collagen Membrane: A Case Report

Abstract Root exposure generates major concerns regarding aesthetics and other problems like hypersensitivity and root caries. Gingival recession has traditionally been treated by periodontal plastic surgery, often using soft tissue grafts to fill the defect with excellent clinical results. Advancements in root coverage procedures in the aesthetic zone have led to increasing the ability of clinicians to harness a treatment modality that delivers better outcomes with less surgical morbidity. Collagen membrane is most commonly used for guided tissue regeneration (GTR). On the other hand, platelet-rich fibrin (PRF) has gained popularity due to its simple method of acquisition, low cost and the presence of growth factors. Therefore, this case report describes the treatment of a 38-year-old patient with bilateral multiple Miller’s class I recession defects extending from central incisors to canines by using the vestibular incision subperiosteal tunnel access (VISTA) with PRF and collagen membrane. Clinical parameters such as recession height (RH) and width of keratinised gingiva (WKG) were measured at 6-month and 1-year follow up intervals. The 6-month follow-up revealed optimum root coverage with excellent outcomes for both sites, with an increase in the width of keratinised gingiva and a decrease in the recession height, and less discomfort in the site treated with a PRF membrane. These clinical parameters were maintained at the 1-year follow up. The increase in the width of keratinised gingiva and the decrease in the recession height in both groups and the patient compliance due to this minimally invasive procedure suggests its potential use when aesthetics and patient comfort are of paramount concern.

Comparative evaluation of platelet rich fibrin matrix (PRFM) membrane and platelet rich fibrin (PRF) membrane using the vestibular incision subperiosteal tunnel access (VISTA) approach technique for the treatment of multiple gingival recession in humans: A double-blind, parallel-group, randomized controlled clinical trial

Background: In this evolutionary era of dentistry, newer techniques have evolved for complete coverage of multiple recession defects (MRDs). Since 2012, MRDs have been treated using the vestibular incision subperiosteal tunnel access (VISTA) approach and a variety of regenerating membranes with varying degrees of success. Platelet‑rich fibrin matrix (PRFM) membrane has shown a robust release of growth factors and was known to enhance the healing process. Thus, in this study we have evaluated the effectiveness of platelet-rich fibrin matrix (PRFM) with that of platelet-rich fibrin (PRF) membrane using the vestibular incision subperiosteal tunnel access (VISTA) technique in Miller Class I and II multiple gingival recession defects. Methods: This randomized, parallel designed, controlled, clinical study was conducted in 20 subjects (10 male and 10 female) having class I/II MGR defects either buccally or labially. The test group was treated with VISTA and PRFM membrane while the control group was treated with VISTA and PRF membrane. The clinical measurements such as plaque index, papillary bleeding index, probing pocket depth, relative attachment level (RAL) and relative gingival marginal level (R-GML), width of keratinized gingiva (WKG), gingival recession (REC) and gingival thickness (GT) were measured at baseline, three and six months. A Student’s paired t-test was utilized to analyse data from the day of surgery to six months. Results: Ten patients in the test group (89.23±15.04) and 10 patients in the control group (85.06±17.71) showed marked root coverage compared to baseline. Conclusions: Both test and control groups showed statistically significant enhancement in root coverage. However, no statistically significant difference was found when a comparison was made between the two groups in terms of PD, relative RAL, R-GML and REC reduction, gain in WKG, and increase in GT. Trial registration: CTRI/2021/07/035240, registered 29 July 2021.

Novel biomaterial advanced platelet rich fibrin plus block for multiple gingival recession.

The study was aimed to assess and compare hard and soft tissue augmentation clinicoradiographically with and without advanced platelet rich fibrin + (A-PRF+) block for the treatment of multiple gingival recession using vestibular incision subperiosteal tunnel access (VISTA). A total of 24 patients, exhibiting multiple Miller's Class I or II recession in maxillary esthetic zone were included. Participants were divided into 2 groups, Group 1 treated with VISTA & A-PRF+ block whereas Group 2 with VISTA technique alone. Clinical parameters Probing Depth (PD), Width of Keratinized Gingiva (WKG), Gingival Biotype (GB), Recession Depth (RD) and Clinical Attachment Level (CAL) were recorded at baseline and at the end of 6 months. The radiographic CBCT measurements of labial plate thickness was taken at baseline and 6 months postoperatively. From baseline to 6 months both the groups showed a clinical and statistical improvement in the parameters. However, a statistically significant difference between both the treatment modalities was not observed. In the inter group comparison radiographically, labial plate thickness was statistically significant at the end of 6 months when compared to the baseline. A-PRF+ block along with VISTA technique can be an alternative effective root coverage procedure for the management of multiple gingival recession in the maxillary esthetic zone. This article is protected by copyright. All rights reserved.

A COMPARATIVE EVALUATION OF VESTIBULAR INCISION SUBPERIOSTEAL TUNNEL ACCESS (VISTA) VERSUS CORONALLY ADVANCED FLAP WITH COLLAGEN MEMBRANE FOR THE TREATMENT OF MILLERS CLASS I AND CLASS II GINGIVAL RECESSION: A CLINICAL STUDY

Background: Gingival recession is defined asThe displacement of soft tissue margin apical to CEJ with exposure of root surface. Factors such as abnormal tooth alignment in the arch, fenestration, dehiscence, faulty tooth brushing, periodontal diseases etc. are few of the causes of gingival recession. The aim of the present study was to compare the effectiveness of minimally invasive Vestibular Incision Subperiosteal Tunnel Access (VISTA) technique and coronally advanced flap using a bioresorbable collagen membrane in Millers Class I and II gingival recessions Material and Methods: 20 sites with Millers Class I or II gingival recession were recruited and allocated into 2 groups with 10 sites each. Test group: VISTA with bioresorbable collagen membrane control group: CAF with bioresorbable collagen membrane. Plaque Index (PI), Gingival Index (GI), relative Clinical attachment level (CAL) Pocket Probing Depth (PPD) Recession Height (RH) and width of keratinized gingiva (WKG) Recession Width (RW) were measured at baseline 3 months and 6 months. Results: A significant improvement was found in all the clinical parameters in the Test group from baseline to 3 months and 6 months Recession width reduction was significantly more in the Test group as compared to Control group. Conclusion: Both the groups, viz: VISTA with resorbable collagen membrane and CAF with resorbable collagen membrane were effective in the treatment of Millers Class I and II gingival recessions VISTA being minimally invasive can be used for covering recession defects.

Microsurgical Approach for the Coverage of Gingival Recession Defects using Vestibular Incision Subperiosteal Tunnel Access (VISTATM) Technique- A Case Report

Gingival recession which is described as the loss of gingival attachment due to apical migration of the gingival margin from the cementoenamel junction leading to the exposure of the root surface, is one of the most prevalent diseases in the world. The treatment of gingival recession is therefore essential to achieve good aesthetics, relieve root hypersensitivity, prevent root caries and cervical abrasions. Till date, many root coverage techniques have been implicated for the coverage of recession defect. This case report focuses on the Vestibular Incision Subperiosteal Tunnel Access (VISTATM) technique for the root coverage procedure and simultaneous application of the microsurgical principles helps in executing the procedure in the most minimally invasive manner. Here, this technique has been accomplished in a 24-year-old female, with the chief complaint of poor aesthetics in the region of maxillary central incisors due to recession defects. Furthermore with the use of microsurgical instruments and magnifying loupes; complete coverage of the recession defects was achieved in a single stage surgery along with superior aesthetics, causing minimal trauma to the patient that was followed by an uneventful inflammatory phase.

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

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.

Comparative evaluation of effect of injectable platelet-rich fibrin with collagen membrane compared with collagen membrane alone for gingival recession coverage.

BACKGROUNDCollagen membrane and platelet-rich fibrin (PRF) have emerged as vital biomaterials in the field of periodontal regeneration. Minimally invasive techniques are being preferred by most periodontists, as it is patient compliant with fewer post-surgical complications as compared to conventional surgical techniques. Thus, in this study we have evaluated the effect of injectable PRF (i-PRF) with collagen membrane compared with collagen membrane alone using vestibular incision subperiosteal tunnel access (VISTA) technique for gingival recession coverage.AIMTo compare the efficacy of VISTA using collagen membrane with collagen membrane soaked in injectable PRF for gingival recession coverage.METHODSA split mouth randomized controlled clinical trial was designed;13 subjects having at least 2 teeth indicated for recession coverage were enrolled in this study. The sites were randomly assigned to control group (VISTA using collagen membrane alone) and the test group (VISTA using collagen membrane with i-PRF). The clinical parameters assessed were pocket depth, recession depth (RD), recession width (RW), relative attachment level, keratinised tissue width (KTW), keratinised tissue thickness (KTT), and percentage root coverage.RESULTSRD showed a statistically significant difference between the test group at 3 mo (0.5 ± 0.513) and 6 mo (0.9 ± 0.641) and the control group at 3 mo (0.95 ± 0.51) and 6 mo (1.5 ± 0.571), with P values of 0.008 and 0.04, respectively. RW also showed a statistically significant difference between the test group at 3 mo (1 ± 1.026) and 6 mo (1.65 ± 1.04) and the control group at 3 mo (1.85 ± 0.875) and 6 mo (2.25 ± 0.759), with P values of 0.008 and 0.001, respectively. Results for KTW showed statistically significant results between the test group at 1 mo (2.85 ± 0.489), 3 mo (3.5 ± 0.513), and 6 mo (3.4 ± 0.598) and the control group at 1 mo (2.45 ± 0.605), 3 mo (2.9 ± 0.447), and 6 mo (2.75 ± 0.444), with P values of 0.04, 0.004, and 0.003, respectively. Results for KTT also showed statistically significant results between test group at 1 mo (2.69 ± 0.233), 3 mo (2.53 ± 0.212), and 6 mo (2.46 ± 0.252) and the control group at 1 mo (2.12 ± 0.193), 3 mo (2.02 ± 0.18), and 6 mo (1.91 ± 0.166), with P values of 0.001, 0.001, and 0.001, respectively. The test group showed 91.6%, 81.6%, and 67% root coverage at 1 mo, 3 mo, and 6 mo, while the control group showed 82.3%, 66.4%, and 53.95% of root coverage at 1 mo, 3 mo, and 6 mo, respectively.CONCLUSIONThe use of minimally invasive VISTA technique along with collagen membrane and injectable form of platelet-rich fibrin can be successfully used as a treatment method for multiple or isolated gingival recessions of Miller’s class-I and class-II defects.

A Prospective, Randomized Controlled Pilot Trial to Compare Vestibular Incision Subperiosteal Access and Sulcular Tunnel Access Root Coverage Procedures to Treat Gingival Recession.

The aim of this randomized prospective study was to compare clinical and patient-centered outcomes of Miller Class I and II gingival recession defects treated with acellular dermal matrix (ADM) grafts and either vestibular incision subperiosteal tunneling access (VISTA) or sulcular tunnel access (STA) techniques. A total of 29 gingival recession defects in nine patients were assessed to determine clinical outcomes, including probing depth (PD), gingival recession (GR), width of keratinized tissue (KT), width of attached tissue (AT), tissue thickness at the gingival margin (TT1), and tissue thickness 4 mm apical to the gingival margin (TT2). Visual analog scale (VAS) assessment of patient-perceived pain, bleeding, swelling, and changes in activity were assessed postoperatively at 7 and 30 days, and professional assessment of postoperative esthetics using the Pink Esthetic Score (PES) was performed at 6 months. All sites demonstrated significant improvements in midfacial GR. No statistically significant differences were noted between the VISTA and STA groups for clinical or patient-centered outcomes, except for preferable midfacial AT in the VISTA sites at 6 months. These findings indicate that both surgical techniques can be used with ADM grafts to achieve improvements in root coverage, alterations in periodontal phenotype, and improved esthetics with high levels of patient satisfaction.

Vestibular incision subperiosteal tunnel access and multilayered advanced platelet rich fibrin membrane for management of multiple gingival recessions

Treatment of multiple recession defects on the lingual is challenging owing to the site-specific anatomical features of this region. Surgical approaches based on the use of subepithelial connective tissue grafts are considered the “gold standard” for the treatment but represent various complications and morbidity. Various techniques have been suggested for the treatment of multiple adjacent recessions with less patient discomfort and enhanced esthetics. Advanced platelet-rich fibrin (A-PRF) has been shown to promote soft-tissue healing. A-PRF is a fibrin matrix network, in which platelets are trapped and release a high amount of growth factors which take part in soft tissue and hard tissue repair and regeneration. The current case report introduces a novel, minimally invasive predictable approach applicable for both isolated as well as multiple defects with the use of the (vestibular incision subperiosteal tunnel access) technique in combination with a multilayered A-PRF membrane.

Orthodontic Correction of a Completely Transposed Impacted Maxillary Canine

In complete dental transposition, aligning the transposed teeth to its normal anatomic position is always a complicated and difficult challenge, which needs multiple clinical considerations. This case report illustrates an orthodontic treatment of a 20-year-old female patient who had a concave profile, skeletal and dental Class III malocclusion with anterior crossbite and complete transposed maxillary left lateral incisor and impacted canine. The correction of transposition was performed by moving the canine by maintaining its high position in the vestibular fold and use lever arm and temporary anchorage device (TAD) to facilitate traction of the maxillary canine. Vestibular incision subperiosteal tunnel access (VISTA) technique also provided as a minimally invasive approach for the tooth exposure. After 48-month of treatment duration, improvement of facial profile and favorable occlusion were achieved with the involved teeth that were moved to their clinically normal sequence without extraction.

Platelet-Rich Fibrin Versus Connective Tissue Graft Using Vestibular Incision Subperiosteal Tunnel Access (VISTA) Technique in Multiple Gingival Recessions: Randomized Controlled Trial

Background: One of the most common esthetic concerns in dentistry is gingival recession (GR), and despite the various treatment strategies for root coverage, multiple recessions still present a great challenge, especially Miller Class III/RT2. Thus, this study aimed to compare the effect of platelet-rich fibrin (PRF) versus connective tissue graft (CTG) using vestibular incision subperiosteal tunnel access (VISTA) in patients with Miller class III/RT2 multiple recessions for root coverage. Methods: Twenty-eight patients with multiple Class III/RT2 gingival recessions were randomly allocated to two equal groups – group 1 (VISTA+PRF) and group 2 (VISTA+CTG). Recession depth (RD) and width (RW), probing depth (PD), clinical attachment level (CAL), gingival thickness, keratinized tissue width, and root coverage esthetic score (RES) were measured at 0, 3, and 6 months. Statistical analysis was performed using repeated measures analysis of variance (ANOVA). Bonferroni’s post-hoc test was used for pair-wise comparisons when ANOVA was significant. For non-parametric data, the Mann-Whitney U test was used to compare between the two groups. Results: Within each group, a significant difference from baseline to six months was found. However, between groups, the results for the VISTA+CTG group significantly surpassed the VISTA+PRF group in most clinical outcomes; gingival recession depth (0.5 [0.25-1.75] and 1.33 [0.75-2], respectively), and width (1 [0.38-3.75] and 2.33 [1.33-3], respectively), gingival thickness at three and six months (2.62±0.36 and 2.63±0.36, respectively) and (1.85±0.2 and 1.87±0.18, respectively), and keratinized tissue width (3.98±0.72 and 3.33±0.56, respectively). However, CAL and PD showed a statistically insignificant difference when comparing both groups. Conclusion: The use of CTG is superior to PRF in root coverage of Miller Class III/RT2 when the VISTA technique is used. Connective tissue grafts can be considered the gold standard for root coverage.

Kinetics of Phenotype Modification Therapy with VISTA: A Retrospective Case Series Using 3D Digital Analysis

Phenotype modification therapy has emerged as one of the main treatment objectives of periodontal plastic surgery. However, long-term data on the stability of gingival thickness gains are not available. This study examined the kinetics of mucosal thickness gain as a measure of phenotype modification therapy following treatment of multiple gingival recession defects with vestibular incision subperiosteal tunnel access (VISTA). Six patients with 14 recession type (RT) II teeth were treated using VISTA and subepithelial connective tissue grafts (SCTG). Scanned images of study casts at pre- and postoperative periods (6 to 66 months) were digitally superimposed for quantitative evaluation of soft tissue dimensional changes. Mucosal thickness gains ranged from 1.0 ± 0.7 mm (1 mm apical to cement-enamel junction [CEJ]) to 1.4 ± 0.4 mm (5 mm apical to CEJ). The gingival thickness gains remained relatively stable, with thickness gains at 66 months of 0.5 ± 0.8, 0.9 ± 0.6, 1.1 ± 0.6, 1.0 ± 0.4, and 1.2 ± 0.6 mm at 1, 2, 3, 4 and 5 mm apical to the CEJ, respectively. Treatment of multiple gingival recession defects with VISTA and SCTG led to stable gingival thickness gains and shows promise as a strategy for phenotype modification therapy.

Clinical and patient-reported outcomes after recession coverage using modified vestibular incision subperiosteal tunnel access with a volume-stable collagen matrix as compared to a coronally advanced flap with a subepithelial connective tissue graft.

Coronally advanced split-or full-thickness (CAST or CAFT) flaps in combination with subepithelial connective tissue grafts (SCTGs) are commonly used in root-coverage procedures despite postoperative pain and bleeding from the graft donor site. Therefore, the modified vestibular incision subperiosteal tunnel access procedure (VISTAX) uses a novel collagen matrix (VCMX) instead of autogenous tissue to address the limitations associated with autogenous tissue grafting. This retrospective study compared the clinical outcomes of VISTAX to the results obtained after using a CAST or CAFT flap in combination with SCTG for root coverage. Patients with single or multiple adjacent recession I/II defects were included, with 10 subjects each in the VISTAX, CAFT, and CAST groups. Defect coverage, keratinized tissue width, esthetic scores, and patients' perceived pain and dentinal hypersensitivity (visual analogue scale [VAS]) were assessed at baseline, 3 months, and 6 months. All surgical techniques significantly reduced gingival recession (P<0.0001). Defect coverage, esthetic appearance, and the reduction in dentinal hypersensitivity were comparable. However, the VAS scores for pain were significantly lower in the VISTAX group than in the CAFT and CAST groups, which had similar scores (P<0.05). Furthermore, the clinical results of VISTAX and CAFT/CAST generally remained stable at 6 months. The clinical outcomes of VISTAX, CAFT, and CAST were comparable. However, patients perceived significantly less pain after VISTAX, indicating a potentially higher patient acceptance of the procedure. A prospective trial with a longer follow-up period and a larger sample size should therefore evaluate VISTAX further.