Since esthetics represents an inseparable part of successful implant therapy, treatment of gingival recessions is an important topic to understand. An array of treatment options exists for treatment of gingival recession, such as a coronally advanced flap (CAF) combined with connective tissue graft (CTG). However, this technique is susceptible to flap retraction, which can result in incomplete root coverage. As such other methods have been suggested, such as the use of CTG with envelopes and tunnels, which reduces the risk of tissue retraction during healing. However these techniques, can be very challenging. The two videos show the application of a novel minimally invasive surgical approach utilizing the vestibular incision subperiosteal tunnel access (VISTA) technique. The first video shows its use to bulk the buccal implant, while the second displays the technique to manage of multiple areas of gingival recession.
“VISTA entails making an access incision in the maxillary anterior frenum, followed by elevation of a subperiosteal tunnel. VISTA allows for both access as well as an opportunity to coronally reposition the gingival margins of all involved teeth. The VISTA approach overcomes some of the short-comings of intrasulcular tunneling techniques used for periodontal root coverage. The remote incision reduces the possibility of traumatizing the gingiva of the teeth being treated. Critical to the success of VISTA is a careful subperiosteal dissection that reduces the tension of the gingival margin during coronal advancement while at the same time maintaining the anatomical integrity of the interdental papillae by avoiding papillary reflection.” VISTA is most advantageous in the esthetic zone.1
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