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| CASE REPORT |
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| Year : 2022 | Volume
: 11
| Issue : 3 | Page : 251-254 |
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VISTA technique combined with collagen membrane for treatment of multiple gingival recession: A case report
Deepti Mittal, Meenakshi Panda, Gautam Khatak
Department of Dental Surgery, RML Hospital, Central Delhi, India
| Date of Submission | 07-Oct-2020 |
| Date of Decision | 24-Feb-2022 |
| Date of Acceptance | 25-Feb-2022 |
| Date of Web Publication | 26-Dec-2022 |
Correspondence Address:
Dr. Deepti Mittal
RML Hospital, Baba Kharak Singh Marg, Cannaught Place, Central Delhi - 110 001
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jdrntruhs.jdrntruhs_162_20
Gingival recession is an exposure of root surface due to the apical migration of the marginal periodontal tissues apical to cementoenamel junction. Many therapeutic options are available for the treatment of gingival recession, among these techniques, Vestibular Incision Subperiosteal Tunnel Access (VISTA) technique in combination with collagen membrane (BIO-GIDE) was used in the present study for the treatment of multiple gingival recession defects in the maxillary anterior region. In the VISTA technique, a single vestibular incision provides broader access to the entire surgical area which reduces the possibility of traumatizing the gingiva, with little or no scar formation. And the use of collagen membrane offers several advantages over other techniques as it is biocompatible, there is no need for donor site or secondary surgical procedure there by reducing post-harvesting morbidity and patient discomfort. In this case report VISTA technique in combination with collagen membrane was found to be a reliable treatment method for multiple gingival recession defects.
Keywords: Collagen membrane, gingival recession, VISTA technique
How to cite this article:
Mittal D, Panda M, Khatak G. VISTA technique combined with collagen membrane for treatment of multiple gingival recession: A case report. J NTR Univ Health Sci 2022;11:251-4 |
How to cite this URL:
Mittal D, Panda M, Khatak G. VISTA technique combined with collagen membrane for treatment of multiple gingival recession: A case report. J NTR Univ Health Sci [serial online] 2022 [cited 2023 Feb 7];11:251-4. Available from: https://www.jdrntruhs.org/text.asp?2022/11/3/251/365015 |
| Introduction | |  |
Gingival recession is defined as the “displacement of marginal tissue apical to the cementoenamel junction”.[1] Main indications for root coverage procedures are an aesthetic concern, dentinal hypersensitivity, prevention of root caries and cervical abrasion, and improved plaque control efforts.[2] Recession defects can be isolated or multiple. The first line of treatment includes removal of etiological factors followed by surgical correction.[3] The etiology is multifactorial; possible causes include a response to bacterial plaque, the position of the teeth in the arch, toothbrush trauma, traumatic occlusion, high insertion of oral frenula, narrow gingival areas, and anatomic defects such as dehiscence and fenestrations.[4]
The purpose of this case report is to evaluate the efficacy of the Vestibular Incision Subperiosteal Tunnel Access (VISTA) technique in combination with collagen membrane in the treatment of multiple gingival recession defects.
| Case Report | | |
A 32-year-old male patient reported to the Department of Dental Surgery with the chief complaint of receding gums and sensitivity in the upper front tooth region. No relevant medical and dental history was reported. On intraoral examination, Miller's class 1 gingival recession was seen in relation to the labial surface of the upper right central incisor, lateral incisor and upper left central incisor, lateral incisor, and canine (number 12,11,21,22,23) [Figure 1]. On radiographic examination, no bone loss was seen.
Treatment
After the initial phase of scaling and root planning, oral hygiene instructions were given to the patient and recalled after 3-weeks. Informed consent for the surgical procedure was obtained from the patient. On the day of surgery, routine presurgical protocols were followed and local anesthesia was administered. The VISTA approach began with a vestibular access incision placed within the midline of the maxillary frenum, providing access to the entire anterior maxilla. The periosteal elevator was used to create a subperiosteal tunnel between the periosteum and bone through the vestibular access incision [Figure 2]. The tunnel extended a minimum of one or two teeth beyond the tooth requiring root coverage and beyond the mucogingival junction, to facilitate the mobilization and coronal repositioning of the gingival margin. Additionally, the subperiosteal tunnel was also extended through the gingival sulci and interproximal below each papilla without making any surface incisions.
A resorbable collagen membrane Bio-Gide (Geistlich Pharma AG, Switzerland) was then trimmed to fit the dimension of the surgical area extending 3 to 5 mm beyond the area of recession. The membrane was inserted through the tunnel using the periosteal elevator and spread uniformly on recession defects [Figure 3]. The membrane and the mucogingival complex were then stabilized using the coronally anchored suturing technique. This technique involves placing a horizontal mattress suture using a 4.0 Ethilon nylon suture at approximately 2–3 mm apical to the gingiva margin of each tooth with recession. The suture was tied and secured at the midcoronal region of the facial surface of every tooth with the help of composite resin. This technique helps to prevent apical migration of the gingival margin during the initial stages of healing [Figure 4]. The midline access incision was then approximated and sutured. | Figure 4: Coronally anchored suture using composite stops followed by suturing of the midline incision
Click here to view |
Postoperative instructions were given including refraining from mechanical cleaning of the surgical area, using 0.2% Chlorhexidine digluconate mouthwash twice daily for the next 21 days. Antibiotic (amoxicillin 500 mg, 1 tablet every 8 h for 5 days) and analgesics (Ibuprofen 400 mg, 1 tablet every 8h for 3 days) were prescribed. Sutures at the midline were removed after 10 days and coronally anchored bonded sutures were removed at 3 weeks postoperatively. At 3 weeks postoperatively 100% root coverage was seen in relation to 12–23 [Figure 5]. The surgical site remained plaque-free with minimal gingival inflammation. The patient was kept under observation and follow up for the next 6 months [Figure 6].
| Discussion | | |
Earlier periodontal therapy was limited to eliminate and avoid disease by the maintenance of a functional healthy dentition and supporting hard and soft tissues.[5]
The concept of Minimally Invasive Surgery is embracing all aspects of surgical techniques aiming to produce minimal wounds, minimal flap reflection, and gentle handling of the soft and hard tissues.[6] In the VISTA technique a single vestibular incision provides broader access to the entire surgical area, it reduces the possibility of traumatizing the gingiva and maintains the integrity of the interdental papilla by avoiding papillary reflection. Some of the limitations of the current techniques like the Connective Tissue Graft (CTG) can be overcome by using collagen membrane. A collagen barrier would eliminate the need for a second surgical site to harvest autogenous connective tissue donor material. It is also anticipated that when placed as a subepithelial graft, keloid formation will be reduced. Collagen also encourages autogenous connective tissue and epithelial cells to attach and migrate over its surface.[7]
An important technical difference between the VISTA and other tunneling approaches and more classical techniques of gingival augmentation is the degree of coronal advancement of the gingival margin advocated during the procedure.[8] The rigid fixation of the gingival margins introduced with the present coronally anchored suturing technique minimizes micromotion of the regenerative site. Reduction of micromotion has proven to be a major advantage of the present technique over conventional methods, where gingival margin may be subject to displacement during facial movements.[8]
Only a few limited studies are available in literature that have mentioned the use of collagen membrane with VISTA technique in the treatment of multiple gingival recession defects. In a study by Zadeh, Bioguide membrane was used in the VISTA technique for root coverage of maxillary anterior teeth.[8] A case report by Pawar et al.[9] describes the successful use of the VISTA technique in combination with collagen Guided Tissue Regeneration (GTR) membrane (Heliguide) for the treatment of multiple gingival recessions in the maxillary anterior region.
As in any study, this study of a case report of the VISTA technique with collagen membrane has certain limitations. This technique requires surgical expertness or mastering skills of surgery for tunnel preparation, as there may be chances of tear or perforation of the gingiva.
| Conclusion | | |
We conclude that the VISTA technique with collagen membrane can be successfully used for the treatment of multiple gingival recessions. Long-term clinical and histological studies are required to obtain more information about the predictability of this technique.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | American Academy of Periodontology. Glossary of Periodontal Terms. 3 rd ed. Chicago: American Academy of Periodontology; 1992.  |
| 2. | Dersot JM, Moubarak N. Decision making in root coverage surgical techniques. Dent News 2005;1:8-12. |
| 3. | Chan HL, Chun YH, MacEachern M, Oates TW. Does gingival recession require surgical treatment? Dent Clin North Am 2015;59:981-96. |
| 4. | Lindhe J, Lang NP, Karring T. Clinical Periodontology and Implant Dentistry. 5 th ed. Copenhagen: Blackwell Munksgaard; 2008. p. 955-1011. |
| 5. | Oates TW, Robinson M, Gunsolley JC. Surgical therapies for the treatment of gingival recession. A systematic review. Ann Periodontal 2003;8:303-20. |
| 6. | Reddy S, Prasad MGS, Bhowmik N, Singh S, Pandit HR, Vimal SK. Vestibular incision subperiosteal tunnel access (VISTA) with platelet rich fibrin (PRF) and connective tissue graft (CTG) in the management of multiple gingival recession- A case series. Int J Appl Dent Sci 2016;2:34-7. |
| 7. | Postlethwaite AE, Seyer JM, Kang AH. Chemotactic attraction of human fibroblasts for Type I, II and III collagen and collagen derived peptides. Proc Natl Acad Sci (USA) 1978;75:871-5. |
| 8. | Zadeh HH. Minimally invasive treatment of maxillary anterior gingival recession defects by vestibular incision subperiosteal tunnel access and platelet-derived growth factor BB. Int J Periodontics Restorative Dent 2011;31:653-60. |
| 9. | Pawar B, Bhuse K, Shetty A, Shetty D. A fantastic approach for multiple recession coverage: Vestibular incision subperiosteal tunnel access technique (Vista)-A case Report. J Dent Med Sci 2016;15:52-6. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
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