VISTA Approach in Conjunction with Enamel Matrix Derivative, Corticocancellous Bone, and Connective Tissue Graft for Periodontal Defect Surgery: A Case Series

Int J Periodontics Restorative Dent. 2023 Nov 3;43(6):715-723. doi: 10.11607/prd.6094.

Abstract

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 (VISTA) 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, application of enamel matrix derivative, defect grafting with corticocancellous 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.

MeSH terms

  • Alveolar Bone Loss* / surgery
  • Bone and Bones / surgery
  • Connective Tissue / surgery
  • Dental Enamel Proteins* / therapeutic use
  • Follow-Up Studies
  • Gingival Recession* / surgery
  • Guided Tissue Regeneration, Periodontal / methods
  • Humans
  • Periodontal Attachment Loss / surgery
  • Treatment Outcome

Substances

  • enamel matrix proteins
  • Dental Enamel Proteins