Vestibular Incision Subperiosteal Tunnel Access (VISTA) Technique Versus Coronally Advanced Flap (CAF) Combined With a Connective Tissue Graft for the Treatment of Maxillary Gingival Recessions

NCT06755294 | Not Yet Recruiting DMC

• 1 other identifier: PER-ECL-2023-09
• Study Type: interventional
• Target: 30
• Locations: 0 countries
• Sites: N/A

Brief Summary

Gingival recession (GR) is a common oral health problem that causes sensitivity, esthetic concerns and hygiene problems. Successful root coverage can be achieved by various surgical techniques. The VISTA technique may overcome some of the limitations of other techniques and present equal results to techniques that are considered the "Gold Standard" in this area of periodontology. The objective of the research is to study the VISTA technique in terms of complete root coverage, % root coverage, gingival thickness gain, bleeding on probing, keratinized gingival width, PROMS, vestibular depth and esthetic results.

Conditions

Gingival Recessions

Keywords

VISTA TECHNIQUE; CAF; Root Coverage

Outcome Measures

Primary Outcomes (1)

• Recession reduction (RR)

  Measured with a periodontal probe and with a STL file

  3 months and 6 months after the surgery

Secondary Outcomes (6)

• mean root coverage (% RC)

  3 and 6 months after the surgery

• PPD

  Baseline, 3 and 6 months after the surgery

• CAL

  Baseline, 3 and 6 months after the surgery

• KTW

  Baseline, 3 and 6 months after the surgery

• Gingival thickness

  Baseline, 3 and 6 months after the surgery

Study Arms (2)

TEST

EXPERIMENTAL

VISTA TECHNIQUE

Procedure: Vestibular incision subperiostal tunnel technique

Control

EXPERIMENTAL

Coronally Advanced Technique

Procedure: CAF

Interventions

Vestibular incision subperiostal tunnel technique PROCEDURE

The VISTA (Vestibular Incision Subperiosteal Tunnel Access) technique is a minimally invasive surgical approach for root coverage. A single vertical incision is made, often at the labial frenulum for optimal access, reaching the periosteum to elevate a subperiosteal tunnel. This tunnel is extended beyond the mucogingival junction and interproximally under each papilla to enable tension-free coronal repositioning of the gingiva. An autologous connective tissue graft, harvested and de-epithelialized from the palate, is introduced into the tunnel. Before placement, teeth are etched (orthophosphoric or hydrofluoric acid depending on surface type). Sutures (6-0 polypropylene) stabilize the graft, with additional composite fixation on treated teeth. The vertical incision is closed using 5-0 sutures, ensuring proper stabilization and healing. This approach minimizes trauma, promotes healing, and achieves effective root coverage.

TEST

CAF PROCEDURE

The Coronally Advanced Flap (CAF) is an effective technique for root coverage in single or multiple gingival recession cases with adequate apical keratinized tissue thickness and height. Following the De Sanctis and Zucchelli protocol (2007), two horizontal incisions are made 3 mm apart, with placement 1 mm apical to the recession height. Vertical beveled incisions extend into the alveolar mucosa, and a flap is elevated in three stages: partial thickness at the papilla, full thickness to the buccal bone table, and apical partial thickness to release muscle fibers for mobility. An autologous connective tissue graft (≥1 mm thick) is harvested from the palatal or retromolar area, de-epithelialized, and shaped to the recession size. The anatomical papillae are de-epithelialized, and the graft is sutured apically to the CEJ using 6-0 Polyglactin 910. Sling sutures (6-0 polypropylene) stabilize the flap 2 mm coronally to the CEJ, ensuring optimal positioning and healing.

Control

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Healthy adults: men and women between 18 and 75 years of age.
• Accepts and signs informed consent.
• Systemically healthy patients with periodontal health or controlled periodontitis.
• Presence of at least two maxillary Cairo Type I or II (RT1/2) recessions \> 2 mm deep on buccal aspect.
• Plaque index ≤20%
• No previous periodontal surgeries performed.
• Presence of the cementoenamel junction (CEJ), a 1 mm step in the CEJ and/or presence of root abrasion, but with an identifiable CEJ will be accepted.

You may not qualify if:

• Smoker of 10 ≥ cigarettes per day.
• Contraindications to periodontal surgery.
• Medications that affect the gingiva or their healing.
• Active orthodontic treatment.
• Pregnant women
• Caries or restorations in the area to be treated.
• Patients who cannot follow the post-surgical medication adequately

Sponsors & Collaborators

• Universitat Internacional de Catalunya: lead

MeSH Terms

Conditions

Gingival Recession

Condition Hierarchy (Ancestors)

Gingival Diseases; Periodontal Diseases; Mouth Diseases; Stomatognathic Diseases; Periodontal Atrophy

Central Study Contacts

Alvaro Babiano Nodal, DDS,MSC

CONTACT

680391415; alvarobabianon@uic.es

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: DDS/MsC

Study Record Dates

• First Submitted: December 23, 2024
• First Posted: January 1, 2025
• Study Start: January 30, 2025
• Primary Completion: January 15, 2026
• Study Completion (Estimated): June 15, 2026
• Last Updated: January 28, 2025

Record last verified: 2025-01