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

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: a Randomized Clinical Trial

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.

Study Overview

• Status: Not yet recruiting
• Conditions: Gingival Recessions
• Intervention / Treatment: Procedure: Vestibular incision subperiostal tunnel technique; Procedure: CAF

• Study Type: Interventional
• Enrollment (Estimated): 30
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Alvaro Babiano Nodal, DDS,MSC; Phone Number: 680391415; Email: alvarobabianon@uic.es

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• 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.

Exclusion Criteria:

• 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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: TEST; VISTA TECHNIQUE	Procedure: Vestibular incision subperiostal tunnel technique; 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.
Experimental: Control; Coronally Advanced Technique	Procedure: CAF; 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Recession reduction (RR)	Measured with a periodontal probe and with a STL file	3 months and 6 months after the surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
PPD	distance from the gingival margin to the base of the gingival sulcus	Baseline, 3 and 6 months after the surgery
CAL	distance from the LAC to the base of the gingival sulcus	Baseline, 3 and 6 months after the surgery
KTW	distance from the gingival margin to the mucogingival line (MGL	Baseline, 3 and 6 months after the surgery
mean root coverage (% RC)	Measured with a periodontal probe and with a STL file	3 and 6 months after the surgery
Gingival thickness	Distance from the most external part of the gingiva to the buccal plate. Measured with a periodontal probe and with a STL file	Baseline, 3 and 6 months after the surgery
Complete root coverage	Measured with a periodontal probe and with a STL file	3 and 6 months after the surgery

Collaborators and Investigators

• Sponsor: Universitat Internacional de Catalunya

Study record dates

Study Major Dates

• Study Start (Estimated): January 30, 2025
• Primary Completion (Estimated): January 15, 2026
• Study Completion (Estimated): June 15, 2026

Study Registration Dates

• First Submitted: December 23, 2024
• First Submitted That Met QC Criteria: December 23, 2024
• First Posted (Actual): March 25, 2025

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: January 25, 2025
• Last Verified: January 1, 2025

More Information

Terms related to this study

• Keywords: Root Coverage; CAF; VISTA TECHNIQUE
• Additional Relevant MeSH Terms: Periodontal Atrophy; Periodontal Diseases; Mouth Diseases; Stomatognathic Diseases; Gingival Diseases; Gingival Recession
• Other Study ID Numbers: PER-ECL-2023-09

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No