Comparative study of the modified VISTA technique (m-VISTA) versus the coronally advanced flap (CAF) in the treatment of multiple Miller class III/RT2 recessions: a randomized clinical trial

Aitziber Fernández-Jiménez, Ruth Estefanía-Fresco, Ana María García-De-La-Fuente, Xabier Marichalar-Mendia, José Manuel Aguirre-Urizar, Luis Antonio Aguirre-Zorzano, Aitziber Fernández-Jiménez, Ruth Estefanía-Fresco, Ana María García-De-La-Fuente, Xabier Marichalar-Mendia, José Manuel Aguirre-Urizar, Luis Antonio Aguirre-Zorzano

Abstract

Objectives: To compare the percentage of mean root coverage (MRC%) obtained in the treatment of multiple Miller class III/RT2 gingival recessions using the modified VISTA (m-VISTA) technique versus the coronally advanced flap (CAF) technique, using a connective tissue graft (CTG) in both cases.

Materials and methods: Twenty-four patients were randomly treated with m-VISTA (test group (TG) = 12) or CAF (control group (CG) = 12). A calibrated, experienced, and blinded examiner collected data related to multiple periodontal clinical variables, especially the recession (REC) in order to calculate the MRC% at 6 and 12 months, which was the primary outcome of the study. Also, the radiological bone level, the characteristics of the CTG, and postsurgical incidences were assessed. Finally, a descriptive and an analytical statistical analysis of the variables and their associations was performed.

Results: The recessions (n = 84) were located mainly in the mandible (n = 65) and in posterior sectors (premolars: n = 35; molars: n = 8). At 6 months, the MRC% was 61% (2 mm) for both study groups, and at 12 months, it increased to 73.26% (2.11 mm) in the TG and decreased to 56.49% (1.78 mm) in the CG.

Conclusion: When approaching multiple Miller class III/RT2 recessions, there were no statistically significant differences in the MRC% at 6 and 12 months between the group treated with the m-VISTA technique and the group treated with the CAF.

Clinical relevance: The characteristics of the m-VISTA technique, such as the closed approach, the mobilization of the papilla, and the coronal stabilization of the CTG, could facilitate the maturation of the tissues in the treatment of Miller class III/RT2 recessions. This would favor better root coverage.

Trial registration: NCT03258996.

Keywords: Clinical trial; Connective tissue; Gingival Recessions; Plastic surgery.

Conflict of interest statement

The authors declare no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
a Miller class III/RT2 multiple gingival recessions from 4.3 to 4.6. b Interproximal bone loss in the teeth with recessions to be treated. c Mucoperiosteal tunnel and elevation of the papillae through a single vestibular incision with a CTG from the palate. d Double-crossed vertical sutures (tunnel-papillae-graft) anchored at each contact point and vertical incision closure with single interrupted sutures (m-VISTA). e Clinical outcome at 1-year follow-up
Fig. 2
Fig. 2
a Multiple Miller class III/RT2 gingival recessions from 3.3 to 3.5. b Interproximal bone loss in the teeth with recessions to be treated. c Split-full-split thickness flap elevation with the CTG secured in position. d Coronal stabilization of the flap with sling sutures (CAF). e Clinical outcome at 1-year follow-up
Fig. 3
Fig. 3
CONSORT flow diagram

References

    1. Guinard EA, Caffesse RG. Localized gingival recessions: 1. Etiology and prevalence. J West Soc Periodontol Periodontal Abstr. 1977;25:3–9.
    1. Sangnes G, Gjermo P. Prevalence of oral soft and hard tissue lesions related to mechanical toothcleansing procedures. Community Dent Oral Epidemiol. 1976;4:77–83. doi: 10.1111/j.1600-0528.1976.tb01607.x.
    1. Miller PD. A classification of marginal tissue recession. Int J Periodontics Restorative Dent. 1985;5:8–13.
    1. Cairo F, Nieri M, Cincinelli S, Mervelt J, Pagliaro U. The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. J Clin Periodontol. 2011;38:661–666. doi: 10.1111/j.1600-051X.2011.01732.x.
    1. Fernández-Jiménez A, García-De-La-Fuente A-M, Estefanía-Fresco R, Marichalar-Mendia X, Aguirre-Urizar J-M, Aguirre-Zorzano L-A. Complete root coverage in the treatment of Miller class III or RT2 gingival recessions: a systematic review and meta-analysis. BMC Oral Health. 2021;21:145. doi: 10.1186/s12903-021-01494-3.
    1. Tatakis DN, Chambrone L, Allen EP, Langer B, McGuire MK, Richardson CR, Zabalegui I, Zadeh HH. Periodontal soft tissue root coverage procedures: a consensus report from the AAP Regeneration Workshop. J Periodontol. 2015;86:S52–S55. doi: 10.1902/jop.2015.140376.
    1. Chambrone L, Tatakis DN. Periodontal soft tissue root coverage procedures: a systematic review from the AAP Regeneration Workshop. J Periodontol. 2015;86:S8–S51. doi: 10.1902/jop.2015.130674.
    1. Barker TS, Cueva MA, Rivera-Hidalgo F, Beach MM, Rossmann JA, Kerns DG, Crump TB, Shulman JD. A comparative study of root coverage using two different acellular dermal matrix products. J Periodontol. 2010;81:1596–1603. doi: 10.1902/jop.2010.090291.
    1. Chakravarthy Y, Chandra RV, Reddy AA, Reddy GP. Lateral osteoperiosteal flap versus lateral pedicle flap in the treatment of class III gingival recession: a single-center, open-label trial. J Indian Soc Periodontol. 2020;24:454–460. doi: 10.4103/jisp.jisp_489_19.
    1. Henriques PS, Pelegrine AA, Nogueira AA, Borghi MM. Application of subepithelial connective tissue graft with or without enamel matrix derivative for root coverage: a split-mouth randomized study. J Oral Sci. 2010;52:463–471. doi: 10.2334/josnusd.52.463.
    1. Parween S, George JP, Prabhuji M. Treatment of multiple mandibular gingival recession defects using MCAT technique and SCTG with and without rhPDGF-BB: a randomized controlled clinical trial. Int J Periodontics Restorative Dent. 2020;40:e43–e51. doi: 10.11607/prd.4505.
    1. Aroca S, Keglevich T, Nikolidakis D, Gera I, Nagy K, Azzi R, Etienne D. Treatment of class III multiple gingival recessions: a randomized-clinical trial. J Clin Periodontol. 2010;37:88–97. doi: 10.1111/j.1600-051X.2009.01492.x.
    1. Mercado F, Hamlet S, Ivanovski S. Subepithelial connective tissue graft with or without enamel matrix derivative for the treatment of multiple Class III-IV recessions in lower anterior teeth: a 3-year randomized clinical trial. J Periodontol. 2020;91:473–483. doi: 10.2334/josnusd.52.463.
    1. Zucchelli G, De Sanctis M. Treatment of multiple recession-type defects in patients with esthetic demands. J Periodontol. 2000;71:1506–1514. doi: 10.1902/jop.2000.71.9.1506.
    1. McLean TN, Smith BA, Morrison EC, Nasjleti CE, Caffesse RG. Vascular changes following mucoperiosteal flap surgery: a fluorescein angiography study in dogs. J Periodontol. 1995;66:205–210. doi: 10.1902/jop.1995.66.3.205.
    1. Fernández-Jiménez A, Estefanía-Fresco R, García-De-La-Fuente A-M, Marichalar-Mendia X, Aguirre-Zorzano L-A. Description of the modified vestibular incision subperiosteal tunnel access (m-VISTA) technique in the treatment of multiple Miller class III gingival recessions: a case series. BMC Oral Health. 2021;21:142. doi: 10.1186/s12903-021-01511-5.
    1. O'Leary TJ, Drake RB, Naylor JE. The plaque control record. J Periodontol. 1972;43:38. doi: 10.1902/jop.1972.43.1.38.
    1. Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J. 1975;25:229–235.
    1. Schulz KF, Altman DG, Moher D, Group C CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c332. doi: 10.1136/bmj.c332.
    1. Domenech JM, Granero R (2010) Macro!NSize for SPSS Statistics. Sample Size and Power: Comparisons and estimations for independent proportions, means, correlations, risks and rates [computer program]. V2010.06.30. Universidad Autònoma de Barcelona, Bellaterra
    1. Zuhr O, Rebele SF, Thalmair T, Fickl S, Hürzeler MB. A modified suture technique for plastic periodontal and implant surgery–the double-crossed suture. Eur J Esthet Dent. 2009;4:338–347.
    1. Aguirre-Zorzano L, García-De-La-Fuente A, Estefanía-Fresco R, Marichalar-Mendia X. Complications of harvesting a connective tissue graft from the palate. A retrospective study and description of a new technique. J Clin Exp Dentistry. 2017;9:e1439. doi: 10.4317/jced.54337.
    1. Cetiner D, Bodur A, Uraz A. Expanded mesh connective tissue graft for the treatment of multiple gingival recessions. J Periodontol. 2004;75:1167–1172. doi: 10.1902/jop.2004.75.8.1167.
    1. Stillman P. A philosophy of the treatment of periodontal disease. Dent Digest. 1932;38:315–319.
    1. Zucchelli G, Gori G, Mele M, Stefanini M, Mazzotti C, Marzadori M, Montebugnoli L, De Sanctis M. Non-carious cervical lesions associated with gingival recessions: a decision-making process. J Periodontol. 2011;82:1713–1724. doi: 10.1902/jop.2011.110080.
    1. Schneider CA, Rasband WS, Eliceiri KW. (2012) NIH Image to ImageJ: 25 years of image analysis. Nat Methods. 2012;9:671–675. doi: 10.1038/nmeth.2089.
    1. Ucak O, Ozcan M, Seydaoglu G, Haytac MC. Microsurgical instruments in laterally moved, coronally advanced flap for miller class III isolated recession defects: a randomized controlled clinical trial. Int J Periodontics Restorative Dent. 2017;37:109–115. doi: 10.11607/prd.2547.
    1. Cairo F, Cortellini P, Tonetti M, Nieri M, Mervelt J, Cincinelli S, Pini-Prato G. Coronally advanced flap with and without connective tissue graft for the treatment of single maxillary gingival recession with loss of inter-dental attachment. A randomized controlled clinical trial. J Clin Periodontol. 2012;39:760–768. doi: 10.1111/j.1600-051X.2012.01903.x.
    1. Ozcelik O, Seydaoglu G, Haytac MC. An explorative study to develop a predictive model based on avascular exposed root surface area for root coverage after a laterally positioned flap. J Periodontol. 2015;86:356–366. doi: 10.1902/jop.2014.140453.
    1. Ozcelik O, Seydaoglu G, Haytac MC. Prediction of root coverage for single recessions in anterior teeth: a 6-month study. J Clin Periodontol. 2015;42:860–867. doi: 10.1111/jcpe.12449.
    1. Cueva MA, Boltchi FE, Hallmon WW, Nunn ME, Rivera-Hidalgo F, Rees T. A comparative study of coronally advanced flaps with and without the addition of enamel matrix derivative in the treatment of marginal tissue recession. J Periodontol. 2004;75:949–956. doi: 10.1902/jop.2004.75.7.949.
    1. De Sanctis M, Clementini M. Flap approaches in plastic periodontal and implant surgery: critical elements in design and execution. J Clin Periodontol. 2014;41:S108–S122. doi: 10.1111/jcpe.12189.
    1. Pini-Prato G. The Miller classification of gingival recession: limits and drawbacks. J Clin Periodontol. 2011;38:243–245. doi: 10.1111/j.1600-051X.2010.01655.x.
    1. Tonetti MS, Jepsen S, Working Group 2 of the European Workshop on Periodontology Clinical efficacy of periodontal plastic surgery procedures: consensus report of Group 2 of the 10th European Workshop on Periodontology. J Clin Periodontol. 2014;41:S36–43. doi: 10.1111/jcpe.12219.
    1. Martins AG, Andia DC, Sallum AW, Sallum EA, Casati MZ, Nociti Júnior FH. Smoking may affect root coverage outcome: a prospective clinical study in humans. J Periodontol. 2004;75:586–591. doi: 10.1902/jop.2004.75.4.586.
    1. Chambrone LA, Chambrone L. Subepithelial connective tissue grafts in the treatment of multiple recession-type defects. J Periodontol. 2006;77:909–916. doi: 10.1902/jop.2006.050249.
    1. Fischer KR, Alaa K, Schlagenhauf U, Fickl S. Root coverage with a modified lateral sliding flap - a case series. Eur J Esthet Dent. 2012;7:120–128.
    1. Jepsen K, Jepsen S, Zucchelli G, Stefanini M, de Sanctis M, Baldini N, Greven B, Heinz B, Wennström J, Cassel B, Vignoletti F, Sanz M. Treatment of gingival recession defects with a coronally advanced flap and a xenogeneic collagen matrix: a multicenter randomized clinical trial. J Clin Periodontol. 2013;40:82–89. doi: 10.1111/jcpe.12019.
    1. Esteibar JRV, Zorzano LAA, Cundín EE, Blanco JDM, De Guinea Medina JRO. Complete root coverage of miller class III recessions. Int J Periodontics Restorative Dent. 2011;31:e1–e7.
    1. Huang LH, Neiva RE, Wang HL. Factors affecting the outcomes of coronally advanced flap root coverage procedure. J Periodontol. 2005;76:1729–1734. doi: 10.1902/jop.2005.76.10.1729.
    1. Müller HP, Stahl M, Eger T. (2001) Failure of root coverage of shallow gingival recessions employing GTR and a bioresorbable membrane. Int J Periodontics Restorative Dent. 2001;21:171–181.
    1. Clauser C, Nieri M, Franceschi D, Pagliaro U, Pini-Prato G. Evidence-based mucogingival therapy. Part 2: ordinary and individual patient data meta-analyses of surgical treatment of recession using complete root coverage as the outcome variable. J Periodontol. 2003;74:741–756. doi: 10.1902/jop.2003.74.5.741.
    1. Aroca S, Barbieri A, Clementini M, Renouard F, de Sanctis M. Treatment of class III multiple gingival recessions: prognostic factors for achieving a complete root coverage. J Clin Periodontol. 2018;45:861–868. doi: 10.1111/jcpe.12923.
    1. Tarnow DP, Magner AW, Fletcher P. The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. J Periodontol. 1992;63:995–996. doi: 10.1902/jop.1992.63.12.995.
    1. Gobbato L, Nart J, Bressan E, Mazzocco F, Paniz G, Lops D. Patient morbidity and root coverage outcomes after the application of a subepithelial connective tissue graft in combination with a coronally advanced flap or via a tunneling technique: a randomized controlled clinical trial. Clin Oral Investig. 2016;20:2191–2202. doi: 10.1007/s00784-016-1721-7.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться