Clinical efficacy of Vestibular Incision Subperiosteal Tunnel Access (VISTA) for treatment of multiple gingival recession defects: a systematic review, meta-analysis and meta-regression

Abstract

Objectives: This study investigated the efficacy of Vestibular Incision Subperiosteal Tunnel Access (VISTA) compared to other methods for treating multiple adjacent gingival recessions (MAGRs) through a systematic review and meta-analysis.

Materials and methods: A systematic literature search was performed through June 2023, to identify clinical trials investigating VISTA for root coverage on MAGRs. A meta-analysis with meta-regression model was employed on the primary outcomes of mean and complete root coverages (MRC, CRC), comparing VISTA with other techniques. Clinical efficacy of various graft materials was assessed.

Results: Fourteen studies were included, 8 of which met the criteria for quantitative assessment. The cumulative MRC (88.15% ± 20.79%) and CRC (67.85% ± 21.72%) of VISTA were significantly higher compared to the tunneling technique (SMD = 0.83 (95% CI [0.36, 1.30], p < 0.01). The baseline recession depth showed a negative correlation with CRC, whereas baseline keratinized gingiva width exhibited a positive correlation with this outcome.

Conclusions: The VISTA technique, particularly with acellular dermal matrix (ADM) or connective tissue graft (CTG) materials, offers superior outcomes compared to the tunneling technique. The capacity of platelet-rich fibrin (PRF) to substitute for connective tissue graft (CTG) in VISTA-root coverage was noteworthy, provided there is adequate keratinized tissue width.

Clinical relevance: VISTA in concert with acellular dermal matrix or CTG resulted in improved root coverage, surpassing the outcomes achieved through tunneling. PRF emerged as a viable alternative to CTG, when used in conjunction with VISTA, demonstrating comparable mean root coverage. This is particularly evident in situations where sufficient keratinized gingiva is available and when patient comfort is taken into consideration.

Keywords: Gingival recession; Periodontal plastic surgery; Root coverage; Tunneling; VISTA; Vestibular incision.