Case Report http://doi.org/10.18231/j.ijpi.2020.009 IP International Journal of Periodontology and Implantology, January-March, 2020;5(1):37-40 37 A novel approach of treating gingival recession by Vestibular Incision Subperiosteal Tunnel Access along with palatal connective tissue graft Surupa Dutta 1* , Farha Nasim 2 , Debarghya Pal 3 , Manoj Kumar Singh 4 , Himadri Chakrabarty 5 1 3 rd Year Postgraduate, 2,3 2 nd Year Postgraduate, 4,5 Professor, Dept. of Periodontics, Guru Nanak Institute of Dental Sciences & Research, Kolkata, West Bengal, India *Corresponding Author: Surupa Dutta Email: surupa.mukta@gmail.com Abstract Gingival recession, defined as the apical migration of gingival margin possesses great degree of functional and aesthetic problems. Recently new techniques for root coverage have been proposed for treating multiple teeth recession. Keeping in mind the limitations of the conventional techniques, a minimally invasive approach for the recipient site in the aesthetic zone, Vestibular Incision Subperiosteal Tunnel Access (VISTA) technique had been introduced. Since the connective tissue graft is the proven gold standard, it is combined with the minimally invasive technique to achieve the best possible result. Here, a series of such cases are discussed and the 6 months post operative follow up is hence analysed to assess the root coverage. Keywords: Gingival recession, Minimally invasive, Root coverage, VISTA, Connective tissue graft. Introduction Gingival recession is a common feature affecting the population leading to functional and esthetic problems. It is defined as the apical migration of the gingival margin below the cemento-enamel junction (CEJ), leading to root exposure. 1 Etiological factors such as faulty tooth brushing, malalignment of teeth, periodontal disease, high frenal attachment, traumatic occlusion and iatrogenic factors related to restorative and periodontal treatment procedures are the possible cause for the development of gingival recession. 2 It is a cause of concern for both the clinician and the patients as it may predispose to further attachment loss, dentinal hypersensitivity and root caries and also appears to be esthetically unpleasant. 3 An array of treatment modalities are available for the treatment with the objective of root coverage. But most of these are suitable to achieve predictable results in isolated defects. 4 While gingival recessions frequently affect group of adjacent teeth, therefore, in order to minimize the surgeries and to optimize the esthetic result, all the contiguous recessions should be treated simultaneously. 5 However, the treatment of multiple recession defects possess great challenge to the clinician owing to extensive avascular root surface area. Other factors like thin gingival phenotype, inadequate keratinized tissue, root prominence and root proximity creates dilemma in the choice of different surgical treatment modalities which further increases the risk of unpredictable outcome. Although, connective tissue graft (CTG) along with coronally advanced flap was considered to be the gold standard for the treatment due to its high predictability of the treatment outcomes, yet we are looking for an alternative owing to the complications CTG harvesting. 6 With the introduction of minimally invasive, tunnelling techniques for gingival augmentation, comparable results could be obtained. It attempts to preserve the interdental papillae, providing unhampered blood supply, and faster wound healing. However, these procedures are quite technique sensitive and may cause tissue trauma to sulcular epithelium, leading to unfavourable healing outcomes. 4 To overcome such complications, the vestibular incision subperiosteal tunnel access (VISTA) approach was introduced by Zadeh. Further the use of CTG would benefit with faster healing, lesser soft tissue contraction and also increase width and thickness of the keratinized tissue, resulting in better root coverage over a long period of time. 7 The purpose of this case series is to evaluate clinically, the efficacy of the novel and minimally invasive VISTA in combination with CTG in the treatment of multiple gingival recession defects. Materials and Methods The study was conducted in the Department of Periodontics in Guru Nanak Institute of Dental Sciences and Research, over a period of 6 months. Three patients were selected with gingival recession in mandibular anterior teeth, with the chief complaint of sensitivity in the same region, along with esthetic concern. Case 1 A 45 year old female patient with Miller’s class III gingival recession in tooth number 41. It was associated with occlusal discrepancy causing interdental bone loss between 31 and 41. Tension test was positive. For treating such a condition, boosting the gingival thickness with connective tissue was adopted in an attempt to cover such gingival recession. Case 2 A 32 year old male patient with Miller’s class I gingival recession in 31 and 41 had the chief complain of sensitivity of teeth. Minimally invasive VISTA technique for root coverage was adopted, considering the aesthetic zone of concern.