Journal of Clinical and Diagnostic Research. 2023 Jan, Vol-17(1): ZD16-ZD18 16 16 DOI: 10.7860/JCDR/2023/59650.17382 Case Report Dentistry Section Microsurgical Approach for the Coverage of Gingival Recession Defects using Vestibular Incision Subperiosteal Tunnel Access (VISTA TM ) Technique- A Case Report CASE REPORT A 24-year-old healthy female patient reported to the Department of Periodontology, Shree Guru Gobind Singh Tricentenary University, Dental Hospital and Research Institute, Gurugram; with the chief complaint of poor aesthetics and sensitivity to cold fluids in the upper front teeth region since 2-3 months which gradually increased with time. On clinical examination, gingival recession defects of 1-2 mm were noticed in relation to the maxillary central incisors 11, 21. Radiographic examination revealed no bone loss. Patient’s oral hygiene was well maintained. All the clinical parameters were recorded- Plaque Index [1], Probing Pocket Depth [1] Recession Width [2] Recession Depth [2] and Clinical Attachment Loss [2] and Gingival Biotype [2], using Hu- Friedy’s TM UNC-15 periodontal probe. A diagnosis of Miller’s Class I gingival recession [3] [Table/Fig-1a,b] was thus made. Surgical technique: A presurgical rinse was advised using 0.2% chlorhexidine gluconate solution (Hexidine mouthwash, ICPA Health Products Ltd). Disinfection of the extraoral surfaces using 10% povidone iodine was done and local anaesthesia (Lignocaine 2% adrenaline,1:200000; Indoco Remedies Ltd) was administered near the operatory site to ensure anaesthesia at the site. [Table/Fig-2] shows the armamentarium used in the procedure. AISHAAN SHARMA 1 , RIDHIMA UPPAL 2 , SHALINI KAPOOR 3 , AMIT BHARDWAJ 4 , AAYUSHEE GUPTA 5 Keywords: Aesthetics, Magnification, Platelet rich fibrin ABSTRACT Gingival recession which is described as the loss of gingival attachment due to apical migration of the gingival margin from the cementoenamel junction leading to the exposure of the root surface, is one of the most prevalent diseases in the world. The treatment of gingival recession is therefore essential to achieve good aesthetics, relieve root hypersensitivity, prevent root caries and cervical abrasions. Till date, many root coverage techniques have been implicated for the coverage of recession defect. This case report focuses on the Vestibular Incision Subperiosteal Tunnel Access (VISTA TM ) technique for the root coverage procedure and simultaneous application of the microsurgical principles helps in executing the procedure in the most minimally invasive manner. Here, this technique has been accomplished in a 24-year-old female, with the chief complaint of poor aesthetics in the region of maxillary central incisors due to recession defects. Furthermore with the use of microsurgical instruments and magnifying loupes; complete coverage of the recession defects was achieved in a single stage surgery along with superior aesthetics, causing minimal trauma to the patient that was followed by an uneventful inflammatory phase. [Table/Fig-1]: a) Baseline recession depth wrt 11; b) Baseline recession depth wrt 21. For the treatment of gingival recession, till date a number of root covering approaches have been suggested like advanced flap techniques, pedicle flap techniques, free gingival graft procedure, and sub-epithelial connective tissue graft procedure [4] but in the present case, the decision of performing VISTA TM technique (Zadeh H in 2011) [5] was made so as to get an access to the multiple recession defects in the aesthetic area in a single-stage surgery with the preservation of interdental papillae simultaneously. The patient was thoroughly explained about the procedure and an informed written consent was taken before starting the procedure. [Table/Fig-2]: Armamentarium: 1. Magnification loupes (Prism loupes,Carl Zeiss 3.5x); 2. Microsurgical papilla elevator (Hu-friedey TM ); 3. Microsurgical periosteal eleva- tor (Hu-friedey TM ); 4. Microsurgical tissue holding forceps (Hu-friedey TM ); 5. Microsur- gical Needle holder (Hu-friedey TM ); 6. Opthalmic blades-cresent shaped and 15-C Surgical blade. [Table/Fig-3]: Vestibular access incision. (Images from left to right). With the help of 15-C blade, surgical access to the site was made using the VISTA TM technique, where a small vertical vestibular access incision was made [Table/Fig-3]. The depth of the incision was extended up to the periosteum, so that a subperiosteal tunnel could be prepared between the periosteum and the bone with the help of a microsurgical periosteal elevator (Hu-Friedy TM - [Table/Fig-4]). The subperiosteal tunnel was extended one tooth adjacent to the site of operation i.e from the mesial of the right maxillary lateral incisor to the mesial of the left maxillary lateral incisor. Adequate elevation of the tunnel was made beyond the mucogingival junction and through the gingival margins to facilitate adequate coronal repositioning of the tunnel without any tension during the advancement. The tunnel was also extended interproximally below each papilla without making any incisions, thereby preserving the anatomy of the papillae.