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NCT Number: NCT06755294

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

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.

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Key information

Conditions

Gingival Recessions Gingival Diseases Gingival Recession Mouth Diseases Periodontal Atrophy Periodontal Diseases Stomatognathic Diseases

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

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

Treatment and study plan

Vestibular incision subperiostal tunnel technique

Procedure

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.

CAF

Procedure

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.

Primary outcomes

  1. Recession reduction (RR)

    Time frame: 3 months and 6 months after the surgery

    Measured with a periodontal probe and with a STL file

Secondary outcomes

  1. mean root coverage (% RC)

    Time frame: 3 and 6 months after the surgery

    Measured with a periodontal probe and with a STL file

  2. PPD

    Time frame: Baseline, 3 and 6 months after the surgery

    distance from the gingival margin to the base of the gingival sulcus

  3. CAL

    Time frame: Baseline, 3 and 6 months after the surgery

    distance from the LAC to the base of the gingival sulcus

  4. KTW

    Time frame: Baseline, 3 and 6 months after the surgery

    distance from the gingival margin to the mucogingival line (MGL

  5. Gingival thickness

    Time frame: Baseline, 3 and 6 months after the surgery

    Distance from the most external part of the gingiva to the buccal plate. Measured with a periodontal probe and with a STL file

  6. Complete root coverage

    Time frame: 3 and 6 months after the surgery

    Measured with a periodontal probe and with a STL file

Study contacts

Contact information is provided by the study sponsor or research team.

Alvaro Babiano Nodal, DDS,MSC

CONTACT

[email protected]

680391415

Sponsors and collaborators

Lead sponsor

Universitat Internacional de Catalunya

Other

Registry information

Official study title

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

Important dates

Study start
2025
Primary completion
2026
Study completion
2026
First posted
Jan 1, 2025
Registry last updated
Jan 28, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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