Vestibular Incision Subperiosteal Tunnel Access associated with Subepithelial Connective Tissue T.M. Marques1, N.M. Santos1, M.C. Sousa1 1 – Lecturer in Periodontology (DCS-UCP) Introduction Gingival recession may be treated using a variety of therapeutic options with varying degrees of success depending on the initial presentation and treatment approach. The limitations of current techniques include scar formation at the recipient site resulting from surface incisions. Materials and Methods The VISTA approach begins with a vestibular access incision mesial to the recession defects being treated. Through this incision a subperiosteal tunnel is created, exposing the facial osseous plate and root dehiscences. The tunnel is extended at least one or two teeth beyond the teeth requiring root coverage to mobilize gingival margins and facilitate coronal repositioning. The mucogingival complex is advanced coronally and stabilized with the coronally anchored suturing technique. Patients were prescribed analgesics as required and were advised to use chlorhexidine mouth rinse daily for 3 weeks. All the patients were provided regular periodontal maintenance for 6 months CASE I 1.Initial (smile) 2.Initial (1.3) 3.Surgical 4.Post-op (5 months) 5.Post-op (5 months) CASE II 1.Initial (smile) 2.Initial (2.3) 3.Post-op(2 weeks) 4.Post-op (2 months) 5.Post-op (2 months) CASE III 1.Initial 2.Initial 3.Surgical 4.Post-op (2 weeks) 5.Post-op (3 months) CASE IV 1.Initial 2.Initial 3.Post-op (2 weeks) 4.Post-op (2 weeks) 5.Post-op (5 months) CASE V 1.Initial (smile) 2.Initial (2.3) 3.Surgical 4.Post-op (3months) 5.Post-op (3 months) CASE VI 1.Initial 2.Initial (2.2) 3.Surgical 4.Post-op (3months) 5.Post-op (3 months) CASE VII 1.Initial (smile) 2.Initial (2.3) 3.Post-op(2 weeks) 4.Post-op (5 months) 5.Post-op (5 months) CASE VIII 1.Initial 2.Initial 3.Post-op(2week) 4.Post-op (6 months) 5.Post-op (6 months) Discussion Conclusion Mean gingival tissue thickness and keratinized tissue width increased significantly. Tissue at the site appeared healthy, with no visible signs of inflammation.This case series describes cases of Miller class I, II and III defects. Despite that complete root coverage wasn’t achieved in class III cases, creeping attachment increased attached gingiva width and stopped progressive gingival recession. The need to simultaneously address multiple recession defects is very difficult with the current procedures. VISTA technique appears to improve biotype, successfully treat multiple recession defects , with no scar formation, avoiding some of the potential complications of intrasulcular tunneling techniques. Zadeh HH. Minimally invasive treatment of maxillary anterior gingival recession defects by vestibular incision subperiosteal tunnel access and platelet-derived growth factor BB. Int J Periodontics Restorative Dent [Internet]. 2011;31(6):653–60. Gupta G, Puri K, Bansal M, Khatri M, Kumar A. Platelet Rich Fibrin (PRF) Reinforced Vestibular Incision Subperiosteal Tunnel Access (VISTA) Technique for Recession Coverage. Clin Adv Periodontics [Internet]. 2014 Jul 20 [cited 2014 Aug 4];1–13.