Comparative evaluation of vestibular incision subperiosteal tunnel access and coronally advanced flap in adjunction with platelet-rich fibrin for maxillary gingival recession - A randomized controlled study.

Abstract

Background: Gingival recession requires root coverage to address esthetics and dentinal hypersensitivity, prevent root caries and abrasion, and improve plaque control. The coronally advanced flap (CAF) with subepithelial connective tissue graft (SCTG) is a widely accepted gold standard but is technique sensitive and less predictable. The vestibular incision subperiosteal tunnel access (VISTA) technique is a minimally invasive alternative that yields more predictable results and better patient compliance. Platelet-rich fibrin (PRF) as a membrane for covering defects is less technique sensitive and improves patient comfort compared to SCTG. This study aims to compare the effectiveness of VISTA and CAF, both combined with PRF, in treating maxillary gingival recession.

Materials and methods: This randomized controlled trial involved 30 sites (15 in each group) in patients with Cairo et al. recession type 1 (RT1) recession. Sites were assigned to the test group (VISTA + PRF) or the control group (CAF + PRF). Primary outcomes, including probing depth (PD), clinical attachment level (CAL), width of keratinized tissue, thickness of attached gingiva (TAG), vertical depth of recession (VDR), gingival recession width (GRW), and percentage root coverage (%RC), were assessed at baseline and 3 months. Secondary outcomes included postsurgical discomfort, evaluated immediately after surgery and at 1 week.

Results: On comparison of the groups, statistically more significant results in terms of PD, CAL, TAG, VDR, GRW, percentage root coverage, and postsurgical discomfort level were seen in the test group compared to the control group.

Conclusion: Both VISTA + PRF and CAF + PRF effectively treat maxillary anterior gingival recession (Cairo et al. RT1), but VISTA + PRF shows superior outcomes.