Vista Technique for lower incisor recession

124 Rating(s).


Posted on By Howard Gluckman In Soft Tissue Enhancement

I find the treatment of recession in the lower incisor area the most challenging area to successfully achieve any sort of result, when treating recession. I have completely reverted to a full thickness tunnel with a VISTA approach together with a zucchelli harvest technique. this case highlites the difficulty of getting a perfect result. This is a classic 3 Millers recession which was treated with the VISTA technique and the 1 year follow up result of the case




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12 Comments

Great result.

Would you consider the old fashioned free gingival graft?


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yes if there was NO attached gingiva anywhere I would go that route however in this case I had good AG both sides so would not be my first option


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Howie;
Absolutely agree. It is a tough area to be successful with CTG of any kind....especially in light of interproximal involvement and IHB loss. I often revert to FGG in areas of muscle pull here or short vestibular depth. In this case, I may do FGG and then follow with some form of CAF technique. thoughts? Mo


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Agreed Mo as I said for the question above I would only go for FGG and vestibuloplasty if I have no AG on the adjacent teeth. but when I have a single tooth then I generally go for the tunnel approach


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You achieved great tissue volume, appearance and stability. In my experience if CTG is applied and flap repositioned tension free, all techniques work (CAF, tunnel, VISTA) also for the lower incisor area, but the most elegant is VISTA.
I like especially that you didn`t focus only on the tooth with recession but thickened the entire area.
Thank you for sharing, great management
Snjezana


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Snjezan and Howie...and obvious area for discussion at XP-NYU Tissue Day 2 at Summit in NYC this August.


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lots of topics for debate that is for sure. Cant wait Mo


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I TEND TO USE A FREE GINGIVAL GRAFT IN THIS CASE, GREAT RESULT, HOPE ALL IS WELL


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Sjnez i do not find any other technique works too well especially not a split flap approach. Only in the lower jaw though nowhere else. I don't know if you have no issue here but I find it extremely,mely difficult to graft thee teeth. I tend to follow Anton Sculean who published a fair amount on the difficulty of treatment of recession in the lower anteriors. He modified the treatments and full thickness treatment definitely tends to work better here


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Howie, 100% sincerely: as I started with recession coverage my first 11 patients were with low incisors recessions. And nowadays the most frequent recessions in my every day practice are low incisors. This way I could apply all techniques and I don´t see any difference. CAF with split flap was my favorite for many years: when we have a decent CTG, flap thickness doesn´t have any influence on prognosis.
But I agree with you: VISTA approach for low incisors is superior to the other techniques. It is simply to perform, heals good and give beautiful scar free tissue.
Thank you for good discussion
Snjezana


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Great Results! Very cool to see this case now. I have one coming up this Saturday ... crossing my fingers. :)


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Gary make sure you do a full thickness flap. the best way to achieve success. good luck


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