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Clinical efficacy of Vestibular Incision Subperiosteal Tunnel Access (VISTA) for treatment of multiple gingival recession defects: a systematic review, meta-analysis and meta-regression

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Abstract

Objectives

This study investigated the efficacy of Vestibular Incision Subperiosteal Tunnel Access (VISTA) compared to other methods for treating multiple adjacent gingival recessions (MAGRs) through a systematic review and meta-analysis.

Materials and methods

A systematic literature search was performed through June 2023, to identify clinical trials investigating VISTA for root coverage on MAGRs. A meta-analysis with meta-regression model was employed on the primary outcomes of mean and complete root coverages (MRC, CRC), comparing VISTA with other techniques. Clinical efficacy of various graft materials was assessed.

Results

Fourteen studies were included, 8 of which met the criteria for quantitative assessment. The cumulative MRC (88.15% ± 20.79%) and CRC (67.85% ± 21.72%) of VISTA were significantly higher compared to the tunneling technique (SMD = 0.83 (95% CI [0.36, 1.30], p < 0.01). The baseline recession depth showed a negative correlation with CRC, whereas baseline keratinized gingiva width exhibited a positive correlation with this outcome.

Conclusions

The VISTA technique, particularly with acellular dermal matrix (ADM) or connective tissue graft (CTG) materials, offers superior outcomes compared to the tunneling technique. The capacity of platelet-rich fibrin (PRF) to substitute for connective tissue graft (CTG) in VISTA-root coverage was noteworthy, provided there is adequate keratinized tissue width.

Clinical relevance

VISTA in concert with acellular dermal matrix or CTG resulted in improved root coverage, surpassing the outcomes achieved through tunneling. PRF emerged as a viable alternative to CTG, when used in conjunction with VISTA, demonstrating comparable mean root coverage. This is particularly evident in situations where sufficient keratinized gingiva is available and when patient comfort is taken into consideration.

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Data availability

The collected and analyzed data in this study will be provided upon reasonable request from the corresponding or first author.

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Authors and Affiliations

  1. Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA

    Hamoun Sabri, Fatemeh SamavatiJame & Hom-Lay Wang

  2. Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Ann Arbor, MI, USA

    Hamoun Sabri

  3. Department of Oral and Maxillofacial Surgery, Gulf Medical University, Ajman, UAE

    Farzin Sarkarat

  4. VISTA Institute for Therapeutic Innovations, 6325 Topanga Canyon Blvd, Suite 101, Woodland Hills, Los Angeles, CA, 91367, USA

    Homayoun H. Zadeh

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Contributions

H. S: Conceptualization, search strategy, statistical analysis, manuscript writing, F.SJ: search strategy, data collection, manuscript writing, F. S: conceptualization, critical review, manuscript writing, H–L. W: conceptualization, critical review, final approval, H. HZ: Conceptualization, manuscript writing, critical review, final approval.

Corresponding author

Correspondence to Homayoun H. Zadeh.

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Competing interests

H.H. Zadeh holds patent for VISTA instruments and discloses financial interest in REGENimmune and iKON Biomedical companies, which hold the patents and are involved in manufacturing of the instruments. Other authors declare no conflict of interest pertinent to this research article.

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Not applicable.

Conflict of interest

H.H. Zadeh holds patent for VISTA instruments and discloses financial interest in REGENimmune and iKON Biomedical companies, which hold the patents and are involved in manufacturing of the instruments.

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Sabri, H., SamavatiJame, F., Sarkarat, F. et al. Clinical efficacy of Vestibular Incision Subperiosteal Tunnel Access (VISTA) for treatment of multiple gingival recession defects: a systematic review, meta-analysis and meta-regression. Clin Oral Invest 27, 7171–7187 (2023). https://doi.org/10.1007/s00784-023-05383-7

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  • DOI: https://doi.org/10.1007/s00784-023-05383-7

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