Mansouri Saeed Sadat, Moghaddas Omid, Torabi Narjes, Ghafari Katayoun
Department of Periodontics, Dental Branch, Islamic Azad University, Tehran, Iran.
Department. of Periodontics, Albert university, Karaj, Iran.
J Adv Periodontol Implant Dent. 2019 Aug 31;11(1):12-20. doi: 10.15171/japid.2019.003. eCollection 2019.
This study aimed to compare the clinical efficacy of vestibular incisional subperiosteal tunnel access (VISTA) with subepithelial connective tissue graft versus a coronally advanced flap (CAF) with subepithelial connective tissue graft for the treatment of gingival recession defects.
This randomized clinical trial was performed on 24 recession defects that were bilaterally Miller's class I or II in the maxillary canine and premolar area. One quadrant in each patient was selected randomly to receive VISTA (test group) or CAF (control group) with connective tissue graft. Clinical parameters measured at baseline and at 3- and 6- month postoperative intervals included recession width (RW), recession depth (RD), keratinized tissue width (KTW), clinical attachment level (CAL) and probing depth (PD).
Healing was uneventful in both the test and control groups. At the 6-month follow-up, there was a significant decrease in RD, RW and CAL and an increase in KTW in both the test and control groups. The PD remained unchanged. At 3 and 6 months, no statistically significant differences were found between VISTA and CAF for root coverage and clinical attachment gain. Mean root coverage (MRC) was 70.69% and 67.22% in the test and control group, respectively. VISTA demonstrated higher frequency of complete root coverage (CRC) compared to CAF: 50% vs. 33% (P<0.05). The mean KTW was 2.4±0.7 mm at the test and 2.7±0.8 mm at the control sites (P>0.05).
VISTA, as a minimally invasive approach, can enhance root coverage, KTW and clinical attachment gain; therefore, it can be used as a substitute for CAF with connective tissue graft as a gold standard for root coverage.
本研究旨在比较前庭切口骨膜下隧道入路（VISTA）联合上皮下结缔组织移植与冠向推进瓣（CAF）联合上皮下结缔组织移植治疗牙龈退缩缺损的临床疗效。
本随机临床试验对24例双侧上颌尖牙和前磨牙区米勒I类或II类牙龈退缩缺损患者进行。在每位患者中随机选择一个象限接受VISTA（试验组）或CAF（对照组）联合结缔组织移植。在基线以及术后3个月和6个月测量的临床参数包括退缩宽度（RW）、退缩深度（RD）、角化组织宽度（KTW）、临床附着水平（CAL）和探诊深度（PD）。
试验组和对照组愈合均顺利。在6个月随访时，试验组和对照组的RD、RW和CAL均显著降低，KTW增加。PD保持不变。在3个月和6个月时，VISTA和CAF在牙根覆盖和临床附着获得方面未发现统计学显著差异。试验组和对照组的平均牙根覆盖（MRC）分别为70.69%和67.22%。与CAF相比，VISTA显示出更高的完全牙根覆盖（CRC）频率：50%对33%（P<0.05）。试验组的平均KTW为2.4±0.7mm，对照组为2.7±0.8mm（P>0.05）。
VISTA作为一种微创方法，可提高牙根覆盖、KTW和临床附着获得；因此，它可替代CAF联合结缔组织移植作为牙根覆盖的金标准。
