Effectiveness of vestibular incision subperiosteal tunnel access technique: A systematic review and meta-analysis

Abstract

Vestibular Incision Subperiosteal Tunnel Access (VISTA) root coverage technique has experienced a surge in popularity in recent times. The methodology employed in this study is characterized by its minimally invasive nature, utilizing a single incision. The primary objective of this systematic review was to assess the effectiveness of the VISTA approach for achieving root coverage. The protocol was registered with PROSPERO and included randomized controlled clinical trials where gingival recessions were managed with VISTA technique or its modifications. Among the total of 416 records, a mere 14 studies were initially deemed eligible for consideration. Ultimately, only eight pieces of research were included in the final analysis. There were six studies that exhibited heterogeneity, while two studies showed homogeneity and were therefore included in the meta-analysis. All of the studies considered in the analysis exhibited a moderate to low risk of bias. The majority of the research included in the analysis focused on selective root coverage outcome indicators, while neglecting to incorporate patient-reported outcome measures and patient experienced outcome measures. The VISTA procedure is commonly acknowledged as the most efficacious approach for managing gingival recession. The current literature provides support for the recommendation of the procedure, with evidence of intermediate certainty. The findings of this systematic review indicates that the available data are restricted due to several methodological limitations observed in the included studies. These limitations include, small sample sizes, selective reporting of outcomes, and very short follow-up periods.

Keywords: Gingival recession; Minimally invasive surgical procedures; Patient reported outcome measures; Systematic review.

Fig. 1

Flow chart as per PRISMA 2020 Guidelines.

Fig. 2

Risk of bias within studies and authors’ judgments about each ‘risk of bias’ item presented as percentages across all included studies. Risk of bias summary for reviewing the authors judgments about each risk of bias item for each included study. Green represents low risk of bias, yellow represents unclear risk of bias and red indicates a high risk of bias and blue indicates no or less information.

Fig. 3

- Forest plots comparing the recession height at baseline between VISTA with CTG and PRF.

Fig. 4

Forest plots comparing the width of keratinized tissue at baseline between VISTA with CTG and PRF.

Fig. 5

Forest plots comparing the recession height at six months post-operatively between VISTA with CTG and PRF.

Fig. 6

Forest plots comparing the width of keratinized tissue at six months post-operatively between VISTA with CTG and PRF.

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