Recession coverage on teeth and implants with the VISTA (Vestibular

Incision Subperiosteal Tunnel Access) Technique.

Soft tissue defects around teeth and implant are common. These can

be managed by treatment of gingival recession around teeth, as well

as improvement of soft tissue quality (keratinized gingiva). A variety

of techniques are available for soft tissue augmentation. However, the

conventional techniques have a number of limitations including, exposure

of graft material due to flap opening, scar formation at recipient sites due

to surface incisions and relapse of recession due to muscle pull during

healing. This presentation will discuss the various techniques and will

introduce a novel, minimally invasive approach, referred to as “vestibular

incision subperiosteal tunnel access” (VISTA), together with a method for

stabilizing mucosal margins to achieve optimal coronal positioning. The

rationale and technique of VISTA will be presented and illustrated with

clinical cases.

Presentation objectives:

Rationale and technique of VISTA for soft tissue augmentation around

teeth and implants.

Application of autogenous tissue, allograft, xenograft and growth factors

for soft tissue augmentation.

Video demonstration of the step-by-step VISTA procedure and suturing

with bonded composite for soft tissue augmentation.

Management of Implants in the Aesthetic Zone with simultaneous hard

and/or soft tissue augmentation.

The management of implants in the aesthetic zone remains a clinical

challenge. Major ridge augmentation surgery involves high morbidity

and long treatment times for the patient and is technique-sensitive for

the clinician. Implants can be placed 6 to 8 weeks after extraction, once

the soft tissue has healed. At the time of early implant placement in the

aesthetic zone, bone augmentation is indicated to treat the common bone

deficiency on the buccal and occlusal side of the implant. A novel and

simple technique will be presented (L-Shape Technique) where a xenograft

mixed with collagen will be trimmed into an L-Shape and positioned

simultaneous to the the implant, on its buccal and occlusal side. This

technique provides proper stability for the bone graft, resulting in healthy

and esthetic hard and soft peri-implant tissues.

Presentation objectives:

Rationale for early and delayed implant placement with bone

augmentation

Discussion of incision design, implant position, bone augmentation,

membrane coverage and tension-free suturing

Step-by-step demonstration of the L-Shape bone augmentation surgery

together with implant placement