title: Minimally invasive treatment of maxillary anterior gingival recession defects by vestibular incision subperiosteal tunnel access and platelet-derived growth factor BB.
abstract: An array of therapeutic options are available for treatment of gingival recession defects, though many of these are better suited for treatment of isolated defects. Some of the limitations of current techniques include the need for harvesting of autogenous donor tissues and their associated morbidity, as well as scar formation at the recipient site resulting from surface incisions. Moreover, muscle pull during healing often leads to incomplete root coverage or relapse of the recession. The current case reports introduce a novel, minimally invasive approach applicable for both isolated recession defects as well as multiple contiguous defects in the maxillary anterior region. Access to the surgical site is obtained by means of an approach referred to as vestibular incision subperiosteal tunnel access (VISTA). This entails making an access incision in the maxillary anterior frenum, followed by elevation of a subperiosteal tunnel. VISTA allows for both access as well as an opportunity to coronally reposition the gingival margins of all involved teeth. In this approach, recombinant human platelet-derived growth factor BB saturated onto a matrix of beta-tricalcium phosphate is introduced using VISTA over root dehiscences to enhance periodontal healing. A novel method of stabilization of the gingival margins is also introduced, referred to as coronally anchored suturing, designed to maintain the coronal positioning during healing. The current report describes the technique and two clinical case documentations for treatment of Miller Class I and II defects, demonstrating stable, long-term outcomes. Although VISTA has been applied in other regions, its application is most advantageous in the esthetic zone.
authors.affiliation: Laboratory for Immunoregulation and Tissue Engineering, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089-0641, USA. zadeh@usc.edu
authors.forename: Homayoun H
authors.initials: HH
authors.lastname: Zadeh
mesh_terms: D020341:Absorbable Implants; D043925:Angiogenesis Inducing Agents / Q000627:therapeutic use*; D000077214:Becaplermin; D018786:Bone Substitutes / Q000627:therapeutic use; D002130:Calcium Phosphates / Q000627:therapeutic use; D003094:Collagen; D005260:Female; D005500:Follow-Up Studies; D005889:Gingival Recession / Q000601:surgery*; D005893:Gingivoplasty / Q000379:methods*; D006801:Humans; D007742:Labial Frenum / Q000601:surgery; D008297:Male; D008437:Maxilla / Q000601:surgery*; D008567:Membranes, Artificial; D008866:Microsurgery / Q000295:instrumentation; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010521:Periosteum / Q000601:surgery; D020574:Proto-Oncogene Proteins c-sis / Q000627:therapeutic use*; D011994:Recombinant Proteins; D013524:Surgical Flaps; D013536:Suture Techniques; D014092:Tooth Root / Q000601:surgery; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects
chemical_list: D043925:Angiogenesis Inducing Agents; C106416:Bio-Gide; D018786:Bone Substitutes; D002130:Calcium Phosphates; D008567:Membranes, Artificial; D020574:Proto-Oncogene Proteins c-sis; D011994:Recombinant Proteins; C485817:beta-tricalcium phosphate; D000077214:Becaplermin; D003094:Collagen