Minimally Invasive Oral Surgery Techniques for Faster Recovery

In oral and periodontal surgery, minimally invasive approaches are increasingly prioritized because they reduce tissue trauma, accelerate healing, and improve patient comfort. One application of minimally invasive techniques is the correction of multiple gingival recession (gum thinning or recession affecting several teeth), where one of the latest techniques is Vestibular Incision Subperiosteal Tunnel Access (VISTA) combined with Platelet-Rich Fibrin (PRF) as a biological medium to enhance tissue regeneration.

A study conducted by a student of the Faculty of Dentistry at Universitas Gadjah Mada (FKG UGM), Dewa Ayu M, under the supervision of drg. Sri Pramestri Lastianny, M.S., Sp.Perio(K) and Dr. drg. Rezmelia Sari, M.Sc., Sp.Perio(K), titled “Pengaruh Platelet-rich Fibrin pada Perawatan Resesi Gingiva Multipel dengan Teknik Vestibular Incision Subperiosteal Tunnel Access” discusses how the combination of the VISTA technique and PRF yields promising clinical outcomes in improving periodontal parameters and treating multiple gingival recession. 

This article outlines the fundamental principles of minimally invasive techniques in oral surgery, particularly VISTA + PRF, as well as their benefits and challenges in the context of rapid recovery.

Principles of Minimally Invasive Oral Surgery

Minimally invasive techniques aim to:

• Minimize incisions and soft tissue damage
• Preserve vascular supply and periosteal integrity
• Reduce bleeding and swelling
• Accelerate healing and improve postoperative comfort
• Lower the risk of complications and pain

In the context of gingival recession, minimally invasive techniques are essential to maintain gingival thickness, preserve interdental tissue, and avoid extensive donor sites (when tissue grafts are used).

The VISTA (Vestibular Incision Subperiosteal Tunnel Access) Technique

VISTA is a minimally invasive periodontal surgical method used to correct multiple gingival recession. Its main principles include:

1. Incision in the Vestibular Area (Base of the Oral Vestibule), Not at the Gingival Margin
   By creating an incision in the vestibule (the space between the lips/cheeks and the gingiva), the cut is not placed directly at the gingival margin, thereby reducing trauma to the gum edge.
2. Creation of a Subperiosteal Tunnel
   Through the vestibular incision, a tunnel is created beneath the periosteum (bone covering) and soft tissue toward the area of recession. This approach preserves the interdental papilla and marginal gingival tissue.
3. Gingival Preparation and Repositioning
   Once the tunnel is formed, the gingival margin is advanced coronally (toward the tooth crown) to cover the exposed root surface.
4. Placement of Biological Material / Graft
   Biological materials such as PRF can be inserted into the tunnel to support tissue regeneration.

With this method, incisions and tissue manipulation are minimized, thereby reducing overall tissue trauma.

The Role of Platelet-Rich Fibrin (PRF)

PRF is a biological material derived from the patient’s own blood and contains growth factors, fibrin, and white blood cells. According to the cited study:

• PRF improved periodontal parameters such as clinical attachment level and probing depth, as well as recession-related parameters including recession depth and root coverage.
• PRF accelerates tissue regeneration by delivering growth factors and providing a fibrin matrix that supports fibroblast proliferation, angiogenesis, and cell migration.

Thus, the use of PRF alongside minimally invasive techniques like VISTA enhances tissue repair effectiveness and promotes faster recovery.

Advantages of the Minimally Invasive VISTA + PRF Technique

The main benefits of combining VISTA and PRF include:

1. Minimal Tissue Trauma
   Incisions placed away from the gingival margin and gentle tissue manipulation protect vascular supply and reduce the risk of gingival necrosis.
2. Faster Recovery and Improved Patient Comfort
   Because of smaller incisions and limited manipulation, postoperative pain, swelling, and discomfort are generally milder.
3. Greater Efficiency in Root Coverage
   The addition of PRF enhances the regenerative capacity of soft tissues, leading to improved coverage of exposed roots.
4. No Need for a Large Secondary Donor Site
   Since PRF is derived from the patient’s own blood, it eliminates the need for tissue harvesting from areas such as the palate, thereby reducing additional trauma and donor-site pain.
5. Improved Esthetic Outcomes
   By preserving gingival tissue with minimal incisions, the gingival margin appears smoother and more naturally integrated.

Challenges and Considerations

Although promising, several challenges must be considered:

• The surgical technique requires high skill and experience to create a subperiosteal tunnel without tearing the tissue.
• Not all gingival recession cases are suitable for this method; extensive recession or cases involving hard tissue loss may require bone grafting or additional techniques.
• The effectiveness of PRF may depend on the patient’s blood quality (e.g., systemic conditions, smoking habits).
• Long-term evaluation is necessary to assess the stability of root coverage and the possibility of relapse over time.

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Minimally invasive oral surgery techniques such as Vestibular Incision Subperiosteal Tunnel Access (VISTA) combined with Platelet-Rich Fibrin (PRF) offer a gentle and biologically driven approach to managing multiple gingival recession. Based on the study “TPengaruh Platelet-rich Fibrin pada Perawatan Resesi Gingiva Multipel dengan Teknik Vestibular Incision Subperiosteal Tunnel Access,” this method has demonstrated significant improvements in periodontal parameters and root coverage. 

By adhering to minimally invasive principles, this approach minimizes trauma, supports rapid healing, and enhances patient comfort. For broader applications in oral surgery, similar techniques may be adapted for surgical wound management, minimally invasive implant procedures, and soft tissue reconstruction supported by biological materials.

References
DEWA AYU M, drg. Sri Pramestri Lastianny, M.S, Sp.Perio(K); Dr. drg. Rezmelia Sari, M.Sc., Sp.Perio(K), Pengaruh Platelet-rich Fibrin pada Perawatan Resesi Gingiva Multipel dengan Teknik Vestibular Incision Subperiosteal Tunnel Access, https://etd.repository.ugm.ac.id/home/detail_pencarian_downloadfiles/1132378

Author: Rizky B. Hendrawan | Photo: Freepik