Patient-centered comparative outcome analysis of platelet-rich fibrin-reinforced vestibular incision subperiosteal tunnel access technique and Zucchelli's technique

• Published in: Journal of Indian Society of Periodontology 2021-07, Vol.25 (4), p.320-329
• Main Authors: Rajeswari, S, Triveni, M, Tarun Kumar, A, Ravishankar, P, Rajula, M, Almeida, Lydia
• Format: Article
• Language: English
• Subjects: Analysis; Fibrin; Gingiva; Gingival index; gingival recession; Hypersensitivity; Methods; Morbidity; Original; Patient satisfaction; Patients; Platelets; Povidone; root coverage; Statistical analysis; surgical flap; Tunnels; Vestibular system
• ISSN: 0972-124X; 0975-1580
• DOI: 10.4103/jisp.jisp_187_20

Background: Multiple gingival recession (MGR) coverage, especially in esthetic area, demands a high patient satisfaction. Coronally advanced flap modifications, namely Zucchelli's technique (ZT) and vestibular incision subperiosteal tunnel access (VISTA), are techniques, recommended in the correction of MGR. Aim: The purpose was to comparatively analyze the ZT and VISTA technique reinforced with the platelet-rich fibrin membrane in the management of MGR. Materials and Methods: This split-mouth, randomized study comprised 16 consenting, systemically healthy participants. The bilateral Miller's multiple class I and II lesions were managed with ZT and VISTA technique and had a follow-up period of 18 months. Gingival thickness (GT), mean percentage of root coverage, and patient-centered outcome scales, including patient comfort score, patient esthetic score, and hypersensitivity score, were the primary outcome measures. Further clinical parameters assessed were gingival index, probing depth, clinical attachment level, and width of keratinized gingiva. Statistical Analysis and Results: Paired t-test and unpaired t-test were used for intragroup comparison and intergroup analysis, respectively. While both the techniques exhibited high root coverage percentage (VISTA: 93.95% and ZT: 96.84%), statistically significant difference was noted with patient esthetic score and surgical mortality score in VISTA. Conclusion: Both ZT and VISTA were effective in terms of root coverage and GT augmentation in MGR management. From the patient's perspective, they preferred VISTA technique over ZT, stating its minimal postoperative morbidity and improved esthetic outcome. Hence, within the limitations of this study, the VISTA technique was found to be a superior alternative compared to that of ZT in MGR management.