UNIVERSIDADE ESTADUAL PAULISTA
“JÚLIO DE MESQUITA FILHO”
Instituto de Ciência e Tecnologia
Campus de São José dos Campos
CASE REPORT DOI: https://doi.org/10.4322/bds.2024.e4434
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Braz Dent Sci 2024 Oct/Dec;27 (4): e4434
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Treatment of peri-implant mucosal fenestration with m-VISTA
technique – a 2-year follow-up case report
Técnica m-VISTA no tratamento de fenestração em mucosa peri-implantar – relato de acompanhamento de 2 anos
Gustavo Macedo PEREIRA1 , Victoria Geisa Brito de OLIVEIRA2 , Marcela Iunes da SILVEIRA2 ,
Sérgio Lucio Pereira de Castro LOPES2 , Emanuel da Silva ROVAI2
1 - Universidade Estadual Paulista (Unesp), Instituto de Ciência e Tecnologia (ICT), Departamento de Prótese. São José dos Campos, SP,
Brazil.
2 - Universidade Estadual Paulista (Unesp), Instituto de Ciência e Tecnologia (ICT), Departamento de Diagnóstico e Cirurgia. São José
dos Campos, SP, Brazil.
How to cite: Pereira GM, Oliveira VGB, Silveira MI, Lopes SLPC, Rovai ES. Treatment of peri-implant mucosal fenestration with m-VISTA
technique – a 2-year follow-up case report. Braz Dent Sci. 2024;27(4):e4434. https://doi.org/10.4322/bds.2024.e4434
ABSTRACT
Background: The modied VISTA technique (modied Vestibular Incision Subperiosteal Tunnel Access) has been
introduced as a minimally invasive approach for the treatment of gingival recessions. This technique could also be
applied to managing peri-implant soft tissue defects (PSTD). Objetive: This case report presents a 2-year follow-up
case in which the m-VISTA technique was used in the treatment of a class 1A PSTD. Description: A 66-year-old
female patient complained of food accumulation and a non-aesthetic aspect in the peri-implant buccal region of
tooth 11. On clinical examination, there was a peri-implant soft tissue defect, with a recession and fenestration
of the buccal mucosa. A Cone Beam Computed Tomography (CBCT) was requested to complement the diagnosis,
and a buccal bone defect was observed. Before the surgical phase, basic peri-implant therapy was performed.
In surgery, the m-VISTA technique was used, seeking the slightest trauma to the soft tissues around the defect,
especially the mucosal margin. The patient returned for suture removal after 14 days. Follow-ups were carried
out in the rst 14 and 21 days, 2 months, 6 months, and 1 and 2 years after surgery. Results: After two years,
there was a complete closure of the peri-implant mucosal fenestration and complete coverage of peri-implant
soft tissue recession. Conclusion: This 2-year follow-up case report showed the m-VISTA technique could be a
successful approach in the treatment of a peri-implant mucosal fenestration and recession.
KEYWORDS
Case report; Dental implantation; Gingival recession; Oral surgery; Periodontics.
RESUMO
Contexto: A técnica VISTA modicada (Acesso ao Túnel Subperiosteal por Incisão Vestibular modicada) foi
introduzida como uma abordagem minimamente invasiva para o tratamento de recessões gengivais. Esta técnica
também pode ser aplicada ao tratamento de defeitos dos tecidos moles peri-implantares (DTP). Objetivo:
Este relato de caso apresenta um caso de acompanhamento de 2 anos em que a técnica m-VISTA foi utilizada
no tratamento de um DTP de classe 1A. Descrição do caso: Paciente do sexo feminino, de 66 anos de idade,
queixava-se de acúmulo de alimentos e de aspeto não estético na região vestibular peri-implantar do dente 11.
Ao exame clínico, vericou-se um defeito nos tecidos moles peri-implantares, com recessão e fenestração da
mucosa bucal. Foi solicitada uma Tomograa Computadorizada de Feixe Cônico (TCFC) para complementar
o diagnóstico, sendo observado um defeito ósseo vestibular. Previamente à fase cirúrgica, foi realizada terapia
básica peri-implantar. Na cirurgia, foi executada a técnica m-VISTA, buscando o menor trauma possível nos
tecidos moles ao redor do defeito, principalmente na margem mucosa. A paciente retornou para a remoção da
sutura após 14 dias. Os acompanhamentos foram realizados nos primeiros 14 e 21 dias, 2 meses, 6 meses e 1
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Braz Dent Sci 2024 Oct/Dec;27 (4): e4434
Pereira GM et al.
T reatment of peri-implant mucosal fenestration with m-VISTA technique – a 2-year follow-up case report
Pereira GM et al. Treatment of peri-implant mucosal fenestration with m-VISTA
technique – a 2-year follow-up case report
INTRODUCTION
Tooth loss is still a common outcome in the
world’s population, mainly due to the progression
of periodontal disease and dental caries [1]. The
use of dental implants has emerged as one of the
main rehabilitation options for partially or totally
edentulous patients [2,3], with the literature
agreeing on their great predictability [4].
Nevertheless, implant therapy rehabilitation
positively affects aesthetics and functionality,
improving the patient’s quality of life [5].
However, errors in diagnosis can lead to an
inadequate treatment plan, which in turn can lead
to the development of peri-implant hard and/or
soft tissue defects, compromising the success of
the therapy [6]. Peri-implant soft tissue defects
(PSTD) are part of a group that includes mucosal
recessions and fenestrations [7]. They can affect
up to 50% of immediate implant cases [8] and
are often associated with aesthetic and functional
complaints [9].
PSTDs are highly prevalent; in fact,
Bengazi et al. [10] reported an incidence of PSTD
≥ 1 mm in 57% of their patients 6 months after
the dental implant installation. However, treating
PSTD is still challenging for clinicians, especially
because anatomical factors such as a lower
number of cells and decreased vascularization
can compromise tissue/graft nutrition and the
healing process [11].
Two recent PSTD classifications were
proposed [8,9]. Both emphasize the importance
of considering the inherent characteristics of the
tissue in the region of interest, such as the quality
and quantity of keratinized mucosa, interproximal
bone height, and the thickness of available tissue.
Despite their valuable contributions to the clinical
basis, there still needs to be more scientific
evidence on the best technique/approach for
conducting each case [12].
Several approaches have been proposed for
the treatment of PSTD, such as the coronal ap
surgery technique [13], tunnel, and the technique
called m-VISTA (modified Vestibular Incision
Subperiosteal Tunnel Access) [14]. This last is
considered minimally invasive, as it avoids incision
or trauma to the marginal gingival tissues to
preserve the vascularization of the area to be treated
[15]. Further, there is a consensus in the literature
that the use of connective tissue grafts (CTG) is the
gold standard in the context of these surgeries due
to their biological characteristics [16].
Therefore, the purpose of this case report
is to present a case in which the m-VISTA
technique was used to treat a peri-implant
mucosal fenestration and recession at the peri-
implant buccal site (tooth #11).
CASE REPORT
A healthy nonsmoker 66-year-old woman,
classied as a patient prole ASA I (American
Society of Anesthesiology - ASA I is a health and
not smoker patient), [17,18], attended a private
dental practice in September 2020 and signed a
consent form for the use of image. The patient’s
main complaint was aesthetic discomfort in the
anterior peri-implant region. Clinical examination
revealed a fenestration-type defect in the peri-
implant vestibular mucosa in the area around
tooth 11 (class 1 A) [8] (Figure 1A).
A Cone Beam Computed Tomography (CBCT)
scan was then requested to visualize the soft and
hard tissues. The image showed a slight interface
between bone and implant in the buccal cortex
(Figure 2). The treatment plan was then drawn
up and a consent form was signed by the patient.
Before the surgical phase, basic periodontal therapy
was carried out, including decontamination of the
implant in the exposed area.
Surgical technique - modied view
The graft recipient area was prepared using
a Nº. 15 scalpel blade to make a single vertical
incision extending to the periosteum in the distal
region of tooth 12 at the height of the peri-implant
tissue defect, maintaining the integrity of the
e 2 anos após a cirurgia. Resultados: Após dois anos, vericou-se o encerramento completo da fenestração da
mucosa peri-implantar e a cobertura completa da recessão dos tecidos moles peri-implantares. Conclusão: Este
relato de acompanhamento de 2 anos demonstrou que a técnica m-VISTA é uma abordagem que pode ser bem
sucedida no tratamento de uma fenestração da mucosa peri-implantar e da recessão.
PALAVRAS-CHAVE
Relato de caso; Implante dentário; Recessão gengival; Cirurgia oral; Periodontia.
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Pereira GM et al.
T reatment of peri-implant mucosal fenestration with m-VISTA technique – a 2-year follow-up case report
Pereira GM et al. Treatment of peri-implant mucosal fenestration with m-VISTA
technique – a 2-year follow-up case report
technique. The CTG had approximately 2 mm
of thickness and dimensions of 15x5 mm. The
donor area received two hemostatic sponges
(Hemospon®, Maquira, Brazil), which were
sutured in X.
Then, the CTG was inserted into the ap
previously made in the recipient area and sutured
(Nylon Blue [Polyamide], 5-0, TechSuture
Suturas Cirúrgicas®, Brazil) in order to obtain
its stabilization and a homogeneous distribution.
In addition, simple sutures were performed in the
M-vista incision (Figure 1B).
After the surgery, the patient was instructed on
oral hygiene and post-operative care and received
post-operative prescriptions. A mouthwash with
0.12% chlorhexidine digluconate (Periogard,
Colgate, Brazil) was prescribed for 30 seconds,
twice a day, for 15 days; ibuprofen arginine
600 mg (Spidufen®, Zambon, Switzerland)
600mg for 3 days every 12 hours; and dipyrone
monohydrate 1g (Novalgina®, Sano, France)
every 12 hours in cases of pain.
Follow-up
After two weeks, the patient returned for
an appointment to have the sutures removed
(Figure 1C and 1D). After 14 days, the fenestration
and part of the connection between the prosthesis
and the implant, which had previously been
exposed, were covered.
Figure 1 - Region of ED 11 With a PSTD classe 1A. A. Initial image pre-operatory in it is possible to see the fenestration defect and a recession
causing exposure of the junction between the prosthetic abut- ment and implant leading to a non-aesthetic grayish appearance; B. immediate
pos operatory aspect; C. 7 days follow up; D. 14 days follow up – where is possible to see the fenestration closure and an ini- tial coverage of
the grayish aspect of the crown. Source: Authors.
Figure 2 - Cone-Beam Computed Tomography (CBCT) axial section
of the implant region of interest. A hypodense interface can be seen
in the vestibular region between the implant and the bone. Source:
Authors.
interdental papillae. From the incisions, a partial-
thickness ap was carefully made using SB003
micro blades (MJK®, France) and Hu-Friedy®
cable (Hu-Friedy, Mfg. Co. LLC, Chicago, USA),
taking special care not to create traumas in the
mucosal margin affected by the peri-implant
defect. Using tunneling instruments (Hu-Friedy,
Mfg. Co. LLC, Chicago, USA) a tunnel was created
extending the region from tooth 13 to tooth 22 until
a loose, tension-free gingival tissue was obtained.
And, to obtain adequate closure of the wound, the
edges of the fenestration were de-epithelialized
using Hu-Friedy® curved surgical microscissors
(Hu-Friedy, Mfg. Co. LLC, Chicago, USA).
Subsequently, a connective tissue graft
(CTG) was obtained using the single incision
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Braz Dent Sci 2024 Oct/Dec;27 (4): e4434
Pereira GM et al.
T reatment of peri-implant mucosal fenestration with m-VISTA technique – a 2-year follow-up case report
Pereira GM et al. Treatment of peri-implant mucosal fenestration with m-VISTA
technique – a 2-year follow-up case report
Follow-up appointments were also made at
21 days, 6 months, 1 and 2 years after surgery
periods in which the adherence of the connective
graft to the recipient area is progressively visible,
thus forming a stable keratinized gingiva that
follows the contour of the adjacent teeth and
helps to promote healthy-looking peri-implant
soft tissue in addition to covering the crown
abutment (Figure 3A-3D).
DISCUSSION
The present case report shows a successful
approach in the treatment of a peri-implant
fenestration in the anterior maxilla region, which
affected the pink aesthetic and compromised the
implant’s maintenance in the mouth. Using the
m-VISTA technique, it was possible to observe the
fenestration closure and the formation of peri-
implant health tissue with adequate keratinized
mucosa width and thickness, which also allowed
the crown abutment to be covered.
Buccal surfaces in the anterior maxillary
region are the areas most commonly affected
by PSTD [19]. This is a challenging region
for implant-supported rehabilitation due to
exacting esthetic demands and difcult anatomy
conditions. Adequate treatment planning
regarding proper implant positioning, amount
of keratinized mucosa, and bone thickness
surrounding the implants is fundamental for
favorable long-term maintenance of dental
implants [20-22]. According to a cohort study
with a one-year follow-up, after immediate
implants in the anterior maxilla, cases with a
buccal bone plate thickness ≤ 1 mm showed
greater peri-implant changes compared to those
with greater thickness [23].
The clinical case reported here shows a thin
buccal bone wall and the presence of dehiscence
(Figures 1A and 2). This possibly contributed
to the appearance of fenestration and gingival
recession in the peri-implant area and is in line
with the literature [8,24]. In a recent systematic
review, Monje and his team highlighted the
important role of the thickness of the peri-implant
tissues for the stability of the tissues surrounding
the implant [24]. In addition to bone thickness,
soft tissue thickness is also fundamental and is
correlated with greater stability at the gingival
margin, less marginal bone loss, and more
satisfactory aesthetic results [25]. Therefore, in
the case reported here, it was decided to correct
the bone fenestration using connective tissue
grafting in an attempt to cover the implant spirals
exposed in the fenestration region.
According to treatment recommendations
proposed by Zucchelli in the PSTD classication
of 2018, defects class IA should be corrected by
coronal advanced ap (CAF) or Tunnel technique
(TT) associated with CTG of another substitute
[8]. Because of the absence of the open ap, the
VISTA or m-VISTA technique allows mobilization
of the papilla and a coronal stabilization of the
CTG. In a recent systematic review comparing the
VISTA technique with other surgical techniques,
the VISTA showed better recession coverage than
Figure 3 - A and B 21 days and 6 months follow up – is possible to see stability in the peri-implant soft tissue coloration and the and the
continuity of the keratinized mucosal zone in relation to the adjacent teeth; C and D. 1 and 2 years follow up showing the stability of the graft
and the peri-implant health condition. Source: Authors.
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Pereira GM et al.
T reatment of peri-implant mucosal fenestration with m-VISTA technique – a 2-year follow-up case report
Pereira GM et al. Treatment of peri-implant mucosal fenestration with m-VISTA
technique – a 2-year follow-up case report
CAF and TT, and no differences were observed
in terms of keratinized gingiva formation,
probing deep, or clinical attachment level [26].
In the present case report, due to the peri-
implant mucosal fenestration, it was desirable
to avoid detachment of the papillae and minimal
handling of the peri-implant margin. Therefore,
the minimally invasive tunneling technique
(m-VISTA) approach was performed.
It is estimated that 30% of installed implants
are affected by peri-implant mucositis and 10%
by peri-implantitis [27]. If not properly corrected,
the lack of peri-implant tissue integrity can
increase the risk of developing peri-implant
mucositis and peri-implantitis. This is justied by
the difculty of maintaining good plaque control,
leading to an increased risk of the development
of peri-implant diseases [21]. In this context,
adequate treatment planning should consider
the bone and mucosa phenotype and prosthetic
planning to avoid future peri-implant soft and
hard tissue defects [21,27,28].
In addition to the functional importance
of maintaining the integrity of the peri-implant
tissues, there is also an aesthetic importance. A
systematic review showed that patient satisfaction
with implant-supported rehabilitations in the
esthetic zone impacts their oral health-related
quality of life [29]. There are also reports that in
the peri-implant area, the patient’s perception of
pink aesthetics tends to be less satisfactory than
that of the crown on implants [30].
CONCLUSION
The m-VISTA technique showed a successful
approach in the peri-implant fenestration
treatment during the two years follow-up.
However, further studies should be carried out
to consolidate the indication of this technique in
peri-implant defects.
Author’s Contributions
ESR: Conceptualization. GMP: Data
Curation. VGBO, MIS: Formal Analysis. ESR:
Funding Acquisition. GMP: Investigation. GMP:
Methodology. ESR: Project Administration. SLPCL,
ESR: Supervision. GMP, ESR: Visualization. GMP,
VGBO, MIS: Writing – Original Draft Preparation.
SLPCL, ESR: Writing – Review and Editing.
Conict of Interest
No conicts of interest declared concerning
the publication of this article.
Funding
The authors declare that no nancial support
was received.
Regulatory Statement
This case report was conducted in a private
clinic and therefore does not have the approval
of an ethics committee. However, the patient
signed a consent form for the use of images and
The Declaration of Helsinki was respected in all
the stages.
REFERENCES
1. Gulati K, Chopra D, Kocak-Oztug NA, Verron E. Fit and forget:
the future of dental implant therapy via nanotechnology. Adv
Drug Deliv Rev. 2023;199:114900. http://doi.org/10.1016/j.
addr.2023.114900. PMid:37263543.
2. Wang Z, Wang J, Wu R, Wei J. Construction of functional
surfaces for dental implants to enhance osseointegration. Front
Bioeng Biotechnol. 2023;11:1320307. http://doi.org/10.3389/
fbioe.2023.1320307. PMid:38033823.
3. Kwok V, Caton JG, Hart ID, Kim TS. Dental implant prognostication:
a commentary. J Periodontol. 2023;94(6):713-21. http://doi.
org/10.1002/JPER.22-0196. PMid:36740787.
4. Buser D, Sennerby L, De Bruyn H. Modern implant dentistry based
on osseointegration: 50 years of progress, current trends and
open questions. Periodontol 2000. 2017;73(1):7-21. http://doi.
org/10.1111/prd.12185. PMid:28000280.
5. Kublitski PMO, Andrade CF, Rosa EC, Bordin GM, Pizzatto E,
Brito MA,etal. Dental implants in esthetic zone and quality of
life related to oral health. Braz J Health Rev. 2022;5(2):5008-21.
http://doi.org/10.34119/bjhrv5n2-088.
6. Berglundh T, Armitage G, Araujo MG, Avila-Ortiz G, Blanco
J, Camargo PM, et al. Peri-implant diseases and conditions:
consensus report of workgroup 4 of the 2017 World Workshop
on the Classification of Periodontal and Peri-Implant Diseases
and Conditions. J Clin Periodontol. 2018;45(Suppl 20):S286-91.
http://doi.org/10.1111/jcpe.12957. PMid:29926491.
7. Hämmerle CHF, Tarnow D. The etiology of hard- and soft-
tissue deficiencies at dental implants: a narrative review. J Clin
Periodontol. 2018;45(Suppl 20):S267-77. http://doi.org/10.1111/
jcpe.12955. PMid:29926502.
8. Zucchelli G, Tavelli L, Stefanini M, Barootchi S, Mazzotti
C, Gori G, et al. Classification of facial peri-implant soft
tissue dehiscence/deficiencies at single implant sites in the
esthetic zone. J Periodontol. 2019;90(10):1116-24. http://doi.
org/10.1002/JPER.18-0616. PMid:31087334.
9. Gamborena I, Avila-Ortiz G. Peri-implant marginal mucosa
defects: classification and clinical management. J Periodontol.
2021;92(7):947-57. http://doi.org/10.1002/JPER.20-0519.
PMid:33119897.
10. Bengazi F, Wennström JL, Lekholm U. Recession of the soft
tissue margin at oral implants. A 2-year longitudinal prospective
6
Braz Dent Sci 2024 Oct/Dec;27 (4): e4434
Treatment of peri-implant mucosal fenestration with m-VISTA
technique – a 2-year follow-up case report
Pereira GM et al.
T reatment of peri-implant mucosal fenestration with m-VISTA technique – a 2-year follow-up case report
Pereira GM et al. Treatment of peri-implant mucosal fenestration with m-VISTA
technique – a 2-year follow-up case report
Date submitted: 2024 July 02
Accept submission: 2024 Nov 22
Emanuel da Silva Rovai
(Corresponding address)
Universidade Estadual Paulista (Unesp) Instituto de Ciências e Tecnologia, Departamento de
Diagnóstico e Cirurgia, São José dos Campos, SP, Brazil.
Email: emanuel.rovai@unesp.br
study. Clin Oral Implants Res. 1996;7(4):303-10. http://doi.
org/10.1034/j.1600-0501.1996.070401.x. PMid:9151595.
11. Sculean A, Chappuis V, Cosgarea R. Coverage of mucosal
recessions at dental implants. Periodontol 2000. 2017;73(1):134-
40. http://doi.org/10.1111/prd.12178. PMid:28000282.
12. Mazzotti C, Stefanini M, Felice P, Bentivogli V, Mounssif I,
Zucchelli G. Soft-tissue dehiscence coverage at peri-implant
sites. Periodontol 2000. 2018;77(1):256-72. http://doi.
org/10.1111/prd.12220. PMid:29473219.
13. Zucchelli G, Mazzotti C, Mounssif I, Mele M, Stefanini M,
Montebugnoli L. A novel surgical-prosthetic approach for
soft tissue dehiscence coverage around single implant. Clin
Oral Implants Res. 2013;24(9):957-62. http://doi.org/10.1111/
clr.12003. PMid:22924841.
14. Lee CT, Hamalian T, Schulze-Späte U. Minimally invasive
treatment of soft tissue deficiency around an implant-supported
restoration in the esthetic zone: modified VISTA technique case
report. J Oral Implantol. 2015;41(1):71-6. http://doi.org/10.1563/
AAID-JOI-D-13-00043. PMid:23510339.
15. Fernández-Jiménez A, Estefanía-Fresco R, García-De-La-Fuente
AM, Marichalar-Mendia X, Aguirre-Zorzano LA. Description of
the modified vestibular incision subperiosteal tunnel access
(m-VISTA) technique in the treatment of multiple Miller
class III gingival recessions: a case series. BMC Oral Health.
2021;21(1):142. http://doi.org/10.1186/s12903-021-01511-5.
PMid:33743644.
16. Zuhr O, Bäumer D, Hürzeler M. The addition of soft tissue
replacement grafts in plastic periodontal and implant surgery:
critical elements in design and execution. J Clin Periodontol.
2014;41(Suppl 15):S123-42. http://doi.org/10.1111/jcpe.12185.
PMid:24640997.
17. Doyle DJ, Hendrix JM, Garmon EH. American Society of
Anesthesiologists Classification (ASA Class). StatPearls
[Internet]. 2019 [cited 2024 nov 22]. Available from: https://
www.ncbi.nlm.nih.gov/books/NBK441940/.
18. Malamed SF. Medical emergencies in the dental office. St. Louis:
Elsevier; 2015.
19. Monje A, Nart J. Management and sequelae of dental implant
removal. Periodontol 2000. 2022;88(1):182-200. http://doi.
org/10.1111/prd.12418. PMid:35103326.
20. Buser D, Martin W, Belser UC. Optimizing esthetics for implant
restorations in the anterior maxilla: anatomic and surgical
considerations. Int J Oral Maxillofac Implants. 2004;19(Suppl):43-
61. PMid:15635945.
21. Chackartchi T, Romanos GE, Sculean A. Soft tissue-related
complications and management around dental implants.
Periodontol 2000. 2019;81(1):124-38. http://doi.org/10.1111/
prd.12287. PMid:31407443.
22. De Rouck T, Collys K, Wyn I, Cosyn J. Instant provisionalization of
immediate single-tooth implants is essential to optimize esthetic
treatment outcome. Clin Oral Implants Res. 2009;20(6):566-
70. http://doi.org/10.1111/j.1600-0501.2008.01674.x.
PMid:19302238.
23. Borges T, Fernandes D, Almeida B, Pereira M, Martins D, Azevedo
L, et al. Correlation between alveolar bone morphology and
volumetric dimensional changes in immediate maxillary implant
placement: a 1-year prospective cohort study. J Periodontol.
2020;91(9):1167-76. http://doi.org/10.1002/JPER.19-0606.
PMid:32012271.
24. Monje A, Roccuzzo A, Buser D, Wang HL. Influence of buccal
bone wall thickness on the peri-implant hard and soft tissue
dimensional changes: a systematic review. Clin Oral Implants
Res. 2023;34(3):157-76. http://doi.org/10.1111/clr.14029.
PMid:36626118.
25. Thoma DS, Gil A, Hämmerle CHF, Jung RE. Management and
prevention of soft tissue complications in implant dentistry.
Periodontol 2000. 2022;88(1):116-29. http://doi.org/10.1111/
prd.12415. PMid:35103320.
26. Sabri H, SamavatiJame F, Sarkarat F, Wang HL, Zadeh HH. Clinical
efficacy of Vestibular Incision Subperiosteal Tunnel Access
(VISTA) for treatment of multiple gingival recession defects: a
systematic review, meta-analysis and meta-regression. Clin Oral
Investig. 2023;27(12):7171-87. http://doi.org/10.1007/s00784-
023-05383-7. PMid:38010424.
27. Lee CT, Huang YW, Zhu L, Weltman R. Prevalences of peri-
implantitis and peri-implant mucositis: systematic review and
meta-analysis. J Dent. 2017;62:1-12. http://doi.org/10.1016/j.
jdent.2017.04.011. PMid:28478213.
28. Andrade GS, Kalman L, Giudice RL, Adolfi D, Feilzer AJ, Tribst
JPM. Biomechanics of implant-supported restorations. Braz Dent
Sci. 2023;26(1):e3637. http://doi.org/10.4322/bds.2023.e3637.
29. Ramani RS, Bennani V, Aarts JM, Choi JJE, Brunton PA. Patient
satisfaction with esthetics, phonetics, and function following
implant-supported fixed restorative treatment in the esthetic
zone: a systematic review. J Esthet Restor Dent. 2020;32(7):662-
72. http://doi.org/10.1111/jerd.12625. PMid:32715619.
30. Arunyanak SP, Pollini A, Ntounis A, Morton D. Clinician
assessments and patient perspectives of single-tooth
implant restorations in the esthetic zone of the maxilla: a
systematic review. J Prosthet Dent. 2017;118(1):10-7. http://doi.
org/10.1016/j.prosdent.2016.10.036. PMid:28385430.
