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Internal Frenectomy-Vestibular Incision Subperiosteal Tunnel Access (IF-VISTA). A technical report.

Vanessa Frazão Cury, Maria das Graças Cruz Najar, Isabela Frazão Gonçalves

The International Journal of Esthetic Dentistry

|October 15, 2025

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This study presents a novel surgical technique combining the Vestibular Incision Subperiosteal Tunnel Access (VISTA) approach with internal frenectomy for treating gingival recession (GR). The method effectively achieves root coverage and prevents frenulum reattachment.

Area of Science:

Periodontology
Oral Surgery

Background:

Gingival recession (GR) is often linked to high frenulum attachment and shallow vestibules, especially in the lower front jaw.
Effective GR treatment requires addressing all contributing factors.

Purpose of the Study:

To present a surgical technique for treating gingival recession caused by high frenulum attachment.
To evaluate the efficacy of the Vestibular Incision Subperiosteal Tunnel Access (VISTA) approach combined with internal frenectomy.

Main Methods:

A bilaminar grafting technique using the VISTA approach was employed.
An internal frenectomy was performed to remove frenulum and muscle attachments.
The surgical protocol aimed for coronal repositioning of the gingival margin.

Keywords:

gingival atrophy gingival recession

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Main Results:

The technique successfully achieved excellent root coverage.
Coronal migration of interproximal papillae was observed.
The obtained root coverage remained stable at 12-month follow-up.

Conclusions:

The VISTA approach with internal frenectomy is an effective surgical protocol for treating gingival recession.
This method addresses frenulum-related GR by eliminating recurrence potential.
The technique promotes significant root coverage and gingival margin stability.