Optimizing Esthetics in Maxillary Anterior Periradicular Surgery: A Case Report on Vestibular Incision

Persistent periapical infections may necessitate surgical intervention when nonsurgical endodontic treatment fails. Conventional surgical approaches in the maxillary anterior region often lead to visible scarring and prolonged healing, compromising esthetic outcomes. The vestibular incision subperiosteal tunnel access (VISTA) technique offers a minimally invasive alternative that preserves soft tissue integrity and reduces scarring.

A 32-year-old male presented with symptomatic apical periodontitis of the maxillary left central incisor; universal Tooth #9 following failed nonsurgical retreatment. Periapical surgery was performed using the VISTA approach via a vestibular incision beneath the maxillary labial frenum to access the lesion with minimal tissue trauma. After debridement and apicoectomy, the defect was filled with a demineralized xenograft and covered with L-PRF membrane. The flap was sutured for optimal healing. Postoperative follow-up at 12 months demonstrated complete radiographic resolution of the periapical lesion, excellent soft tissue healing without visible scarring, and patient-reported minimal discomfort and anxiety.

This case illustrates a potential application of the VISTA approach in anterior periradicular surgery, a well-established method in periodontal plastic surgery. The integration of VISTA with regenerative materials, such as xenografts and platelet-rich fibrin (PRF), may enhance bone healing and esthetic outcomes, thereby generating hypotheses for future research.