Tunneling & VISTAGum Grafting in San Francisco

Two ways to treat gum recession through small openings instead of open flaps: the gum is lifted as one continuous sleeve, moved up over the roots, and supported from underneath while it heals.

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Recession Treated Without Opening the Gums

Traditional gum surgery cuts the gum away from the teeth so a graft can be laid in place. Tunneling and VISTA (vestibular incision subperiosteal tunnel access) reach the same place from small openings instead. The gum between the teeth, the papillae, is left attached, which protects the blood supply the healing tissue depends on and keeps the natural shape of the gum line.

Dr. Samadian uses both, along with the Pinhole Surgical Technique and connective-tissue grafting, and chooses between them once he has measured the recession and the thickness of your gum tissue.

How the Tunnel Technique Works

Small openings are made inside the gum collar around each tooth. Through them, the gum and the tissue under it are gently released from the bone, creating a tunnel that runs under several teeth at once. A graft is slid into the tunnel, the gum is drawn up over the exposed roots, and fine sutures hold everything in its new position while it heals.

Because nothing is cut across the papillae, several neighboring teeth can be treated together and the gum keeps its scalloped shape.

How VISTA Works

VISTA uses a single small opening placed higher up, in the fold of the lip, away from the teeth entirely. From there a tunnel is made under the gum across the area being treated. The tissue is advanced over the roots and held in place with sutures anchored to the teeth, so it can heal without tension pulling it back down.

Keeping the opening away from the gum line means the area that will show in your smile is not cut at all. VISTA is especially useful across the front teeth and where several teeth need treatment together.

What Goes Under the Gum

Moving the gum up covers the roots. What is placed underneath decides how thick, and therefore how durable, the new gum line is. Depending on your tissue, that may be:

Your own connective tissue from the palate, which gives the most predictable thickening and is still chosen where the gum is very thin
A collagen matrix or donor-tissue matrix, which avoids a second wound in the palate (see alternatives to traditional gum grafting)
PRF membranes made from your own blood, to support early healing (see PRF)
A growth factor such as PDGF or Emdogain® where the root surface also needs regeneration (see growth factors)

Who It Suits

Tunneling and VISTA suit recession across one or several teeth, particularly in the smile zone. They are less suitable where there is very little gum to move, or where bone loss between the teeth has already lowered the papillae; no technique can predictably cover a root once the bone between the teeth is gone. The cause of the recession, whether aggressive brushing, a bite overloading certain teeth, grinding or gum disease, is dealt with as part of the plan, or the recession returns.

Recovery

Expect swelling and soreness for the first several days, managed with the medication prescribed for you. For a period after surgery you avoid brushing the treated teeth and use a prescribed rinse instead, eat soft food, and do not pull the lip out to look at the area. Sutures are usually removed at a follow-up visit. If palate tissue is used, the palate is the sorer of the two sites. Final gum shape continues to mature for several months.

Risks

As with any gum surgery: bleeding, swelling, bruising and infection; partial rather than complete root coverage; some return of recession over time, especially if the cause is not controlled; temporary sensitivity; and a graft that does not take, needing a second procedure. Smoking reduces the chance of success substantially. These are discussed at your consultation and in writing before treatment.

Related Treatments

Tunneling & VISTA FAQ

Is the tunnel technique the same as the Pinhole Surgical Technique?

They are related but not the same. All three avoid open flaps. The Pinhole Surgical Technique uses a needle-sized entry point and collagen strips, usually without sutures or a graft. Tunneling works through small openings around the teeth and usually places a graft under the gum. VISTA uses one opening higher in the lip. Dr. Samadian performs all three and recommends one after examining your gums.

Do I need tissue taken from the roof of my mouth?

Not always. Where the gum is thick enough, a collagen matrix or donor-tissue matrix can be used instead, so there is no second wound. Where the gum is very thin, your own connective tissue gives the most predictable result, and Dr. Samadian will tell you if he recommends it.

How many teeth can be treated at once?

Both techniques are designed to treat several neighboring teeth in one appointment, which is one of their main advantages over grafting each tooth separately. How many is appropriate in one session is decided case by case.

Will there be stitches?

Yes, fine sutures are used to hold the gum in its new position while it heals. With VISTA they are anchored to the teeth so they hold the gum up without tension. They are removed at a follow-up visit.

How long before the gum looks final?

The gum is usually comfortable within a couple of weeks, but it continues to firm up and settle over several months. Any final cosmetic work at the gum line is timed after that.

Can VISTA or tunneling fix a black triangle between teeth?

Not predictably. A dark gap between teeth usually reflects bone loss between them, and gum tissue cannot be reliably rebuilt above the bone that supports it. It can sometimes be improved with restorative or orthodontic changes, which Dr. Samadian will explain if that applies to you.

Treating patients throughout San Francisco. Dr. Samadian specializes in treatments such as smile makeovers, porcelain veneers, digital reconstructions, aesthetic dentistry, and dental implants. Focusing on regeneration and restoring tooth structure, bone loss, and gum recession utilizing the latest LANAP laser technology.