An array of complications are encountered in periodontal and peri-implant therapy, including occurrence of gingival/peri-implant recession, some of which are due to clinician errors. There are also biological complications that are mostly inflammatory in nature. Other inherent limitations such as thin mucosa can predispose to future complications. Periodontal and peri-implant plastic surgical approaches can be employed to avoid or solve much of these problems. The application of Vestibular Incision Subperiosteal Tunnel Access (VISTA) technique for periodontal and peri-implant soft tissue regeneration will be discussed. This presentation will review the risk factors that influence disease progression and predict therapeutic outcomes. The rationale, scientific evidence and material selection for various therapeutic approaches will be discussed.