Tunneling Techniques for Root Coverage
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Purpose of Review
Tunneling technique (TUN) has been introduced as a minimally invasive and highly esthetic treatment option for the treatment of gingival recession, one of the most frequent mucogingival deformities and conditions. The purpose of the present article is to review how specific technique modifications, different grafting materials, and different defect characteristics may affect the outcome of TUN for root coverage.
TUN has been shown to be an efficacious root coverage technique that, in combination with various grafting materials, can achieve satisfactory root coverage outcomes in Miller class I and II recession defects that are more predictable in the maxilla and when multiple adjacent defects are treated. Recent evidence suggests that specific technique modifications may be promising for the treatment of challenging multiple Miller class III recession defects.
In order to achieve successful root coverage outcomes with TUN, the etiology of the defect should be identified and risk factors controlled, case selection is critical, specific technique modifications may be beneficial, and a variety of graft materials may be utilized.
KeywordsRecession Root coverage Tunnel Grafting
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 7.• Allen AL. Use of the supraperiosteal envelope in soft tissue grafting for root coverage. I. Rationale and technique. Int J Periodontics Restorative Dent. 1994;14(3):216–27 This is the first article to apply tunneling concept on root coverage treatment of multiple adjacent recession defects. PubMedPubMedCentralGoogle Scholar
- 10.• Aroca S, Keglevich T, Nikolidakis D, Gera I, Nagy K, Azzi R, et al. Treatment of class III multiple gingival recessions: a randomized-clinical trial. J Clin Periodontol. 2010;37(1):88–97 The study shows that modified tunnel/CTG technique is predictable for the treatment of multiple class III recession-type defects. CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Aroca S, Molnar B, Windisch P, Gera I, Salvi GE, Nikolidakis D, et al. Treatment of multiple adjacent Miller class I and II gingival recessions with a Modified Coronally Advanced Tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: a randomized, controlled clinical trial. J Clin Periodontol. 2013;40(7):713–20.CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Allen EP, Cummings LC. Minimally invasive soft tissue grafting. Minimally invasive periodontal therapy: clinical techniques and visualization technology. 2014;1:143.Google Scholar
- 26.Abhyankar V, Wong D, Mascarenhas J. Treatment of a mandibular anterior lingual recession defect with minimally invasive laterally closed tunneling technique and sub-epithelial connective tissue graft. Int Arch Oral Maxillofac Surg. 2018;2:017.Google Scholar
- 32.• Allen EP. Multiple tooth recession: papilla retention pouch procedure. Contemporary Oral Plastic Surgery Procedural Manual. Dallas, TX: Center for Advanced Dental Education. 2004:9–16. The “double back continuous sling suture," designed specifically for TUN with allograft, was first described by this article. Google Scholar
- 34.Santamaria MP, Neves F, Silveira CA, Mathias IF, Fernandes-Dias SB, Jardini MAN, et al. Connective tissue graft and tunnel or trapezoidal flap for the treatment of single maxillary gingival recessions: a randomized clinical trial. J Clin Periodontol. 2017;44(5):540–7.CrossRefPubMedPubMedCentralGoogle Scholar
- 36.Gobbato L, Nart J, Bressan E, Mazzocco F, Paniz G, Lops D. Patient morbidity and root coverage outcomes after the application of a subepithelial connective tissue graft in combination with a coronally advanced flap or via a tunneling technique: a randomized controlled clinical trial. Clin Oral Investig. 2016;20(8):2191–202.CrossRefGoogle Scholar
- 37.Azaripour A, Kissinger M, Farina VS, Van Noorden CJ, Gerhold-Ay A, Willershausen B, et al. Root coverage with connective tissue graft associated with coronally advanced flap or tunnel technique: a randomized, double-blind, mono-centre clinical trial. J Clin Periodontol. 2016;43(12):1142–50.CrossRefGoogle Scholar
- 40.•• Tavelli L, Barootchi S, Nguyen TVN, Tattan M, Ravida A, Wang HL. Efficacy of tunnel technique in the treatment of localized and multiple gingival recessions: a systematic review and meta-analysis. J Periodontol. 2018;89(9):1075–90 This article provides a meta-analysis of the efficacy of tunnel technique in the management of different ginigval recession defects. CrossRefPubMedPubMedCentralGoogle Scholar
- 47.Chaparro A, De la Fuente M, Albers D, Hernandez D, Villalobos AM, Gaedechens D, et al. Root coverage of multiple Miller class I and II recession defects using acellular dermal matrix and tunneling technique in maxilla and mandible: a 1-year report. Int J Periodontics Restorative Dent. 2015;35(5):639–45.CrossRefPubMedPubMedCentralGoogle Scholar
- 52.Paolantonio M, Dolci M, Esposito P, D'Archivio D, Lisanti L, Di Luccio A, et al. Subpedicle acellular dermal matrix graft and autogenous connective tissue graft in the treatment of gingival recessions: a comparative 1-year clinical study. J Periodontol. 2002;73(11):1299–307.CrossRefPubMedPubMedCentralGoogle Scholar
- 56.Fahmy RA, Taalab MR. Modified tunnel technique for management of gingival recession in esthetic zone using acellular dermal matrix versus connective tissue graft. Future Dental J. 2018.Google Scholar
- 57.Cosgarea R, Juncar R, Arweiler N, Lascu L, Sculean A. Clinical evaluation of a porcine acellular dermal matrix for the treatment of multiple adjacent class I, II, and III gingival recessions using the modified coronally advanced tunnel technique. Quintessence Int. 2016;47(9):739–47.PubMedPubMedCentralGoogle Scholar
- 60.Pietruska M, Skurska A, Podlewski L, Milewski R, Pietruski J. Clinical evaluation of Miller class I and II recessions treatment with the use of modified coronally advanced tunnel technique with either collagen matrix or subepithelial connective tissue graft: a randomized clinical study. J Clin Periodontol. 2019;46(1):86–95.CrossRefPubMedPubMedCentralGoogle Scholar
- 63.Sculean A, Cosgarea R, Stahli A, Katsaros C, Arweiler NB, Brecx M, et al. The modified coronally advanced tunnel combined with an enamel matrix derivative and subepithelial connective tissue graft for the treatment of isolated mandibular Miller class I and II gingival recessions: a report of 16 cases. Quintessence Int. 2014;45(10):829–35.PubMedPubMedCentralGoogle Scholar
- 64.• Sculean A, Cosgarea R, Stahli A, Katsaros C, Arweiler NB, Miron RJ, et al. Treatment of multiple adjacent maxillary Miller class I, II, and III gingival recessions with the modified coronally advanced tunnel, enamel matrix derivative, and subepithelial connective tissue graft: a report of 12 cases. Quintessence Int. 2016;47(8):653–9 This study shows that modified tunneling in combination with EMD and SCTG can result in predictable root coverage outcomes in multiple maxillary Miller class I, II, and III recession defects. PubMedPubMedCentralGoogle Scholar
- 67.• Yaman D, Demirel K, Aksu S, Basegmez C. Treatment of multiple adjacent Miller class III gingival recessions with a modified tunnel technique: a case series. Int J Periodontics Restorative Dent. 2015;35(4):489–97 This study shows that modified tunneling may be a valuable and predictable technique for the treatment of multiple Miller class III recession defects. CrossRefPubMedPubMedCentralGoogle Scholar