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Global Translational Medicine

REVIEW ARTICLE
Evolution of tunneling techniques in

periodontics: A narrative review

Alan R. George 1† , Han S. Kim 1† , Carsen R. McDaniel 2 , Richard B. Hill 3 ,
Albert W. Cheng 1,4 , Brian W. Stancoven 1 , Claudia P. Millan 1 , Kimberly Ann
1

Inouye 1 , Adam R. Lincicum 1 ,and Thomas M. Johnson *
1 Department of Periodontics, Army Postgraduate Dental School, Postgraduate Dental College,
Uniformed Services University, Fort Gordon, Georgia, United States of America
2 Department of Periodontics, Army Postgraduate Dental School, Postgraduate Dental College,
Uniformed Services University, Fort Bliss, Texas, United States of America
3 Periodontics, Private Practice, Arvada, Colorado, United States of America
4 Department of Periodontics, Army Postgraduate Dental School, Postgraduate Dental College,
Schofield Barracks, Hawaii, United States of America

Abstract

Over the past several decades, a trend toward minimally invasive surgery
has emerged in various disciplines of medicine and dentistry. In periodontics,
one manifestation of this phenomenon is the use of tunneling techniques for
† These authors contributed equally mucoperiosteal flap reflection. Tunnel flaps are characterized by the establishment
to this work. of a space between the alveolar bone or periosteum and the overlying soft tissue while
*Corresponding author: maintaining intact interdental gingiva and/or crestal keratinized mucosa. The oral and
Thomas M. Johnson facial interdental papillae and col areas remain intact during the procedure. Retaining
(thomas.m.johnson34.mil@health.mil) interproximal tissue integrity may enhance wound stability during early healing, and
Citation: George AR, Kim HS, limited evidence suggests that tunnel flaps can improve several patient-reported
McDaniel CR, et al. Evolution outcome measures, such as comfort level, initial esthetics, and time required for return to
of tunneling techniques in
periodontics: A narrative review. normal activities. Multiple refinements have been promulgated since the introduction
Global Transl Med. 2025;4(3):36-50. of the first tunneling techniques, and clinical applications have expanded into
doi: 10.36922/GTM025220048 numerous areas of the field, including surgical treatment of periodontitis, periodontal
Received: May 30, 2025 plastic surgery, and alveolar ridge augmentation. The purpose of this narrative review is
to describe the evolution of tunneling techniques over time and suggest opportunities
Revised: August 10, 2025
to further develop tunneling applications. Two clinical circumstances are described
Accepted: August 15, 2025 in which multi-surface tunneling at oral, facial, and proximal tooth surfaces can be
Published online: September 3, employed to achieve favorable clinical and patient-oriented outcomes.
2025
Copyright: © 2025 Author(s). Keywords: Alveolar bone loss; Gingival recession; Minimally invasive surgical procedures;
This is an Open-Access article
distributed under the terms of the Patient-reported outcome measures; Periodontitis; Tissue grafts
Creative Commons Attribution
License, permitting distribution,
and reproduction in any medium,
provided the original work is
properly cited. 1. Introduction
Publisher’s Note: AccScience Although no universally accepted definition exists, minimally invasive surgery
Publishing remains neutral with encompasses techniques that seek to accomplish surgical goals while limiting incision
regard to jurisdictional claims in
published maps and institutional size, maximizing wound stability, and enhancing patient-oriented outcomes. Over the
affiliations. last several decades, virtually every surgical specialty of medicine and dentistry has

Volume 4 Issue 3 (2025) 36 doi: 10.36922/GTM025220048