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Global Translational Medicine Evolution of tunneling techniques

7. Conclusion form for training, education, research, and publication. All
consent forms are maintained in the appropriate patient
Tunneling procedures represent a subset of the minimally electronic health records.
invasive surgeries that have emerged in contemporary
periodontics. Virtually all tunneling procedures aim to Consent for publication
limit patient morbidity, enhance wound stability, and
avoid exposure of implanted membranes, grafts, and Patients consented to the publication of their data.
biomaterials. The procedures often represent refinements Availability of data
of techniques that involve reflection of crestal or papillary
gingival tissue. Tunnel flaps for root coverage derive from Not applicable.
one of the simplest procedures used to treat isolated gingival
recession defects—the Raetzke pouch. Subsequent authors References
have expanded tunneling to sites exhibiting multiple 1. Azar FM. Minimally invasive surgery: Is less more? Orthop
adjacent recession defects and enhanced the procedures Clin North Am. 2020;51(3):xiii-xiv.
using external incisions, specialized instruments, distinct doi: 10.1016/j.ocl.2020.04.001
surgical protocols for addressing the interproximal gingiva,
advanced suturing techniques, and implantation of various 2. Mills MP, Rosen PS, Chambrone L, et al. American Academy
grafts and biologics. In periodontal regeneration, tunneling of Periodontology best evidence consensus statement on the
techniques represent the natural extension of highly efficacy of laser therapy used alone or as an adjunct to non-
surgical and surgical treatment of periodontitis and peri-
successful and well-validated M-MIST. Tunnel-based ARA implant diseases. J Periodontol. 2018;89(7):737-742.
procedures are intriguing; however, supporting evidence is
limited to case reports. This narrative review recounts the doi: 10.1002/JPER.17-0356
evolution of tunneling within periodontics and suggests 3. Cortellini P, Cortellini S, Bonaccini D, Tonetti MS. Modified
opportunities for further derivations of the technique. minimally invasive surgical technique in human intrabony
Multi-surface and circumferential tunneling may be defects with or without regenerative materials-10-year
applicable in specific clinical circumstances. follow-up of a randomized clinical trial: Tooth retention,
periodontitis recurrence, and costs. J Clin Periodontol.
Acknowledgments 2022;49(6):528-536.
None. doi: 10.1111/jcpe.13627
4. Raetzke PB. Covering localized areas of root exposure
Funding employing the “envelope” technique. J Periodontol.
The treatment depicted in this report was entirely funded 1985;56(7):397-402.
by the Defense Health Agency, United States, with no doi: 10.1902/jop.1985.56.7.397
extramural funding provided to the authors.
5. Allen AL. Use of the supraperiosteal envelope in soft tissue
Conflict of interest grafting for root coverage. I. Rationale and technique. Int J
Periodontics Restorative Dent. 1994;14(3):216-227.
The authors declare that they have no competing interests.
6. Zabalegui I, Sicilia A, Cambra J, Gil J, Sanz M. Treatment
Author contributions of multiple adjacent gingival recessions with the tunnel
subepithelial connective tissue graft: A clinical report. Int J
Conceptualization: Alan George, Han Kim, Thomas M. Periodontics Restorative Dent. 1999;19(2):199-206.
Johnson 7. Zuhr O, Fickl S, Wachtel H, Bolz W, Hürzeler MB. Covering
Visualization: Thomas M. Johnson of gingival recessions with a modified microsurgical tunnel
Writing – original draft: Alan George, Han Kim, Thomas technique: Case report. Int J Periodontics Restorative Dent.
M. Johnson 2007;27(5):457-463.
Writing – review & editing: Claudia P. Millan, Kimberly 8. Allen EP. Subpapillary continuous sling suturing method
Ann Inouye, Brian W. Stancoven, Adam R. Lincicum, for soft tissue grafting with the tunneling technique. Int J
Carsen R. McDaniel, Albert W. Cheng, Richard Hill Periodontics Restorative Dent. 2010;30(5):479-485.

Ethics approval and consent to participate 9. Aroca S, Molnár B, Windisch P, et al. Treatment of multiple
adjacent miller class I and II gingival recessions with a
Each patient completed an informed consent process modified coronally advanced tunnel (MCAT) technique
involving verbal and written components. The consent process and a collagen matrix or palatal connective tissue graft: A
included completion of a standardized photographic release randomized, controlled clinical trial. J Clin Periodontol.

Volume 4 Issue 3 (2025) 47 doi: 10.36922/GTM025220048