Soft tissue grafting with the tunnel technique in the mandibular anterior: Myths and realities

Abstract

Objective To address the myths and realities of soft tissue grafting with the tunnel technique in the mandibular anterior region. Materials and Methods Myths associated with use of the tunnel technique for soft tissue grafting in the mandibular anterior region are identified and examined. Explanations for the misunderstandings are presented and documented with case examples and evidence from scientific studies. Results Six myths are described and the realities are presented. Conclusions This report demonstrates that the tunnel technique can be successfully used in the mandibular anterior region in the presence of anatomic features thought to favor the use of more invasive surgical methods. Clinical Significance Soft tissue grafting in the mandibular anterior region has complicating anatomical features including a strong frenal attachment, shallow vestibule and thin tissue. These features may be successfully managed with a free gingival graft, but that procedure results in an uncomfortable experience for the patient. The tunnel technique, especially when combined with an acellular dermal matrix, dramatically improves the patient experience and esthetic outcome without compromising the clinical outcome.

Tunnel vs. coronally advanced flap in combination with a connective tissue graft for the treatment of multiple gingival recessions: a multi-center randomized clinical trial

“…Tunneling techniques (TUN), always in combination with a CTG, have also demonstrated high clinical efficacy in the treatment of multiple adjacent LGRs [12,[19][20][21][22][23][24]. This surgical approach, however, has been modified by different authors depending on the type of the submarginal dissection (split versus full thickness) and the gingival margin position with respect to the CTG (non-advanced exposing the coronal part of the CTG or coronally/laterally moved to fully cover the CTG) [21,23,25,26].…”

Acellular dermal matrix in reconstructive surgery: Applications, benefits, and cost

“…It is applied in periorbital soft tissue, dura mater, extraoral and intraoral, and oropharyngeal defects. It also has applications in skeletal support, nasal soft tissue, and tympanic membrane repair (1,(15)(16)(17)(18)(19)(20)(21)(22)(23).…”

Does vestibular incision improve the outcomes of vestibular incision subperiosteal tunnel technique: A randomized clinical trial for treatment of multiple adjacent type 1 gingival recession

“…17 At that time, connective tissue graft was exposed partially after suture. 8,9 However, the exposed graft did not match the adjacent gingiva, resulting in esthetic problems. Then, tunnel technique was modified with marginal tissue coronal positioning, which allowed complete coverage of the graft.…”

“…6,7 Tunnel technique, as a promising method without detachment of the papillary tissues, was commonly used with CTG. 4,[8][9][10][11][12][13][14][15] The authors reported the complete root coverage of 85% and the mean root coverage of 90%, for using a tunneling flap procedure in conjunction with a CTG for treatment of multiple adjacent RT 1 recessions at 12-month. 16 Tunnel technique originated from the envelope method.…”