Evolution of tunneling techniques in periodontics: A narrative review

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 mucoperiosteal flap reflection. Tunnel flaps are characterized by the establishment of a space between the alveolar bone or periosteum and the overlying soft tissue while maintaining intact interdental gingiva and/or crestal keratinized mucosa. The oral and facial interdental papillae and col areas remain intact during the procedure. Retaining interproximal tissue integrity may enhance wound stability during early healing, and limited evidence suggests that tunnel flaps can improve several patient-reported outcome measures, such as comfort level, initial esthetics, and time required for return to normal activities. Multiple refinements have been promulgated since the introduction of the first tunneling techniques, and clinical applications have expanded into numerous areas of the field, including surgical treatment of periodontitis, periodontal 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 to further develop tunneling applications. Two clinical circumstances are described in which multi-surface tunneling at oral, facial, and proximal tooth surfaces can be employed to achieve favorable clinical and patient-oriented outcomes.

Keywords

Alveolar bone loss / Gingival recession / Minimally invasive surgical procedures / Patient-reported outcome measures / Periodontitis / Tissue grafts

Funding

The treatment depicted in this report was entirely funded by the Defense Health Agency, United States, with no extramural funding provided to the authors.

Conflict of interest

The authors declare that they have no competing interests.

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