Raetzke PB. Covering localized areas of root exposure employing the ‘envelope’ technique. J Periodontol. 1985; 56:397-402
Allen AL. Use of the supraperiosteal envelope in soft tissue grafting for root coverage. I. Rationale and technique. Int J Periodontics Restorative Dent. 1994; 14:216-227
Zabalegui I, Sicilia A, Cambra J Treatment of multiple adjacent gingival recessions with the tunnel subepithelial connective tissue graft: a clinical report. Int J Periodontics Restorative Dent. 1999; 19:199-206
Zuhr O, Fickl S, Wachtel H Covering of gingival recessions with a modified microsurgical tunnel technique: case report. Int J Periodontics Restorative Dent. 2007; 27:457-463
Aroca S, Keglevich T, Nikolidakis D Treatment of class III multiple gingival recessions: a randomized-clinical trial. J Clin Periodontol. 2010; 37:88-97
Aroca S, Molnár B, Windisch P, Gera I, Salvi GE, Nikolidakis D, Sculean A 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; 40:713-720
Sculean A, Allen EP. The laterally closed tunnel for the treatment of deep isolated mandibular recessions: surgical technique and a report of 24 cases. Int J Periodontics Restorative Dent. 2018; 38:479-487
Carranza N, Pontarolo C, Rojas MA. Laterally stretched flap with connective tissue graft to treat single narrow deep recession defects on lower incisors. Clin Adv Periodontics. 2019; 9:29-33

Lateral thinking: the laterally closed tunnel technique for root coverage. a case series

From Volume 49, Issue 5, May 2022 | Pages 437-440


Devan S Raindi

BDS Hons (Birm) MJDF RCS (Eng) MClinDent Hons (KCL) MPerio RCS (Edin) AFHEA, BDS Hons (Birm), MJDF RCS (Eng), MClinDent Hons (KCL), MPerio RCS (Edin), AFHEA

Specialist in Periodontics, Guy‘s Hospital, London

Articles by Devan S Raindi

Email Devan S Raindi

Hiten Halai

BDS, MFDS, RCSEd, PG Dip MPerio, RCSEd DClinDent Perio

Specialist and Clinical Teacher in Periodontics, Private Practice, Dental Specialists, Windsor

Articles by Hiten Halai


The laterally closed tunnel is a novel technique to achieve root coverage over narrow recession defects. This article presents three clinical cases completed in private practice settings demonstrating positive outcomes using the technique for both single and multiple recession defects in the anterior mandible. The techniques are described in detail, including appropriate case selection.

The use of tunnelling techniques for root coverage has gained popularity within the field of periodontal mucogingival surgery. Historically, the tunnelling approach was first proposed by Raetzke in 1985 where the preparation of a supra-periosteal envelope that allowed for insertion of a connective tissue graft, which was left partially exposed was described.1 The technique evolved to treat multiple gingival recessions, as described by Allen in 1994, and was finally coined the ‘tunnel’ approach by Zabalegui et al in 1999.2,3

Zuhr et al and Aroca et al described a modified microsurgical tunnel technique whereby the entire gingiva-papillary unit was coronally advanced with the use of either anchoring sutures into the palatal mucosa, or suspensory sutures with composite stops to allow coverage of the connective tissue graft.4,5,6 More recently, Sculean and Allen described a laterally closed tunnel (LCT), whereby tension-free lateral closure of the tunnel over isolated mandibular recession defects is obtained following the principles of tunnel preparation described in previous techniques.7 A similar technique (if not identical) has also been termed the laterally stretched flap (LAST) by Carranza.8

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