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

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