AccScience Publishing / GTM / Online First / DOI: 10.36922/GTM025220048
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REVIEW ARTICLE

Evolution of tunneling techniques in periodontics: A narrative review

Alan R. George1 ,  Han S. Kim1 ,  Carsen R. McDaniel2 ,  Richard B. Hill3 ,  Albert W. Cheng1,4 ,  Brian W. Stancovenv ,  Claudia P. Millan1 ,  Kimberly Ann Inouye1 ,  Adam R. Lincicum1 ,  Thomas M. Johnson1*
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1 Department of Periodontics, Army Postgraduate Dental School, Postgraduate Dental College, Uniformed Services University, Fort Gordon, Georgia, United States of America
2 Department of Periodontics, Army Postgraduate Dental School, Postgraduate Dental College, Uniformed Services University, Fort Bliss, Texas, United States of America
3 Periodontics, Private Practice, Arvada, Colorado, United States of America
4 Department of Periodontics, Army Postgraduate Dental School, Postgraduate Dental College, Schofield Barracks, Hawaii, United States of America
Global Translational Medicine, 025220048 https://doi.org/10.36922/GTM025220048
Received: 30 May 2025 | Revised: 10 August 2025 | Accepted: 15 August 2025 | Published online: 3 September 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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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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Global Translational Medicine, Electronic ISSN: 2811-0021 Print ISSN: 3060-8600, Published by AccScience Publishing
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