Gingival recession is a common finding in clinical practice, and several surgical approaches have been described to achieve root coverage, ranging from coronally advanced flaps to various graft-based techniques. Among these, the tunnelling technique has become established as a minimally invasive and esthetically favorable option, particularly suited to the treatment of single or multiple adjacent recessions in visible areas of the mouth.

In the classic tunnel approach, a supraperiosteal or subperiosteal tunnel is prepared beneath the recession without the vertical releasing incisions used in more traditional flap designs, and a connective tissue graft is introduced and stabilized through this tunnel. Because the papillae are left intact and the blood supply to the flap is preserved, this approach tends to produce favorable healing and esthetic outcomes with reduced patient morbidity compared to open flap techniques.

This presentation reviews the classical principles and instrumentation of the tunnelling technique before turning to more recent developments in the field, including modifications to tunnel access and instrumentation, the use of platelet concentrates alongside connective tissue grafts, and current thinking on case selection for single versus multiple recession defects.