In this operation Prof. Hürzeler (Munich) shows how to cover large recessions in the buccal area of posterior teeth. Using the modified tunnel technique, a subepithelial connective tissue graft taken from the palate is inserted into the prepared gingival pouch. Initially, the root surfaces are cleaned with scalers and ultrafine diamond burs. Afterwards the proximal contact points of the affected teeth are etched and connected with a flowable composite to enable the surgeon to perform a special suturing technique later on.

The tunnelling and mobilization of the gingival tissues is performed using special tunneling instruments including microsurgical blades. It is of utmost importance to obtain passively and fully mobilized tissue, including the papillae. After completion of the preparation of the reception bed a subepithelial connective tissue graft is taken from the palatal region. Care has to be taken not to hit the palatal artery and to leave an epithelial flap with a thickness of at least one millimeter to avoid healing problems. At the same time, the surgeon should harvest a graft of maximal thickness including the periosteum.

The palatal wound is closed by a running suture and a splint is placed to support the initial healing period in the palatal area. For the insertion of the connective tissue graft, the surgeon leads a Gore-Tex thread through the tunnel starting at its mesial “entrance” in order to pick up the graft at the distal end. The graft is carefully pulled and pushed through the tunnel towards the mesial end and at the same time held in position with sutures at other end. When the final position of the inserted graft has been ensured, sutures over the connected interproximal contacts are used to pull the entire prepared gingival flap up and fix it in the coronal position so that the recession areas are covered.