In this surgery Prof. Wachtel, Munich/Germany, shows how to cover recessions in the buccal area with a connective tissue graft taken from the palate. Initially, the root surfaces are cleaned with scalers and ultrasonic diamond tips. The tunnelling technique involves the careful undermining and elevating of the papillae with full mobilization of their basis, while not damaging the tip and maintaining an intact blood supply in the latter area.

The tunnelling and mobilization of the gingival tissue is performed using microsurgical blades and a papillae elevator. It is of utmost importance to obtain passively and fully mobilized tissue, including the papillae. After final preparation of the reception bed a connective tissue graft is obtained from the palatal region. Care has to be taken not to hit the palatal artery and to leave a palatal epithelial thickness of approximately one millimeter to avoid healing problems.

The palatal wound is closed by a running suture and a splint is placed to support the initial healing period. One suture per side is then moved underneath the papillae (one suture from the mesial end and one suture from the distal end). With the help of the mesial suture the graft is pulled into the prepared pouch. When the final position of the inserted graft has been ensured, the proximal contact points between the treated teeth are connected with a flowable composite to enable the surgeon to perform a special suturing technique.

Sutures over the connected contact points are used to pull the tunneled flap coronally aiming to reach the cementoenamel junction. This special suturing technique facilitates the fixation and stabilization of the coronally positioned flap so that the recession areas are covered.