Increasing Gingival Thickness: The Modified Tunnel Technique - Dental Online College
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Increasing Gingival Thickness: The Modified Tunnel Technique

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Duration:

07:26

Surgeon:

Prof. Dr. Hürzeler

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.

 

Content of the expert video

In the initial situation the exposed root surfaces are cleaned by root planing.
In the initial situation the exposed root surfaces are cleaned by root planing.
The buccal split-flap is now fully mobilised and the pouch for the subepithelial soft tissue graft prepared.
The buccal split-flap is now fully mobilised and the pouch for the subepithelial soft tissue graft prepared.
The subepithelial graft is placed into the prepared pouch with the help of a mesial and distal suture.
The subepithelial graft is placed into the prepared pouch with the help of a mesial and distal suture.
The graft is in place and the sutures pull the entire situation in the occlusal direction in order to cover the recessions.
The graft is in place and the sutures pull the entire situation in the occlusal direction in order to cover the recessions.

The expert

Prof. Dr. Markus Hürzeler

Private practice Hürzeler/Zuhr in Munich

  • Practising dentist in the joint practice Hürzeler/Zuhr in Munich
  • 2003 Conferment of degree; adjunct professor by the Albert-Ludwigs University in Freiburg
  • Specialist for periodontology (medical specialist equivalent) according to the Swiss (SSP) and German Association of Periodontology (DGP)
  • Specialist for prosthetics (medical specialist equivalent) according to the German Association for Dental Prosthetics and Materials Science (DGZPW)
  • Professorship at the Albert-Ludwigs University in Freiburg and at the University of Texas in Houston / Texas / USA
  • more »
  • Align Technology Inc.
  • BEGO Implant Systems GmbH & Co. KG
  • DSI DentaScience Institute®
  • Kuraray
  • CAMLOG
  • Health AG
  • IDI-PARO
  • W&H Deutschland GmbH
  • Dentsply Sirona Implants
  • Henry Schein
  • IPI München
  • CLINICAL HOUSE EUROPE
  • Zimmer Dental
  • Sirona
  • botiss dental Gmbh
  • Komet/Gebr. Brasseler GmbH &Co KG
  • DZR
  • Mectron

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