{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T03:59:29Z","timestamp":1792036769461,"version":"4.4.0"},"reference-count":60,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2018,8,13]],"date-time":"2018-08-13T00:00:00Z","timestamp":1534118400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aap.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Periodontology"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tunnel technique (TUN) has recently gained popularity among clinicians for its promising clinical and esthetic results in treating gingival recession (GR) defects. However, evidence regarding the efficacy of the TUN is not yet conclusive. Therefore, the aim of the present systematic review and meta\u2010analysis was to investigate the predictability of TUN and its comparison to the coronally advanced flap (CAF) procedure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A literature search on PubMed, Cochrane libraries, EMBASE, and hand\u2010searched journals through November 2017 was conducted to identify clinical studies investigating TUN for root coverage procedures. Only randomized controlled trials (RCTs) were considered for the meta\u2010analysis comparing TUN to CAF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 20 articles were included in the systematic review and six in the meta\u2010analysis. The overall calculated mean root coverage (mRC) of TUN for localized and multiple GR defects was 82.75 \u00b1 19.7% and 87.87 \u00b1 16.45%, respectively. Superior results were found in maxillary and in Miller Class I and II GR defects. TUN outcomes may have been enhanced by split\u2010thickness flap preparation and microsurgical approach. TUN and CAF had comparable mRC, complete root coverage (CRC), keratinized tissue gain, and root coverage esthetic score when varying combinations of graft material were evaluated. However, CAF demonstrated superior outcomes to TUN when the same graft (connective tissue or acellular dermal matrix) was used in both techniques.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>TUN is an effective procedure in treating localized and multiple GR defects. Limited evidence is available comparing TUN to CAF; however, CAF seemed to be associated with higher percentage of CRC than was TUN when the same grafts (connective tissue or acellular dermal matrix) were used in both techniques.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jper.18-0066","type":"journal-article","created":{"date-parts":[[2018,5,14]],"date-time":"2018-05-14T22:24:37Z","timestamp":1526336677000},"page":"1075-1090","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":150,"title":["Efficacy of tunnel technique in the treatment of localized and multiple gingival recessions: A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"89","author":[{"given":"Lorenzo","family":"Tavelli","sequence":"first","affiliation":[{"name":"Department of Periodontics &amp; Oral Medicine University of Michigan School of Dentistry  Ann Arbor MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shayan","family":"Barootchi","sequence":"additional","affiliation":[{"name":"Department of Periodontics &amp; Oral Medicine University of Michigan School of Dentistry  Ann Arbor MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trang V.N.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Periodontics &amp; Oral Medicine University of Michigan School of Dentistry  Ann Arbor MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Tattan","sequence":"additional","affiliation":[{"name":"Department of Periodontics &amp; Oral Medicine University of Michigan School of Dentistry  Ann Arbor MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Ravid\u00e0","sequence":"additional","affiliation":[{"name":"Department of Periodontics &amp; Oral Medicine University of Michigan School of Dentistry  Ann Arbor MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hom\u2010Lay","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Periodontics &amp; Oral Medicine University of Michigan School of Dentistry  Ann Arbor MI"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,8,13]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/prd.12059"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1967.38.4.316"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/prd.12186"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2015.130674"},{"key":"e_1_2_8_6_1","first-page":"152","article-title":"Free autogenous gingival grafts. 3. Utilization of grafts in the treatment of gingival recession","volume":"6","author":"Sullivan HC","year":"1968","journal-title":"Periodontics"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-051X.29.s3.11.x"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.2008.01267.x"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12182"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12780"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1985.56.7.397"},{"key":"e_1_2_8_12_1","first-page":"302","article-title":"Use of the supraperiosteal envelope in soft tissue grafting for root coverage. II. Clinical results","volume":"14","author":"Allen AL","year":"1994","journal-title":"Int J Periodontics Restorative Dent"},{"key":"e_1_2_8_13_1","first-page":"199","article-title":"Treatment of multiple adjacent gingival recessions with the tunnel subepithelial connective tissue graft: a clinical report","volume":"19","author":"Zabalegui I","year":"1999","journal-title":"Int J Periodontics Restorative Dent"},{"key":"e_1_2_8_14_1","first-page":"457","article-title":"Covering of gingival recessions with a modified microsurgical tunnel technique: case report","volume":"27","author":"Zuhr O","year":"2007","journal-title":"Int J Periodontics Restorative Dent"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12112"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12178"},{"key":"e_1_2_8_17_1","first-page":"653","article-title":"Treatment of multiple adjacent maxillary Miller Class I, II, and III gingival recessions with the modified coronally advanced tunnel, enamel matrix derivative, and subepithelial connective tissue graft: a report of 12 cases","volume":"47","author":"Sculean A","year":"2016","journal-title":"Quintessence Int"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.2009.01492.x"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12714"},{"key":"e_1_2_8_20_1","first-page":"216","article-title":"Use of the supraperiosteal envelope in soft tissue grafting for root coverage. I. Rationale and technique","volume":"14","author":"Allen AL","year":"1994","journal-title":"Int J Periodontics Restorative Dent"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12627"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2009.06.005"},{"key":"e_1_2_8_23_1","first-page":"8","article-title":"A classification of marginal tissue recession","volume":"5","author":"Miller PD","year":"1985","journal-title":"Int J Periodontics Restorative Dent"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.2011.01732.x"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2009.080565"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d5928"},{"key":"e_1_2_8_27_1","volume-title":"Joanna Briggs Institute Reviewer's Manual","author":"Moola S","year":"2017"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v036.i03"},{"key":"e_1_2_8_29_1","volume-title":"Practical meta\u2010analysis","author":"Lipsey MW","year":"2001"},{"key":"e_1_2_8_30_1","unstructured":"HigginsJPT GreenS Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]: The Cochrane Collaboration; 2011."},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.17219\/acem\/44849"},{"key":"e_1_2_8_32_1","first-page":"34","article-title":"Zucchelli's technique or tunnel technique with subepithelial connective tissue graft for treatment of multiple gingival recessions","volume":"16","author":"Bherwani C","year":"2014","journal-title":"J Int Acad Periodontol"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.11607\/prd.1998"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2016.150676"},{"key":"e_1_2_8_35_1","first-page":"739","article-title":"Clinical evaluation of a porcine acellular dermal matrix for the treatment of multiple adjacent class I, II, and III gingival recessions using the modified coronally advanced tunnel technique","volume":"47","author":"Cosgarea R","year":"2016","journal-title":"Quintessence Int"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tripleo.2007.03.013"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.11607\/prd.2748"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12477"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2008.070546"},{"key":"e_1_2_8_40_1","first-page":"829","article-title":"The modified coronally advanced tunnel combined with an enamel matrix derivative and subepithelial connective tissue graft for the treatment of isolated mandibular Miller Class I and II gingival recessions: a report of 16 cases","volume":"45","author":"Sculean A","year":"2014","journal-title":"Quintessence Int"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2009.080438"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.11607\/prd.2278"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/jerd.12337"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1111\/jerd.12170"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12172"},{"key":"e_1_2_8_46_1","first-page":"CD007161","article-title":"Root coverage procedures for the treatment of localised recession\u2010type defects","author":"Chambrone L","year":"2009","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12603"},{"key":"e_1_2_8_48_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2005.76.10.1729"},{"key":"e_1_2_8_49_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.2005.00831.x"},{"key":"e_1_2_8_50_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12189"},{"key":"e_1_2_8_51_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.2006.01039.x"},{"key":"e_1_2_8_52_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1999.70.9.1077"},{"key":"e_1_2_8_53_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12254"},{"key":"e_1_2_8_54_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.2010.01559.x"},{"key":"e_1_2_8_55_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2004.75.6.886"},{"key":"e_1_2_8_56_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0765.1975.tb00001.x"},{"key":"e_1_2_8_57_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2010.090698"},{"key":"e_1_2_8_58_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0757.2011.00434.x"},{"key":"e_1_2_8_59_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2009.090041"},{"key":"e_1_2_8_60_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2003.74.5.741"},{"key":"e_1_2_8_61_1","doi-asserted-by":"publisher","DOI":"10.17219\/acem\/44849"}],"container-title":["Journal of Periodontology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2FJPER.18-0066","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/JPER.18-0066","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/JPER.18-0066","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/JPER.18-0066","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T08:37:07Z","timestamp":1760863027000},"score":1,"resource":{"primary":{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/10.1002\/JPER.18-0066"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,8,13]]},"references-count":60,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2018,9]]}},"alternative-id":["10.1002\/JPER.18-0066"],"URL":"https:\/\/doi.org\/10.1002\/jper.18-0066","archive":["Portico"],"relation":{},"ISSN":["0022-3492","1943-3670"],"issn-type":[{"value":"0022-3492","type":"print"},{"value":"1943-3670","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,8,13]]},"assertion":[{"value":"2018-01-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-03-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-08-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}