title: Tunnel technique with a surgical maneuver to increase the graft extension: case report with a 3-year follow-up.
abstract: BACKGROUND
  This article reports a clinical case with a 3-year follow-up in which a subepithelial connective tissue graft (SCTG) was used with the tunnel technique to treat multiple gingival recessions, and describes a technique used to enlarge the extension of the graft.
  
  
  METHODS
  A 41-year-old female patient was referred for evaluation and treatment of maxillary multiple recessions. Following basic therapy, the plaque index was 23%, and the gingival index was 12%. Thus, SCTG with the tunnel technique was proposed to provide root coverage of Miller Class I recession on teeth #8 through #11 and a Miller Class III recession on tooth #12. After the donor area had been prepared, SCTG was removed and split cross-sectionally to lengthen it. The graft was placed through the tunnel and sutured.
  
  
  RESULTS
  Two weeks after the surgical procedure, the tissue color was nearly homogeneous with some reddish regions where the connective tissue was left uncovered, and there were no signs of incisions or suture marks. After 3 years of follow-up, the mean coverage of the recessions was 2.2 +/- 0.7 mm (74.2%), which corresponded to the gain of keratinized tissue. In addition, a gain in tissue thickness was observed.
  
  
  CONCLUSIONS
  In a long-term evaluation, the tunnel technique with the elongated SCTG was used successfully for treatment of multiple gingival recessions with an increase of the soft tissue volume and gain of keratinized tissue.
authors.affiliation: School of Dentistry, Integrated Faculties of Santa Fé do Sul, Santa Fé do Sul, SP, Brazil. fernandosalimon@yahoo.com.br
authors.forename: Fernando S
authors.initials: FS
authors.lastname: Ribeiro
authors.forename: Daniela L
authors.initials: DL
authors.lastname: Zandim
authors.forename: Ana Emília F
authors.initials: AE
authors.lastname: Pontes
authors.forename: Rafael V
authors.initials: RV
authors.lastname: Mantovani
authors.forename: José Eduardo C
authors.initials: JE
authors.lastname: Sampaio
authors.forename: Elcio
authors.initials: E
authors.lastname: Marcantonio
mesh_terms: D000328:Adult; D003238:Connective Tissue / Q000637:transplantation; D005260:Female; D005500:Follow-Up Studies; D005881:Gingiva / Q000473:pathology / Q000637:transplantation*; D005889:Gingival Recession / Q000145:classification / Q000601:surgery*; D006801:Humans; D020858:Tissue and Organ Harvesting / Q000379:methods; D014092:Tooth Root / Q000601:surgery; D014945:Wound Healing / Q000502:physiology