Mucogingival surgery techniques: Coronally advanced flap versus tunnel approach

BACKGROUND: Mucogingival surgery techniques for treating gingival recessions (GRs) have evolved significantly over decades, reflecting advances in surgical understanding and patient demands. This narrative review tracesexamines the historical development of the coronally advanced flap-multiple coronally advanced flap (CAF/MCAF) and tunnel techniques, highlighting how these procedures have been refined to improve clinical outcomes and esthetic results. Emphasis is placed on the biological principles underlying these approaches and their adaptation based on growing scientific evidence. METHODS: A comprehensive review of the literature was conducted, synthesizing historical milestones and recent clinical studies including randomized controlled trials and systematic reviews. The focus was on comparing the CAF and tunnel approaches in terms of surgical principles, technical variations, and effectiveness in root coverage treatment, considering adjunctive use of grafting materials. RESULTS: Both the CAF/MCAF and tunnel techniques demonstrate high predictability and effectiveness in GR coverage. Their evolution reflects a trend toward minimally invasive surgery, improved vascularization, and tissue stability. Current evidence supports the choice of technique based on defect characteristics, tissue phenotype, and esthetic requirements, with connective tissue grafts (CTGs) and biomaterials enhancing outcomes in many cases. CONCLUSIONS: Both CAF and tunnel techniques provide predictable root coverage, enhanced by CTGs (gold standard) or substitutes (reducing morbidity but with limited evidence). The choice between the two techniques should be guided by recession and tissue phenotype characteristics to optimize functional and esthetic outcomes. PLAIN LANGUAGE SUMMARY: This study highlights the history and development of two key mucogingival surgical techniques, the coronally advanced flap and the tunnel technique, demonstrating that both provide reliable and effective options for treating gingival recessions, enabling successful root coverage outcomes.