Preserving a sufficient blood supply and maintaining wound stability during the healing phase are the most crucial factors for success in root coverage procedures. Selecting the surgical technique and suturing protocol used to achieve these goals is therefore indispensable for predictable treatment outcomes. Tunneling flap procedures have evolved as a technical advancement in periodontal plastic surgery, particularly focusing on improving the vascular supply at the surgical site. Along with the development of newer flap designs for recession coverage, several suturing protocols for flap stability have been described. This paper illustrates the use of a modified suturing method for soft tissue graft stabilization in a coronally advanced tunnel flap procedure for the treatment of isolated gingival recession. It allows precise three-dimensional positioning and tripod stabilization of the graft in the tunnel as an independent step, differing from previously described techniques. A modified tissue-supported vertical mattress suture is then placed for coronal advancement and improved wound adaptation. The present authors have found that the proposed suturing protocol achieves successful integration of graft, maximum root coverage, excellent esthetic results, and limited postoperative morbidity. The suturing technique is described in detail with schematic illustrations and clinical cases, and its advantages and potential limitations are discussed.
