Bone regeneration using the pouch-and-tunnel technique

Several surgical techniques, such as the papilla preservation flap, the modified papilla preservation flap, and the sulcular incision flap, have attempted to achieve clot stabilization and graft coverage in an attempt to regenerate lost tissue due to periodontal disease. This case report focuses on soft tissue root coverage and bone regeneration in a one-wall osseous defect using the pouch-and-tunnel surgical procedure. The pouch-and-tunnel surgical technique is a minimally invasive periodontal plastic surgical procedure that uses subepithelial connective tissue as a free graft in a pouch beneath the gingival margin, created by sulcular incisions around the involved teeth. The autogenous bone graft placed in this one-wall osseous defect through a sulcular incision after root planing is protected in a stable pouch-like recipient site with an abundant blood supply. The free connective tissue graft also prevents epithelial migration into the recipient site. The use of Emdogain may help with cementogenesis around the planed root surface. This technique warrants further evaluation of cases with similar defects using this surgical procedure. (Int J Periodontics Restorative Dent 2009;29:515-521.).