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The Tunneled Coronally Advanced Flap (TCAF) for Root Coverage Procedures: Rationale, Indications, and a Novel

Lorenzo Tavelli^1,2,3,4, Shayan Barootchi^1,2,4

¹Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA.

Journal of Periodontal Research

|July 4, 2026

Summary

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This report explains the clinical reasoning for tissue-selective cavernous artery flow (TCAF) and presents a new decision tree for choosing between open or tunnel surgical strategies for papilla preservation.

Area of Science:

Periodontology
Oral Surgery

Background:

The management of interdental papilla defects requires precise surgical strategies.
Selecting the optimal approach for papilla regeneration is crucial for successful periodontal therapy.

Purpose of the Study:

To outline the clinical rationale behind tissue-selective cavernous artery flow (TCAF).
To introduce a novel papilla-based decision tree for guiding surgical strategy selection.

Main Methods:

The report details the clinical indications and benefits of TCAF.
A decision tree is presented, utilizing papilla morphology as a key determinant.

Main Results:

The TCAF approach offers a rationale for specific clinical scenarios.

Keywords:

TCAF decision tree gingival recession papilla root coverage tunneled coronally advanced flap

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The decision tree effectively categorizes papilla types to guide strategy selection.

Conclusions:

TCAF provides a framework for understanding papilla regeneration.
The papilla-based decision tree aids clinicians in choosing between open and tunnel surgical techniques for optimal patient outcomes.