A subepithelial connective tissue graft is the gold standard for localized recession defects due to its predictability in increasing the width of keratinized gingiva and in obtaining root coverage. 4 The drawback of this autogenous graft is the need for a second surgical site for harvesting donor tissue. This procedure increases patient morbidity, prolongs surgical time and could result in postoperative complications. Since the amount of tissue harvested can be limited due to tissue thickness

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... the palate and anatomical limitations, its predictability is less. These shortcomings of SECTG led to the introduction of soft tissue substitutes. Root coverage with soft tissue substitutes has proved an alternative to SECTG owing to its ease of management and material availability. Hence the objective of this systemic review is to evaluate IntroductIon Gingival recession is an esthetically challenging periodontal defect. This leads to dentin sensitivity, esthetic concern, root caries and cervical wear. If untreated, it can compromise the prognosis of the tooth in question. The etiology of gingival recession is multifactorial which includes inflammation, faulty toothbrushing, habits, high frenum attachment, inadequate attached gingiva, occlusal trauma, and lip piercing. In order to meet the esthetic demands of patients, surgical procedures that preserve the integrity of the papilla by TUN have been proposed by Allen. He used the supraperiosteal envelope technique, which comprises partial-thickness dissection at the recipient area without vertical incisions. 1 The SECTG was then inserted into the tunnel, partly exposed over the recessions and sutured in this position. Since the amount of root coverage depends on the size of the graft which survives over the root surface, necrosis of the exposed parts of the SECTG limits the predictability of this original technique. To overcome this problem, it has been suggested to coronally advance the pouch and the tunnel. This modification has been described by Azzi R and Etienne D. 2 It requires a mucoperiosteal dissection beyond the mucogingival junction and under each papilla. The strategy of this technique is that it preserves the continuity of gingival papillae and optimizes lateral blood vessels. It also intimates the contact of the graft with the recipient site. 3 Thereby resulting faster rate of healing with satisfying aesthetic results.