Explore Publications on the Pinhole® Surgical Technique

Long-term Retrospective Case Series of the Pinhole Surgical Technique

Author(s): John Chao, Elio Reyes Rosales, Edgard El Chaar, Othman Shibly, Mohanad Al-Sabbagh, Le Wen Ma

Published On: January 14, 2025

Published In: International Journal of Periodontics & Restorative Dentistry

Key Highlights:

• This long-term retrospective case series provides follow-up data on the Pinhole Surgical Technique (PST) for 28 patients with 68 Miller Class I-II sites.
• The average follow-up period for this study was 14.5 years, with a total of 173.8 ± 32.2 months.
• In the follow-up study, the percentage of complete root coverage (CRC) was 77.9%, and the mean root defect coverage was 86.6%, indicating long-term predictability and effectiveness of PST.
• These findings support the sustainability of root coverage achieved through PST over an extended period.

A Novel Approach to Root Coverage: The Pinhole Surgical Technique

Author(s): John C. Chao, DDS

Published On: 2012

Published In: The International Journal of Periodontics & Restorative Dentistry

Key Highlights:

• This study examines the feasibility of the Pinhole Surgical Technique (PST) for root coverage, showing an 81.2% success rate for Class I and II sites.
• PST achieved a mean defect reduction of 94.0%, with minimal postoperative complications and no need for secondary surgical sites.
• The procedure is minimally invasive, with a mean surgery time of 22.3 minutes per site, and offers excellent patient satisfaction (95.1%).
• PST is shown to be a predictable, effective, and time- and cost-efficient alternative to traditional methods like free connective tissue grafting (FCTG).
• The study also reports a significant reduction in recession depth, clinical attachment level gain, and keratinized gingiva gain.

Treatment of Gingival Recession Using the Pinhole Surgical Technique With Collagen Membrane vs Coronally Advanced Flap Technique With Connective Tissue Graft: A Split-Mouth Randomized Clinical Trial

Author(s): Othman Shibly, DDS, MS; John C. Chao, DDS; Jasim M. Albandar, DMD, PhD; Nehal Almehmadi, BDS, MS; Mohanad Al-Sabbagh, DDS, MS

Published On: January 01, 2025

Published In: Compendium, Volume 46, Issue 1

Key Highlights:

• This study compared the treatment of gingival recession defects using two techniques: the Coronally Advanced Flap (CAF) with Connective Tissue Graft (CTG) and the Pinhole Surgical Technique (PST) with Collagen Membrane (CM).
• The investigation was a randomized, split-mouth clinical trial involving 36 subjects with bilateral gingival recession defects.
• At the 1-year follow-up, both groups showed significant reduction in recession depth, with similar outcomes in root coverage (PST + CM: 63.6% vs CAF + CTG: 65.4%) and recession reduction (PST + CM: 1.97 mm vs CAF + CTG: 1.98 mm).
• Both treatments resulted in a significant gain in clinical attachment levels, and both showed improvements in the width of keratinized tissue, though the CAF + CTG group had a more significant increase.
• There were no significant differences between the groups in postoperative pain or patient satisfaction.

Clinical Trial of the Efficacy of Pinhole Surgical Technique Compared to Connective Tissue Graft in Treatment of Gingival Recession

Author(s): Othman Shibly DDS, MS; John Chao DDS, MAGD

Published On: January 2, 2020

Published In: University at Buffalo, Periodontics Department

Key Highlights:

• This clinical trial aims to compare the efficacy of Pinhole Surgical Technique (PST) with Connective Tissue Graft (CTG) in treating Miller Class I and II gingival recession defects.
• The study uses a randomized, split-mouth, double-blinded clinical trial design involving 52 subjects.
• Primary endpoints include complete root coverage, pain index, and healing index, while secondary endpoints include clinical attachment level, probing depth, and gingival thickness.
• Subjects will receive treatments with either PST or CTG, with follow-up evaluations at 6 weeks, 3, 6, 12, 18, and 24 months post-treatment.
• The research protocol emphasizes maintaining subject privacy, data security, and compliance with HIPAA guidelines.

Treatment of 27 Class III Gingival Recession Sites: A 35-month Case Study

Author(s): John Chao, DDS, MAGD; Othman Shibly, DDS, MS; Vincent Tso, DMD, FACP; Lewen Ma, BS

Published On: 2024

Published In: Journal of Cosmetic Dentistry

Key Highlights:

• This case study explores the combination of the Pinhole Surgical Technique (PST) and Surgical Crown Shortening (SCS) in treating 27 Class III gingival recession sites over a 35-month period.
• The study highlights the success of achieving complete root coverage (CRC) for maxillary teeth and near-CRC for mandibular incisors, offering both immediate and long-term esthetic results.
• Clinical results include significant reductions in recession depth (RD), probing depth (PD), clinical attachment level (CAL) gain, and keratinized tissue (KT) width.
• The combined use of PST and SCS, performed simultaneously, allows for rapid and effective restoration of both functional and esthetic gingival health.

Pinhole Surgical Technique with Platelet-Rich Fibrin to Enhance Soft-Tissue Grafting

Author(s): Scott Froum, DDS; John C. Chao, DDS, MAGD

Published On: February 3, 2025

Published In: Perio-Implant Advisory

Key Highlights:

• The combination of Pinhole Surgical Technique (PST) with platelet-rich fibrin (PRF) significantly enhances outcomes in treating gingival recession by improving soft-tissue healing and root coverage.
• PRF, derived from the patient’s blood, acts as a natural scaffold to accelerate tissue repair, reduce inflammation, and improve attachment of gingival tissues.
• Studies show PST with PRF offers better results than PST alone, including greater keratinized tissue width and recession coverage.
• PRF has demonstrated the ability to reduce postoperative pain and enhance long-term esthetic and clinical outcomes compared to other biomaterials.
• Patients experience reduced discomfort and higher satisfaction with root-coverage esthetics when PST is combined with PRF.

Pinhole Gum Surgery: Treatment for Gum Recession

Author(s): Medically Reviewed By Colgate Global Scientific Communications

Published On: February 13, 2023

Published In: Colgate Website

Key Highlights:

Pinhole gum surgery is a minimally invasive procedure for treating gum recession. It has shown a 96.7% success rate in root coverage and a 95% satisfaction rate in aesthetic outcomes, according to the Journal of Indian Society of Periodontology.

Assessment of alveolar bone changes in response to minimally invasive periodontal surgery: A cone-beam computed tomographic evaluation

Author(s): Solaleh Shahmirzadi, Taraneh Maghsoodi-Zahedi, Sarang Saadat, Husniye Demirturk Kocasarac, Mehrnoosh Rezvan, Rujuta A. Katkar

Published On: November 30, 2022

Published In: Imaging Sci Dent. 2023 Mar;53(1):1-9. English.

Key Highlights:

This study evaluates 3D CBCT images of alveolar bone changes in patients who underwent Pinhole Surgical Technique (PST) for gum recession. The results show an average bone gain of >0.5 mm following PST.

Pinhole Surgical Technique: A 10-year evaluation of root coverage

Author(s): Dr. Scott Froum

Published On: May 18, 2022

Published In: Dental Economics

Key Highlights:

This study evaluates the Pinhole Surgical Technique (PST) over a decade, focusing on its effectiveness in treating gingival recession. It highlights significant reductions in recession, with 81% complete root coverage in class I and II defects.

Treatment of gingival recession defects using non-invasive pinhole technique with propolis application, a case report

Author(s): Diana Mostafa, Obada Amer Mandil

Published On: June 2021

Published In: International Journal of Surgery Case Reports

Key Highlights:

This case report describes the use of the Pinhole Surgical Technique (PST) combined with propolis for root conditioning in treating gingival recession defects. The procedure showed positive outcomes, including enhanced healing and minimized postoperative complications.

Comparative evaluation of the efficacy of Collagen membrane and PRF membrane in a non-invasive approach to root coverage using Pinhole Surgical Technique- A case report

Author(s): Sourav Boro Choudhury, Sachit Anand Arora, Rupali Kalsi, Kumar Saurav Singh, Lukram slim

Published On: April 2021

Published In: International Journal of Scientific and Research Publications

Key Highlights:

This case report compares the efficacy of collagen membrane and PRF membrane used in conjunction with the Pinhole Surgical Technique (PST) for treating Miller’s Class I gingival recession. Both methods showed positive results in root coverage and gingival regeneration.

The Pinhole Technique in the Treatment of Gingival Recession Defects

Author(s): Mostafa Diana, Al Shateb Safa, Thobaiti Bashayer, Alotaibi Bariah, Al Rabeea Sukania, Aldossry Sarah

Published On: August 17, 2020

Published In: Advances in Dentistry & Oral Health, Volume 13, Issue 1

Key Highlights:

This study evaluates the Pinhole Surgical Technique (PST) for treating gingival recession, demonstrating its effectiveness as a minimally invasive procedure that achieves high esthetic results with no need for donor sites or graft exposure. The review highlights the technique’s success in treating multiple recession defects in a single appointment.

Pinhole Surgical Approach in the Treatment Modality of Gingival Recession: A Case Report

Author(s): Anjali Gaba, Jaishree Garg, Manvi C Agarwal, Sunil Upadhyay

Published On: January 2020

Published In: Journal of Dental Sciences and Oral Rehabilitation

Key Highlights:

This case report explores the effectiveness of the Pinhole Surgical Technique (PST) in treating gingival recession defects, highlighting its minimally invasive nature, reduced patient discomfort, and excellent esthetic results with no need for donor tissue or sutures.

A Team Effort, Part 1: Noninvasive Soft Tissue Advancement in Conjunction with Aesthetic Dentistry

Author: John K. Zalesky

Published On: November 22, 2018

Published In: A Closer Look, Fall 2018

Key Highlights:

This article introduces the Pinhole Surgical Technique (PST) as a noninvasive approach to treat gingival recession. It discusses the causes of gingival recession and compares traditional methods, such as free gingival grafts, to the PST, highlighting its advantages including minimal discomfort, no need for grafts, and minimal post-operative pain.

The Pinhole Surgical Technique: A Clinical Perspective and Treatment Considerations From a Periodontist

Author: Tina M. Beck

Published On: March 7, 2023

Published In: Journal of the California Dental Association

Key Highlights:

This article provides an in-depth review of the Pinhole Surgical Technique (PST) for treating gingival recession. It highlights the benefits and limitations of PST, comparing it to traditional grafting methods like subepithelial connective tissue grafting. The article also discusses patient selection, surgical procedure, post-operative care, and long-term considerations for PST.

Re-invigoration of Pink Esthetics by a Novel Minimally Invasive Technique: A Report of Two Cases

Authors: Himani Sharma, Divya Dureja, Ritika Arora

Published On: October-December 2019

Published In: Contemporary Clinical Dentistry, Vol. 10, Issue 4, pp. 668-671

Key Highlights:

• The Pinhole Surgical Technique (PST) provides a minimally invasive approach to treating Miller's Class I and II gingival recession.
• Patients experienced complete root coverage with minimal postoperative discomfort and no need for sutures or grafting.
• The study emphasizes the advantages of PST in terms of patient comfort and esthetics, particularly for localized recession defects.
• Further studies with longer follow-up periods are needed to assess the technique's long-term stability.

Pinhole Surgical Technique for Treatment of Marginal Tissue Recession

Authors: Reddy, Saravanan Sampoornam Pape

Published On: November–December 2017

Published In: Journal of Indian Society of Periodontology, Vol. 21, Issue 6, pp. 507-511

Key Highlights:

• The Pinhole Surgical Technique (PST) offers a minimally invasive approach to manage Miller's Class I and II marginal tissue recession.
• In a case series of 18 recession sites, PST achieved 96.7% mean root coverage with minimal postoperative complications.
• The technique eliminates the need for donor tissue, sutures, and reduces postoperative swelling, pain, and bleeding.
• Patients experienced immediate esthetic improvements, with results showing minimal discomfort and a rapid healing process.
• Further studies are required to evaluate the long-term effects and the biological mechanisms behind the technique.

Feasibilities of the Pinhole Surgical Technique: Mini Review

Author: Saad Al-Almaie

Published On: April 07, 2017

Published In: Advances in Dentistry & Oral Health, Vol. 4, Issue 3, Article ID: ADOH.MS.ID.555638

Key Highlights:

• The Pinhole Surgical Technique (PST) is a minimally invasive approach to treating gum recession, offering a less painful and faster recovery alternative to traditional grafting methods.
• The technique involves creating a small hole in the gum tissue to reposition it, without the need for scalpels, sutures, or donor tissue.
• Studies show PST can achieve up to 94% defect reduction with minimal post-operative complications.
• PST offers long-lasting, natural-looking results with significant benefits in terms of patient comfort, recovery time, and esthetics.
• Further long-term research is necessary to assess the stability and effectiveness of PST for managing single or multiple recession defects.

Pinhole Surgical Technique in Historical Perspective

Authors: John Chao, D.D.S., J.D., M.A.G.D. & Dennis Shanelec, D.D.S.

Published On: September 2014

Published In: Il Dentista Moderno

Key Highlights:

• The Pinhole Surgical Technique (PST) is a scalpel-free, suture-free approach to treating root recession, developed as a minimally invasive option for periodontal surgery.
• Originating from the principles of microsurgery introduced by Shanelec and Tibbetts, PST revolutionized gum recession treatment with less postoperative discomfort and faster recovery times.
• The technique has been shown to achieve high levels of root coverage (81.2% in Class I and II cases), comparable to the gold standard free connective tissue grafting (FCTG) procedure.
• PST also offers significant advantages over traditional methods by eliminating the need for donor tissue, reducing patient morbidity, and providing predictable, long-lasting esthetic results.
• Further studies have reinforced PST’s effectiveness in reducing recession, gaining keratinized tissue, and improving clinical attachment levels, while also minimizing postoperative pain and complications.

Comparative evaluation of pinhole surgical technique with and without A-PRF in the treatment of multiple adjacent recession defects: A clinico radiographic study

Author(s): Divya S. Trivedi BDS, Abhay P. Kolte MDS, Rajashri A. Kolte MDS, Neha M. Deshpande MDS

Published On: July 19, 2023

Published In: The Journal of Esthetic and Restorative Dentistry, Volume 36, Issue 2, Pages 324-334

Key Highlights:

• The study compares the effectiveness of the Pinhole Surgical Technique (PST) alone versus PST combined with Advanced Platelet Rich Fibrin (A-PRF) in the treatment of multiple adjacent gingival recession defects (MAGRD).
• 165 MAGRD sites were randomly assigned to the control group (treated with PST) and the test group (PST with A-PRF).
• Both groups showed significant improvements in clinical parameters such as Gingival Recession Depth (GRD), Gingival Recession Width (GRW), and Gingival Thickness (GT), with the test group showing better results.
• The test group exhibited a greater reduction in GRD and GRW, along with better outcomes in Keratinized Tissue Width (KTW) and GT compared to the control group.
• Patient satisfaction and root coverage aesthetic scores were recorded, showing better results in the test group, which included A-PRF.

The Pinhole Surgical Technique - A Distinct Approach for a Marginal Tissue Recession Coverage Using Amniotic Membrane

Authors: Patel, Chandni; Solanki, Vanraj; Dattani, Vidhi; Gajjar, Shreya; Girdhar, Gaurav; Joshi, Surabhi; Kumar, Santosh

Published On: Jul–Sep 2024

Published In: Advances in Human Biology

Key Highlights:

• Pinhole Surgical Technique (PST) combined with amniotic membrane was used to treat Miller's Class I and II gingival recession defects.
• Clinical parameters such as recession depth (RD), recession width (RW), and clinical attachment level (CAL) showed significant improvement after 12 months.
• The use of amniotic membrane, a self-adhesive soft-tissue allograft, aided in wound healing and enhanced the surgical procedure.
• PST is considered less invasive, time-efficient, and cost-effective compared to other methods, with no need for donor tissue harvesting.
• The study observed minimal postoperative pain and shorter recovery times for patients treated with PST and amniotic membrane.

Pinhole Surgical Technique – A Novel Minimally Invasive Approach for Treatment of Multiple Gingival Recession Defects: A Case Series

Author(s): Agarwal, Manvi Chandra; Kumar, Geetika; Manjunath, R. G. Shiva; Karthikeyan, S. S. Sai; Gummaluri, Shiva Shankar

Published In: Contemporary Clinical Dentistry, 11(1):97-100, Jan–Mar 2020

DOI: 10.4103/ccd.ccd_449_19

Key Highlights:

• The study explores the effectiveness of the Pinhole Surgical Technique (PST) as a minimally invasive treatment for Miller's Class I and II gingival recession defects.
• Ten patients (20 sites) with recession defects in the esthetic zone were treated using PST along with titanium-prepared platelet-rich fibrin (T-PRF) membrane.
• Results showed a statistically significant reduction in recession depth and width, with an 87% root coverage rate at the 6-month follow-up.
• Patients showed high satisfaction (VAS score of 3.4 ± 0.84) with minimal postoperative discomfort, including bleeding, swelling, and pain.
• The technique offers advantages like no second surgical site, no vertical incisions, minimal tissue manipulation, and faster recovery compared to traditional methods.