Category: Study

For root coverage, the subepithelial connective tissue graft (SCTG) has long been regarded as the gold standard for Miller Class I–II recession, with significant root coverage and keratinized tissue gain.¹ However, newer evidence supports the Chao Pinhole^® Surgical Technique (PST) as a minimally invasive alternative that can be integrated before or in close coordination with orthodontic care.

Key Evidence

• Long-term outcomes (14.5 years). A retrospective follow-up of the original PST cohort (28 patients; 68 Class I–II sites) reported complete root coverage of 77.9% and mean root coverage of 86.6%, concluding PST shows “long-term predictability and effectiveness.”²
• Randomized clinical trial (12 months). In a split-mouth RCT (36 subjects), PST + collagen membrane and CAF + CTG achieved statistically similar outcomes at 1 year: mean recession reduction 1.97–1.98 mm (P=0.53) and mean percent root coverage 63.6–65.4% (P=0.72). Authors concluded both methods can successfully treat recession with no significant difference in efficacy.³

When Orthodontics Is Also Planned

In patients at risk (e.g., thin phenotype) or already presenting recession, literature on timing indicates that soft-tissue augmentation/management before or alongside orthodontics may help reduce recession progression, though high-level evidence on exact timing remains limited.^4–5 A periodontal-orthodontic RCT in periodontitis-susceptible patients also supports simultaneous ortho during periodontal therapy without compromising clinical outcomes.⁶

Our Coordinated Protocol (Concise)

Step 1: Place a passive retainer/inactive aligner to hold occlusion and minimize traumatic forces.
Step 2: Perform PST for recession/soft-tissue stabilization (no graft harvest, no sutures).
Step 3: After a brief healing window (~3–4 months), reactivate orthodontic movement.

Why Consider PST with Ortho?

• No palatal donor site or sutures; rapid recovery and aesthetics.
• Designed to stabilize soft tissues prior to re-applying orthodontic forces.
• Clinical outcomes comparable to SCTG at 12 months (in RCT), with long-term case-series support.

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References

1. Chambrone L, Chambrone D, Pustiglioni FE, Chambrone LA, Lima LA. Can subepithelial connective tissue grafts be considered the gold standard procedure in the treatment of Miller Class I and II recession-type defects? J Dent. 2008;36(9):659-671. Conclusion: SCTG provided significant root coverage, attachment and KT gain; “consider it as the ‘gold standard’.” PubMed, DOI.
2. Chao J, Reyes Rosales E, El Chaar E, Shibly O, Al-Sabbagh M, Ma LW. Long-term Retrospective Case Series of the Pinhole Surgical Technique. Int J Periodontics Restorative Dent. 2025 Jan 14:1-16. Online ahead of print. Abstract: CRC 77.9%; mean root coverage 86.6%; PST shows long-term predictability over 14.5 years. PubMed, DOI.
3. Shibly O, Chao JC, Albandar JM, Almehmadi N, Al-Sabbagh M. Treatment of Gingival Recession Using the Pinhole Surgical Technique with Collagen Membrane vs Coronally Advanced Flap with Connective Tissue Graft: A Split-Mouth Randomized Clinical Trial. Compend Contin Educ Dent. 2025;46(1):35-41. Abstract: No significant differences at 12 months for recession reduction (1.98 vs 1.97 mm; P=0.53) or % root coverage (65.4% vs 63.6%; P=0.72). PubMed.
4. Kloukos D, Gkantidis N, Katsaros C, Eliades T. Indication and timing of soft tissue augmentation at maxillary and mandibular incisors in orthodontic patients: a systematic review. Eur J Orthod. 2014;36(4):442-449. Abstract: Limited evidence; studies implementing soft-tissue intervention before orthodontics “may yield satisfactory results,” but RCTs are needed. PubMed, DOI.
5. Chen J, et al. Efficacy of periodontal soft tissue augmentation prior to orthodontic treatment on preventing gingival recession: study protocol for a randomized controlled trial. BMJ Open. 2022;12:e058942. Intro cites prior review suggesting prophylactic augmentation may limit recession progression; high-quality trials are underway. BMJ Open.
6. Zasčiurinskienė E, Basevičienė N, Lindsten R, Slotte C, Jansson H, Bjerklin K. Orthodontic treatment simultaneous to or after periodontal cause-related treatment in periodontitis-susceptible patients. Part I: Clinical outcome. A randomized clinical trial. J Clin Periodontol. 2018;45(2):213-224. Conclusion: Simultaneous orthodontic treatment during periodontal therapy can be used in routine care of plaque-induced periodontitis patients. PubMed, DOI.

Introduction

Gingival recession is a common oral health issue that can lead to root exposure, increased sensitivity, and aesthetic concerns. Traditional treatment methods, such as free connective tissue grafting, have been effective but often come with higher morbidity, longer recovery times, and secondary surgical sites.

The Pinhole Surgical Technique (PST), developed by Dr. John Chao, has emerged as a minimally invasive alternative to traditional grafting. This blog explores the long-term efficacy of PST through an in-depth look at a 33-month case study and an extended 14.5-year follow-up.

The 33-Month Case Study: Evaluating PST’s Predictability and Effectiveness

Study Overview

A retrospective study was conducted on 43 patients with 121 gingival recession sites to assess the feasibility and success of PST. Of these, 85 were Class I or II defects, and 36 were Class III defects.

Key Findings

• Complete Root Coverage (CRC) for Class I and II sites: 81.2%.
• Mean defect reduction for Class I and II sites: 94.0% ± 14.8%.
• Mean defect reduction across all sites (Class I, II, and III): 88.4% ± 19.8%.
• No secondary graft site was needed, as the procedure relied on bioresorbable membranes or acellular dermal matrix.
• Minimal post-operative complications with rapid healing.
• Mean procedure duration: 22.3 ± 10.1 minutes.
• Patient aesthetic satisfaction: 95.1% realized within 7.34 ± 13.5 days.

These results demonstrated that PST is an effective, predictable, and minimally invasive alternative to traditional grafting techniques for root coverage and gingival recession treatment.

The 14.5-Year Follow-Up: Assessing PST’s Long-Term Stability

Study Overview

Following the original case series, a long-term retrospective assessment was conducted on 28 patients with 68 Miller Class I-II sites from the original study. The goal was to evaluate the stability and effectiveness of PST over 14.5 years.

Key Findings

• Complete Root Coverage (CRC) for Class I-II sites: 77.9% (compared to 81.2% in the initial study).
• Mean root defect coverage: 86.6% ± 27.4% (compared to 94.0% ± 14.8% in the original study).
• Long-term stability of PST with minimal recession relapse.
• Patients retained functional and aesthetic improvements over the study period.

These findings confirm that PST remains an effective and long-lasting solution for gingival recession treatment. Although there was a slight decrease in CRC and defect coverage over time, the results remained highly favorable, with stable gum positioning and sustained root coverage for most patients.

Why PST Is a Game-Changer in Gum Recession Treatment

Advantages of PST Over Traditional Grafting

• Minimally invasive: No need for scalpel incisions or sutures.
• Faster healing times: Patients recover within 24 to 48 hours.
• No secondary grafting site required: Reduces discomfort and risk of complications.
• High predictability and success rates: Over 77% CRC after 14.5 years.
• Aesthetic and functional improvements: Enhances smile appearance and protects tooth roots from further exposure.

What This Means for Patients

Patients suffering from gingival recession can trust PST as a proven long-term solution. The high success rate, minimal invasiveness, and rapid recovery time make it a preferred alternative to traditional gum grafting.

What This Means for Dental Professionals

Dentists looking to enhance their periodontal practice should consider incorporating PST as a predictable and effective technique for treating gingival recession. The long-term stability of PST ensures that patients receive lasting benefits with fewer complications.

Conclusion

The 14.5-year follow-up case study of the Pinhole Surgical Technique (PST) confirms that it is a viable, long-term solution for treating gingival recession. With sustained root coverage, high patient satisfaction, and minimal post-operative complications, PST has redefined modern periodontal therapy.

For patients seeking an innovative, minimally invasive treatment for receding gums, PST remains a cutting-edge option backed by over a decade of clinical success. For dental professionals, offering PST can elevate patient outcomes and practice growth.

Interested in learning more? Contact a certified Pinhole provider today to explore how PST can transform gum recession treatment for you or your patients.

Introduction

Gum recession is a common dental concern affecting millions of people worldwide. When the gums pull away from the teeth, it exposes the root surface, leading to increased sensitivity, aesthetic concerns, and a higher risk of decay. Traditional treatments for gum recession involve invasive grafting techniques that require harvesting tissue from the patient’s palate. However, the Pinhole Surgical Technique (PST) has revolutionized soft-tissue grafting by offering a minimally invasive approach to reposition the gums.

Now, the integration of Platelet-Rich Fibrin (PRF) into PST is setting a new standard in periodontal therapy. This advanced combination enhances healing, promotes tissue regeneration, and improves the overall success of gum recession treatments.

Understanding the Pinhole Surgical Technique (PST)

What is PST?

The Pinhole Surgical Technique (PST) is a groundbreaking, scalpel-free procedure designed to reposition receded gum tissue without traditional grafting. Instead of making incisions or sutures, a small pinhole is created in the gum tissue, and specialized instruments are used to loosen and reposition the gums over the exposed root surfaces.

Benefits of PST

• Minimally invasive: No need for cutting or sutures.
• Faster healing: Patients recover within 24 to 48 hours.
• Less discomfort: Minimal post-operative pain compared to traditional grafting.
• Immediate aesthetic improvement: Patients see noticeable results right after the procedure.
• Long-lasting results: Clinical studies have shown stable outcomes in multiple-year follow-ups.

The Role of Platelet-Rich Fibrin (PRF) in Periodontal Therapy

What is PRF?

Platelet-Rich Fibrin (PRF) is an autologous biomaterial derived from the patient’s own blood. It contains a high concentration of growth factors and cytokines, which accelerate wound healing and tissue regeneration.

How PRF Enhances Healing

• Stimulates collagen production for thicker, healthier gums.
• Promotes angiogenesis (new blood vessel formation), improving gum tissue vitality.
• Reduces inflammation and infection risk, leading to faster recovery.
• Supports tissue regeneration, making it an ideal supplement to PST.

Combining PRF with PST: A Game-Changer for Soft-Tissue Grafting

By incorporating PRF into the Pinhole Surgical Technique, dental professionals can optimize patient outcomes. PRF acts as a natural scaffold that enhances the healing process while stabilizing the gum tissue in its new position.

Advantages of PST + PRF Combination

• Superior root coverage compared to PST alone.
• Increased gingival thickness for improved long-term results.
• Reduced post-operative pain due to PRF’s anti-inflammatory properties.
• Improved patient comfort and satisfaction.

Scientific Evidence Supporting PST + PRF

Clinical Success Stories

Studies have shown that combining PRF with PST significantly enhances clinical outcomes. Key findings include:

• Higher success rates in achieving complete root coverage.
• Better long-term stability of the repositioned gum tissue.
• Greater patient satisfaction compared to PST alone.
• Reduced post-operative pain and faster healing times.

One clinical trial comparing PST alone vs. PST + PRF found that the PRF group experienced higher keratinized tissue gain and more stable recession coverage over a two-year follow-up period.

Why Dentists Should Adopt PST + PRF

The combination of Pinhole Surgical Technique and Platelet-Rich Fibrin is a breakthrough in modern periodontal care. This technique is ideal for patients with multiple sites of gingival recession who seek a minimally invasive yet highly effective solution. For dental professionals, incorporating PST + PRF into their practice offers:

• Enhanced clinical outcomes with minimal surgical intervention.
• Increased patient acceptance due to the procedure’s comfort and efficiency.
• Faster recovery times, making it a preferred option over traditional grafting.

Conclusion

The integration of Platelet-Rich Fibrin (PRF) with the Pinhole Surgical Technique (PST) represents a significant advancement in periodontal therapy. This innovative, minimally invasive approach offers faster healing, superior root coverage, and improved long-term stability compared to traditional soft-tissue grafting.

For patients struggling with gum recession, PST + PRF provides a cutting-edge solution that enhances both aesthetics and oral health. For dental professionals, embracing this technique means delivering the highest standard of care while staying ahead in modern dentistry.

Introduction

Gingival recession is a prevalent issue among dental patients, leading to root exposure, sensitivity, and potential periodontal complications. As dental professionals, selecting the most effective and patient-friendly surgical technique is essential. This blog reviews a recent split-mouth randomized clinical trial comparing two leading techniques: Coronally Advanced Flap with Connective Tissue Graft (CAF + CTG) and the Pinhole Surgical Technique with Collagen Membrane (PST + CM).

Clinical Study Overview

A total of 36 patients with bilateral gingival recession defects were treated with both techniques in a controlled clinical study. The study assessed clinical outcomes and patient-centered factors over a one-year follow-up period.

Key Clinical Findings

• Recession Reduction:
  • CAF + CTG: 1.98 mm ± 0.74 mm
  • PST + CM: 1.97 mm ± 1 mm (P = .53)
  • No significant difference in recession reduction.
• Root Coverage:
  • CAF + CTG: 65.4% ± 24.6%
  • PST + CM: 63.6% ± 24.5% (P = .72)
  • Both methods provided comparable results.
• Clinical Attachment Level Gain:
  • Both techniques demonstrated significant attachment gain (P = .9).
• Keratinized Tissue Width (KTW) Increase:
  • CAF + CTG: Increased from 2.38 mm to 2.61 mm (P = .002)
  • PST + CM: No significant change.
• Postoperative Pain and Patient Satisfaction:
  • No statistically significant differences between the two techniques.

Clinical Implications for Periodontists and General Dentists

This study reinforces that both PST + CM and CAF + CTG are effective in treating gingival recession. While CAF + CTG remains the gold standard for increasing keratinized tissue width, PST + CM offers a viable, less invasive alternative with similar root coverage success. The choice of technique should be based on patient needs, anatomical considerations, and the clinician’s experience.

Conclusion

Both surgical approaches provide successful treatment outcomes for gingival recession defects. PST + CM stands out for its minimally invasive nature and reduced morbidity, making it a strong alternative for select cases.

FAQs for Dental Professionals

1. How does PST + CM reduce postoperative discomfort? PST + CM avoids the need for a donor site and sutures, leading to a faster, less painful recovery process.

2. When should a dentist opt for PST + CM instead of CAF + CTG? PST + CM is ideal for patients who prefer a minimally invasive procedure and do not require significant keratinized tissue width gain.

3. What follow-up care is required after these procedures? Both techniques require meticulous oral hygiene, regular professional cleanings, and monitoring for tissue stability over time.

Introduction

Gingival recession is a common dental concern that can lead to root exposure, sensitivity, and aesthetic concerns. The Pinhole Surgical Technique (PST) has emerged as a minimally invasive solution, offering significant advantages over traditional grafting methods. A recent 14.5-year retrospective study confirms its long-term effectiveness in maintaining root coverage.

What is the Pinhole Surgical Technique (PST)?

PST is a minimally invasive procedure that involves creating small pinhole-sized entry points in the gum tissue, allowing for repositioning without the need for sutures or traditional grafting techniques. The process promotes natural healing and reduces recovery time.

Key Findings from the Study

A long-term retrospective study analyzed 28 patients with 68 Miller Class I-II gingival recession sites over an average period of 14.5 years. The study found:

• Sustained Root Coverage: The percentage of complete root coverage (CRC) was 77.9% in the follow-up study compared to 81.2% in the original study.
• High Effectiveness: Mean root defect coverage was 86.6%, confirming the long-term success of PST.
• Increased Keratinized Tissue (KT): KT gain improved significantly from 2.4 mm in the original study to 4.3 mm in the follow-up study.
• Minimal Probing Depth (PD) Reduction: PD decreased by 0.8 mm, indicating stable periodontal health post-treatment.

Comparison with Other Techniques

Compared to traditional methods like the connective tissue graft (CTG) and coronally advanced flap (CAF), PST offers similar or superior long-term results. Previous studies have shown CTG achieving CRC in 82% of cases over an 11-year period, while PST demonstrated 77.9% CRC over 14.5 years.

Advantages of PST Over Traditional Techniques

• Minimally Invasive: No need for cutting or suturing.
• Faster Healing: Patients experience less post-operative discomfort.
• Predictable Results: High rates of complete root coverage.
• Improved Aesthetics: Natural gum contour restoration.

Patient Testimonials & Clinical Evidence

Patients who underwent PST have reported long-term satisfaction with the procedure. Clinical images from the study show stable gum health 17 years post-treatment, reinforcing the predictability of PST.

Conclusion

The 14.5-year retrospective study confirms that the Pinhole Surgical Technique is a highly effective, minimally invasive solution for treating gingival recession. Its ability to maintain long-term root coverage makes it a preferred choice among periodontists and general dentists alike.

FAQs

1. Is the Pinhole Surgical Technique painful? No, PST is performed under local anesthesia and is minimally invasive, leading to minimal discomfort.

2. How long does it take to recover from PST? Most patients experience full recovery within a few days, with little to no downtime.

3. How long do the results of PST last? As shown in the study, PST provides long-term root coverage, with results lasting over 14 years.

4. Is PST covered by dental insurance? Coverage varies by provider. It’s best to consult with your dental insurance company regarding reimbursement for PST.