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.
References
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
Installing the app made everything so much easier. No more refreshing the browser, just instant access to the games. Love using bdr777betapk on my phone.
Finally found a platform that actually delivers on its promises. The game variety is insane and the support team is very helpful. Check out pk44plataforma
Quick deposits and even quicker withdrawals. That is all I really care about and they nail it. I am sticking with jilicashslotlogin from now on.
Such a hidden gem. The variety of games is impressive and the loading time is almost zero. Give neu88com a try!
Really impressed with the betting odds on this platform. It feels fair and the updates are instant. I’m sticking with br3355bet46 from now on.
The variety of games here is amazing. I spent hours playing and won a decent amount. Definitely check out phjiliasia77.
The graphics are amazing and the gameplay is so immersive. I hit a nice win yesterday. Go to 777brasino and try your luck.
The graphics on these slots are top notch. It feels much more immersive than other sites I’ve tried. ph20jili is definitely my new favorite spot.
I’ve tried a few sites lately but this one feels the smoothest. The payouts are quick and the interface is very user friendly. Highly recommend checking out phjiliuno if you love slots.
The graphics are stunning and the gameplay is very addictive. I had a blast playing here last night. Definitely check out citrabet777.
Very stable connection and the registration was a breeze. I appreciate how they keep things simple and efficient. Big thumbs up for jili178login.
Such a fun experience! The promotions they offer are actually fair and the registration process was a breeze. I am loving the vibes here. jilibeecasino
The game variety on this site is top notch. I really enjoy the interface and how smooth everything runs on my mobile phone. Highly recommend ph291jili
The game selection is amazing and the bonuses are a huge plus for new players. I am having a blast on brb777games.
I’ve been playing here for a week now and the payouts are actually legit. Really smooth interface and the games load fast. Definitely check out kkjilivip if you want a reliable spot.
The login process is seamless and I never encounter any glitches. Everything just works perfectly on 24jiliparklogin.
The game selection is fantastic and I have had some lucky wins here recently. It is a very entertaining platform. Go for bundaslotlogin.
I hit a decent jackpot here last week and the money hit my account almost instantly. This is where the real action is. Visit ph777richjili
The mobile experience is just top notch. I can play my favorite games anywhere thanks to 7a777app.
Super easy to get started and the login process is a breeze. It is my go-to spot for some quick gaming sessions. Highly recommend jilicologin to everyone.
Really impressed with the customer support here. They helped me sort out my account in minutes. idselayar88 is definitely my new favorite spot for gaming.
Had a lucky streak here last night! The site is stable and the games load instantly. If you want a fun time, pkcr777 is the way to go.
I had some trouble with my old account but the support team here fixed it in minutes. Love the variety of games on jili01login. Highly recommended!