Q: What are the pros and cons of pinhole gum surgery?

Pros Pinhole gum rejuvenation takes less time than gum grafting, with the same oral health benefits of treating gum recession, preventing tooth loss and gum disease, reducing sensitivity, and improving the look of your smile. Unlike a more invasive procedure, pinhole surgery doesn't require a donor site or soft tissue grafts. This means less discomfort and swelling than the traditional gum recession treatment, as well as an easier healing process. It’s also reported to have fewer complications. You can treat the whole mouth in a single appointment. Repairing extensive gum recession with grafting techniques can take up to a year. One small five-patient study found that the pinhole surgical technique was able to improve root coverage by 96.7% by the six-month follow-up. The patients required analgesics for only four to five days post-procedure, and the biggest complication was post-surgical swelling. Cons The amount of root coverage can be unpredictable, especially in areas where there is a lack of thick gum tissue or in cases of advanced bone loss. Studies show that the pinhole surgical technique is appropriate only for correcting Miller Class I and Class II gum recession. You must be free of inflammation and active periodontal disease to undergo the procedure. To maintain your results, you will have to refrain from aggressive tooth-brushing and wear a night guard to protect teeth and gums from grinding. Because it’s a relatively novel approach, long-term follow-up studies aren't yet available. As with all surgeries, a pinhole procedure comes with risks, such as infection, bleeding, and discomfort.

Question 1

What is pinhole gum surgery?

Accepted Answer

Pinhole surgery, also called the Chao pinhole surgical technique (PST), is a minimally invasive surgery for treating receding gums. It restores soft-tissue coverage to exposed roots without the need for the scalpels or sutures used in gum grafting.

Your dentist or periodontist creates a small hole in the gum, then inserts a special tool to free the gingiva from the underlying bone and tooth. Then they reposition the gum tissue over the exposed root, lowering the gumline.

The pinhole surgical technique is a relatively new procedure, developed by Dr. John Chao, an Alhambra, California dentist and research professor of Periodontics at the University of Buffalo, SUNY. It's a less invasive treatment option than the current standard of care for gum recession: traditional gum grafting, which uses donor tissue taken from your palate or a cadaver.

Candidates for PST are selected on a case-by-case basis. As Dr. Elly Tehrani, a periodontist in Toronto, explains in a RealSelf Q&A, “It is not suitable for all patients. You need to have some thick gum tissue available.” Additionally, the pinhole technique isn’t recommended for people with advanced bone loss.

Question 2

What are the pros and cons of pinhole gum surgery?

Accepted Answer

Pros

Pinhole gum rejuvenation takes less time than gum grafting, with the same oral health benefits of treating gum recession, preventing tooth loss and gum disease, reducing sensitivity, and improving the look of your smile.
Unlike a more invasive procedure, pinhole surgery doesn't require a donor site or soft tissue grafts. This means less discomfort and swelling than the traditional gum recession treatment, as well as an easier healing process. It’s also reported to have fewer complications.
You can treat the whole mouth in a single appointment. Repairing extensive gum recession with grafting techniques can take up to a year.
One small five-patient study found that the pinhole surgical technique was able to improve root coverage by 96.7% by the six-month follow-up. The patients required analgesics for only four to five days post-procedure, and the biggest complication was post-surgical swelling.

Cons

The amount of root coverage can be unpredictable, especially in areas where there is a lack of thick gum tissue or in cases of advanced bone loss. Studies show that the pinhole surgical technique is appropriate only for correcting Miller Class I and Class II gum recession.
You must be free of inflammation and active periodontal disease to undergo the procedure.
To maintain your results, you will have to refrain from aggressive tooth-brushing and wear a night guard to protect teeth and gums from grinding.
Because it’s a relatively novel approach, long-term follow-up studies aren't yet available.
As with all surgeries, a pinhole procedure comes with risks, such as infection, bleeding, and discomfort.

Question 3

What happens during a PST procedure?

Accepted Answer

A pinhole surgical procedure usually takes one to two hours and requires only local anesthesia.

Once you're numb, the dentist uses a specialized needle to make pinhole-size incisions (roughly two to three millimeters) in the gums. They insert a thin instrument to loosen the soft tissue and reposition the gumline over areas of exposed root, inserting resorbable collagen strips beneath the tissue grafts to improve healing.

Postoperative pain is significantly less than what you'd have after traditional gum grafting surgery, but you may need over-the-counter pain medication for a few days. Icing the area can also ease discomfort.

Question 4

How long does pinhole surgery recovery take?

Accepted Answer

You'll have about a week of recovery time, with some swelling and tenderness. Avoid hard, sharp, and stringy foods and avoid brushing, flossing, and touching the area until your dentist gives you the green light to resume routine oral care.

According to RealSelf members’ before and after pictures, you may see optimal results around six weeks post-treatment.

Pinhole gum surgery results are permanent. However, aging, aggressive brushing, and teeth grinding can continue to erode gums and teeth over time.

PINHOLE GUM SURGERY

Elly Tehrani, DMD, MSD

Andrea Karr

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Elly Tehrani, DMD, MSD

Andrea Karr

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