Pinhole Gum Rejuvenation

What is Pinhole Gum Rejuvenation?

Pinhole Gum Rejuvenation is a patented, minimally invasive, microsurgical procedure for treating receding gums and a wonderful alternative to traditional gum grafting.Minor swelling, redness, and tenderness is common and can be managed with an over the counter pain medication.

The Pinhole Surgical Technique

Enter the Pinhole Surgical Technique (PST), a minimally invasive treatment option to reverse gingival recession without grafting or sutures. What is PST (also referred to as the Lunchtime Gum Lift or Pinhole Gum Rejuvenation)? It is a novel procedure that combines techniques from traditional periodontal surgical procedures, such as coronally positioned flaps and guided bone regeneration, to reverse gingival recession. A coronally positioned flap (CPF) is a technique that requires creating an incision in the sulcus and across the papillae of affected teeth, elevating a flap (either full or split thickness), pulling the flap coronally, and suturing it into place. These techniques are often combined with autogenous grafts, allografts (cadaver), or xenografts (animal).

Limitations

Like conventional grafting, there are limitations to the success of PST for reversing gingival recession. For example, root coverage is less predictable in areas of advanced bone loss due to a lack of bone support for the newly positioned tissue. Additionally, the patient must be free of inflammation and active periodontal disease at the time of surgery, compliant with postoperative instructions, and cease any traumatic activities that may have contributed to the recession, such as aggressive brushing. It is also recommended that the patient wear an appliance to protect from bruxism-induced occlusal trauma when indicated.

PST procedure

Like a CPF, PST allows coronal positioning of the gingival margin to cover recession defects, but it is not done with the use of scalpels, periosteal elevators, or sutures. Instead, a small pinhole is created by piercing the mucosa apical to the mucogingival junction in the area of recession, and then inserting specialized instruments through that hole to elevate a full-thickness “flap” in an apico-coronal direction.Once the periosteum is elevated from the underlying bone and tooth, it easily can be pushed coronally. But how does it stay in the new coronal position during the healing period without stitching? This is where I think the real genius of this procedure is-collagen strips! These collagen strips are actually pieces of a resorbable collagen membrane called Bio-Gide (Geistlich Biomaterials), which has been used for decades in periodontics for periodontal regeneration-just not in this same way.

Advantages

A major advantage of PST compared to traditional autogenous grafting (connective tissue grafting) is the ability to treat as many teeth in one sitting as the patient desires. When using the patients’ own tissue, there are inherent limitations in the number and size of the area that can be treated at one time. It is not uncommon to take over a year to treat an entire mouth, requiring multiple rounds of palatal grafting. In contrast, PST can be used to treat the whole mouth and be completed in a single sitting. Additional advantages include significantly less chair time than conventional procedures.

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