Pinhole Surgical Technique with platelet-rich fibrin to enhance soft-tissue grafting

Introduction

Gingival recession, more commonly described as the condition where the gum tissue surrounding the teeth pulls back, leading to root exposure, is a common periodontal concern (figure 1). Addressing this issue is not only crucial for maintaining oral health but also for achieving cosmetic satisfaction, particularly in individuals dealing with multiple teeth affected by recession (MAR).

Pinhole Surgical Technique with platelet-rich fibrin to enhance soft-tissue grafting — Figure 1: Initial recession

The Pinhole Surgical Technique (PST) has emerged as a minimally invasive approach to manage gingival recession, with promising outcomes in root coverage and improved esthetic benefits. The introduction of platelet-rich fibrin (PRF) to PST represents a significant advancement, potentially enhancing healing processes and improving clinical outcomes.

The Pinhole Surgical Technique in treating gingival recession

What is PST?

PST, developed as a minimally invasive procedure, is designed to reposition gingival tissue to cover exposed roots.^1,2 Unlike conventional methods, PST eliminates the need for grafting with tissue from the palate and invasive incisions, significantly reducing postoperative discomfort and scarring (figure 2).

Its application has garnered attention for restoring esthetics and improving oral health among patients with mild to moderate gingival recession in multiple sites.^3,4 Recent studies have shown that the PST technique is comparable to the gold standard of soft-tissue grafting, which involves harvesting connective tissue from the palate or other areas of the patient’s mouth.^1,2

What are the clinical benefits of PST?

Multiple studies have highlighted the efficacy of PST in reducing gingival recession in both length and width. PST has also shown a remarkable ability to stabilize keratinized tissue width (KTW), enhance gingival thickness (GT), and achieve complete root coverage (CRC). These outcomes are particularly valuable for individuals with MAR where simultaneous multisite treatment is essential for uniformity and esthetics. The PST technique has demonstrated good long-term stability in treating soft-tissue recession and is similar to soft-tissue grafting with the patient’s own connective tissue.²

How does PRF enhance PST outcomes?

PRF is an autogenous biomaterial derived from the patient’s blood. It is rich in growth factors and cytokines that accelerate tissue repair, angiogenesis, and wound healing. When combined with PST, PRF acts as a natural scaffold, promoting soft-tissue healing, maintaining tissue volume, and potentially reducing gingival inflammation. PRF’s bioactive properties allow for improved attachment of gingival tissues and greater stability in areas of multiadjacent recession (figures 3–5).

Recent advancements in combining PRF (i.e., Bio-PRF) with PST have shown increased effectiveness in root coverage, enhanced gingival thickness, and better postoperative outcomes when compared to PST alone (figure 6).

What are the other benefits of using PRF with PST

Reduction in postoperative pain. PRF significantly reduces postoperative pain and discomfort.⁵ The localized anti-inflammatory effects and enhanced healing capacity of PRF contribute to this benefit, increasing patient acceptance of the procedure.
Long-term esthetic and clinical outcomes. The ability of PST + PRF to maintain long-term outcomes is another advantage. Studies have demonstrated that patients undergoing this combined therapy exhibit not only durable improvements in gingival health but also a higher level of satisfaction with root-coverage esthetics when compared to PST alone.⁶
Superior results compared to other biomaterials. When comparing PRF to alternative biomaterials, such as resorbable collagen membranes, PRF demonstrates superior healing properties and patient satisfaction. A trial comparing PST with PRF and PST with collagen matrices indicated more significant gains in clinical outcomes and lower pain scores in the PRF group, further underscoring its advantages as an adjunct to PST.⁷

Comparative studies of PST with PRF versus PST alone

One randomized clinical trial analyzing multiple noninvasive soft-tissue grafting techniques highlights the tangible benefits of PRF augmentation in PST. Data demonstrates that the combination of PST and PRF not only achieves significant reductions in recession but also outperforms PST alone in improving gingival parameters.⁸

Another study assessing 165 MAR cases revealed that while both groups showed improvement, the test group (PST + PRF) outperformed the control group (PST alone) on several parameters, including a more substantial gain in keratinized tissue and recession coverage.⁹

Conclusion

The addition of PRF to PST represents an evolution in periodontal therapy. For dental professionals, this combination not only enhances clinical efficiency but also yields highly satisfactory outcomes for patients, particularly in cases with multiple adjacent gingival recession defects. PRF acts as a cost-effective and biologically sustainable enhancement to the already minimally invasive PST. The simplicity of adding PRF, along with its ability to promote healing, makes it an indispensable tool for dentists striving to offer cutting-edge care. Its proven benefits in minimizing recession defects, improving patient comfort, and achieving esthetic excellence make it a valuable procedure for any modern dental practice.

Key takeaways from the article

Clinical superiority: PST with PRF consistently shows better resolution of gingival recession defects than PST alone.
Patient outcomes: Reduced postoperative pain and better esthetic results make it a patient-preferred option.
Efficiency: The minimally invasive nature of PST combined with the regenerative properties of PRF simplifies complex multisite treatments.

Editor’s note: This article originally appeared in Perio-Implant Advisory, a chairside resource for dentists and hygienists that focuses on periodontal- and implant-related issues. Read more articles and subscribe to the newsletter.

References

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