Within the past few decades, stress levels have increased significantly in the human population. We have shifted to an era where chronic diseases has dominantly overpowers infectious diseases that were the most common causes of death. Stress can disrupt homeostasis which could lead to a fluctuation of immune response levels. The direct association between periodontal disease (gum disease) and stress remains to be proven, however, recent studies indicate that stress is a risk indicator for the disease (Goyal et al., 2013).
Pinhole Surgical Technique (PST) is a form of periodontal disease management that is new to treating marginal tissue recession (MTR). Invented and practiced since 2006, it has been growing in popularity over the past few years and is only available from a handful of prestigious and rigorously trained dentists (Reddy, 2017). I have the fortune of working under one of the few dentists in Colorado certified to perform this technique, and the privilege to assist on these procedures. PST entails taking existing gingiva to cover an exposed root surface using a 16-gauge hypodermic needle. The needle penetrates the alveolar mucosa and the periosteum apical of the recessed area, creating a “pinhole” in the gums through the mucosal and tissue layer and freeing muscular and fibrous adhesions (Beck, 2018). Instruments designed by Dr. John C. Chao DDS, specific to PST, are inserted through the pinhole, moving the mucogingival tissue until the tissue advances to the desired coronal position to cover the exposed root. The tissue is then stabilized by collagen membrane, positioned at interdental papillae until there is sufficient fullness to allow for tissue regeneration, sufficiently gum recession (Reddy, 2017).
This technique makes for a minimally invasive procedure as it requires no other incisions besides the pinhole, no sutures, no scalpels, and no grafts, while providing immediate, visible results of root coverage. Not only is PST a minimally invasive technique with immediate visualized results and a 95% rate of high satisfaction, studies have demonstrated that PST results in fewer postoperative complications and quicker healing time. After an average of 4 days post-op, painkillers are discontinued; pain, swelling and bleeding is minimal, only presenting in an average of 30-35% of cases, and subsiding after 2-3 days (Reddy, 2017). The development of new techniques and procedures that not only improves the health care offered, but the quality of life experienced after, demonstrates the benefits of innovation and motivation to continue research.
Beck , T. M. (2018). The Pinhole Surgical Technique: A Clinical Perspective and Treatment Considerations From a Periodontist. CDA Journal, 46(10), 647–651. Retrieved from https://pinholesurgicaltechnique.com/pdf/Beck-CDA-journal-Pinhole-article-October-2018.pdf
Chao, J. C. (2012). A Novel Approach to Root Coverage: The Pinhole Surgical Technique . The International Journal of Periodontal & Restorative Dentistry, 32(5), 521–530. Retrieved from https://pinholesurgicaltechnique.com/wp-content/uploads/2019/07/ChaoBrochure.pdf
Goyal, S., Gupta, G., Thomas, B., Bhat, K. M., & Bhat, G. S. (2013). Stress and periodontal disease: The link and logic!!. Industrial psychiatry journal, 22(1), 4–11. doi:10.4103/0972-6748.123585
Reddy S. (2017). Pinhole Surgical Technique for treatment of marginal tissue recession: A case series. Journal of Indian Society of Periodontology, 21(6), 507–511. doi:10.4103/jisp.jisp_138_17
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