The Pinhole Surgical Technique - A Distinct Approach for a Marginal Tissue Recession Coverage Using Amniotic Membrane

Abstract

Introduction: Root coverage procedures are often carried out for compromised aesthetics, dentinal hypersensitivity, difficulty in the maintenance of plaque control, root caries and bone loss. Regenerative attempts are hindered by the root surface’s avascularity and microbiologically compromised condition. Furthermore, freshly created tissue needs to withstand the physical pressures of mastication and procedures related to the maintenance of oral hygiene by the patient. The key issues include surgical challenges, time and patients’ discomfort despite the various surgical methods that have been performed for the root coverage. The complications related to donor site, sparked interest for the development of newer innovative techniques that helps to meet patient’s aesthetic and functional needs. Pinhole surgical technique (PST) being minimally invasive is used in our study to treat gingival recession using amniotic membrane. Materials and Methods: A total of 20 participants were selected randomly with having Miller’s Class I or II recession. Each patient received thorough information on how to practice good oral hygiene. A scaling and root planning process was carried out across the entire mouth. Re-evaluation of research sites was done 1 month after phase I therapy to validate its appropriateness. PST was done randomly on the chosen sites, along with the application of amniotic membrane. Results: All the clinical parameters i.e., recession depth (RD), recession width (RW) and clinical attachment level (CAL), were seen improving significantly at 6 months postoperatively compared to baseline except width of keratinized gingiva (WKG) (P = 0.08) and thickness of keratinized gingiva (TKG) (P = 0.14). All the clinical parameters i.e., RD (P = 0.017), RW (P = 0.017), probing depth (P = 0.03) and CAL (P = 0.05) improved significantly at 12 months postoperatively compared to baseline. However, WKG and TKG showed statistically insignificant changes at 12 months postoperatively (P = 0.08, P = 0.14). Significant difference in Visual Analogue Scale score was seen postoperatively at day 1, 3 and 5. Conclusion: Pinhole surgical approach is used to treat Miller’s Class I–II recession. It may be a better option than the other techniques because it is less invasive, time and money efficient. For the establishment of a normal vasculature and early wound healing, the usage of amniotic membrane as an adjunct is a better alternative.