News & Press
John C. Chao, D.D.S., M.A.G.D
Faculty, USC School of Dentistry
Pinhole Surgical Technique™: Breakthrough Invention In Plastic Gum Surgery
A revolutionary suture-free plastic surgery technique for correcting receded gum line called the Pinhole Surgical Technique™ (PST)™, invented by Dr. John Chao, has been accepted for world-wide publication by the International Journal of Periodontics and Restorative Dentistry, one of most prestigious journals in the field of dentistry. It’s called “Pinhole Surgical Technique” ™ because through a 0.1 inch “pinhole” incision a properly trained dentist, using specially designed instruments (pending patent), can bring the gum line to its normal position. Without the need for needles and suturing, the surgeon using the PST™ can stabilize the normalized gum line with special collagen material. The in press article cites statistics that show the Pinhole Surgical Technique was effective over 90%of the time. Post-operative symptoms were minimal, with patients using only 1 or 2 non-prescription pain pills on the average. Over 95% of the patients reported complete satisfaction with the results within one week.
Traditionally, the “gold standard” for treating teeth with receded gums has been the “connective tissue graft” (CTG). This technique calls for the “harvesting” precisely measured “donor” tissue from the roof of the mouth (palate). The wound left by the harvesting procedure is sutured together. Then incisions of various designs and lengths are made at the site of the gum recession (recipient site) to create, in essence, a pocket into which the palatal tissue is tugged. The graft tissue is meticulously sutured (stitched) to the overlying gum tissue. Then the wound edges of the incised tissue (flaps) are carefully placed in close approximation to each other. Thereafter the careful placement of the sutures with appropriate tension allows for proper wound healing, which generally takes about three weeks.
The advantage of the connective tissue graft (CTG) is that it is highly effective. Published results indicate effectiveness of CTG techniques to be as high as 96%. The complications associated with the traditional methods of gum grafting is frequency of pain, bleeding, swelling and other postoperative symptoms, particularly at the “donor site” (palate). Human and animal donor tissue made of collagen have been used with success rates not comparable to the use of patients own (autogenous) tissue from the palate. Grafting with donor or animal tissues still require intricate incisions and suturing, which leads inevitably to certain complications. Another disadvantage of this method is that palatal tissue is sometimes noticeably different in appearance from normal gum tissue. Cosmetically this may be an issue, depending on esthetic requirements of the patient.
Pinhole Surgical Technique™ requires no harvesting of the patient’s own tissue, no suturing and only one .1 inch (pinhole) entry incision. Specially designed instruments are used to gently displace the tissue to its normal position. Because this technique is so minimally invasive, there is minimal post-operative discomfort. Cosmetically, there is no issue as far as tissue matching.
This in press article reports the results of an 18-month retrospective study of 43 patients with 121 gum recession sites.
The International Journal of Periodontics and Restorative Dentistry will publish “A Novel Approach to Root Coverage: The Pinhole Surgical Technique,” in 2011.
Trademark has been approved for the Pinhole Surgical Technique™, which is also known as PST™. Patent is pending for the Pinhole Surgical Technique as well for its instruments.
1. What is gum recession? What is the cause?
Have you ever felt that you have become “long in the tooth?” Do you show too much teeth, look too “toothy,” your "teeth seem really long" or that the "roots of your teeth are exposed"? Shrinking of your gums to the extent the roots of the teeth are exposed is known as “gum recession.” Gum recession is a fairly common consequence of overly aggressive tooth brushing, grinding your teeth, or periodontal disease. Common side effects are sensitivity to hot or cold liquids.
2. How can gum recession be prevented?
Over-brushing your teeth can occur with overly vigorous brushing, as you know. However what is not well-known is that gum recession can also occur by using a hard toothbrush, abrasive toothpaste or not being careful with the electric tooth brush. If you already have gum recession, use a softer tooth brush with non-abrasive toothpaste. Before you have the opportunity to consult with a professional, you may use the “roll technique,” which calls for gently rolling the tooth brush from the gum to the teeth. Don’t use the electric tooth brush as if you are brushing with a hand-held tooth brush. You may be double brushing your teeth and gum and thereby cause “electric toothbrush abrasion.” Hold the electric tooth brush gently against the surface you desire to clean. Use the lightest pressure possible on the handle. Don’t move the brush up and down or back and forth. Slowly and gently move the electric toothbrush from place to place. The electric tooth brush is already cleaning your teeth. Putting more pressure on the handle will only produce damage to the roots and the gums. Doubling the “pressure” does not double the fun! Read and follow manufacturer’s instructions. See your dentist or hygienist for clarification, if any questions arise.
Heavy grinding of your teeth minutely flexes the necks of your teeth. This flexing (called abfraction), according to some authoritative sources, can lead to the microscopic crystals that form the roots of your teeth to break off little by little. Eventually the gums will recede as the underlying root surface is lost. If you suspect that you clench or grind your teeth, consult your dentist regarding getting a night-guard. This appliance will protect your teeth from being worn down, besides preventing further gum recession.
The condition that most often underlies most gum recession problems is periodontitis, a genetic inflammatory disease condition associated infection caused by certain kinds of oral bacteria (periodontal pathogens). An aberration or glitch in the immune system leads to destruction of the connective tissue (gums and bone) supporting the teeth by one’s own inflammatory process. White blood cells, instead of aiding the immune system to destroy infection-causing bacteria, undergo a process that results in the destruction of bone and gums. This process affects the gum line and causes the gums to recede. When the gums recede, the roots of the teeth are exposed. When the protective surface of the roots, called cementum, is worn away by over-brushing or decay, the teeth will become hypersensitive to cold and touch.
3. What treatments are available for gum recession?
What can be done to restore the gum line to its normal position? First of all, the possible causes of gum recession must be dealt with. Proper brushing habits must be taught and learned. Bite guards should be worn consistently, if clenching and grinding is habitual. Periodontitis must be treated and then controlled by good home care followed by regular dental maintenance visits as prescribed.
Secondly, a “root coverage” procedure can be considered. There are a variety of surgical procedures to restore the gum line to its original position. The “gold standard” is the “connective tissue graft.” This method incorporates two separate procedures. First, a thin piece of tissue is removed or “harvested” from the palate. Since this tissue comes from the patient, it is called an “autogenous” graft. The second part of this method requires a surgical procedure that makes a tissue flap. A flap is made by an incision extending from the recession site the adjacent teeth. Then the gums are “elevated” or peeled away from the underlying gum or bone. This filleting effect allows for a “pouch” in the gum into which the graft tissue is placed and stitched or sutured into place.
The advantage of this method is that it is “predictably” successful. Literature reviews of this method report various percentages of success, some of which approach 90% or better. The admitted disadvantage of this method is postoperative symptoms, such as bleeding and/or mild-moderate pain from the palatal wound. Cosmetically, the graft tissue may not match the surrounding tissue.
Other methods include using “donated” human collagen tissue or animal collagen tissue as graft materials. The success rates are reported to be generally less than the autogenous connective tissue graft.
Dr. Chao is the inventor of a soon-to-be published “breakthrough” method designed to treat gum recession in a minimally invasive way with minimal postoperative symptoms and without palatal grafting. The “International Journal of Periodontics and Restorative Dentistry” will publish Dr. Chao’s article on the Pinhole Surgical Technique in 2011. (See above). Trademark and pending patents have been obtained both for the instruments as well as the method At this time this ground-breaking method of treating gum recession is only available at Dr. Chao’s office for selected patients. Prospective patients are invited to call our office at 626-308-9104 for important information.