Abstract
Gingival recession is a prevalent clinical condition that compromises esthetics, root sensitivity, and periodontal stability. Traditional root coverage procedures, such as free gingival grafts and coronally advanced flaps, though effective, are often limited by donor site morbidity, esthetic mismatches, and patient discomfort. To address these shortcomings, minimally invasive periodontal plastic surgical techniques have been developed, with the tunneling technique and the Pinhole Surgical Technique (PST) being among the most notable. The conventional tunneling approach, often combined with subepithelial connective tissue grafts (SCTG), provides predictable outcomes with excellent long-term stability due to enhanced gingival thickness and dual vascular supply. In contrast, PST is a flapless, sutureless procedure introduced as a less invasive alternative, eliminating the need for graft harvesting and reducing postoperative morbidity. It utilizes a small pinhole access and collagen membranes for stabilization, achieving excellent esthetic results and patient satisfaction. However, while tunneling with SCTG is well supported by long-term evidence and histological findings of true periodontal regeneration, PST currently lacks robust randomized controlled trials and data on long-term stability. Both approaches have distinct advantages: tunneling remains the gold standard for predictable and stable root coverage, while PST offers an attractive alternative for esthetically conscious patients seeking minimally invasive treatment. This review critically compares their biological principles, surgical protocols, outcomes, and limitations, providing evidence-based insights to guide clinicians in selecting the most appropriate technique according to patient-specific needs and clinical scenarios.
Keywords: Collagen Membrane, Connective Tissue Graft, Esthetics, Gingival Recession, Pinhole Surgical Technique, Root Coverage, Tunneling Technique