Pinhole Surgery

Pinhole Surgery Downtown Toronto

Downtown Toronto Pinhole Surgery

What is recession?

Economic recession is one thing, and gingival recession is another. When speaking with your dentist, it’s typically the gingival type! So just as the economy can fall so can your gums, hence they are receding. I won’t even bother to get into explaining economic recession, but rather stick to what I know. Gingival recession, the loss of the gum/bone that comes up to the neck of your teeth, this in turn can expose the roots of the teeth. It will not get better on its own, if treatment is needed it is only through minor gum surgery that this can be made better.

What are the causes of gum recession?

Many factors can contribute to gum recession. It can be a combination of a few factors or the result of one of them.
Some Common contributors to gum recession:
• Gum disease (Gingivitis- gum inflammation, Periodontitis- bone loss around teeth)- and yes you can have recession without gum disease…
• Improper brushing techniques
• Clenching/Grinding of teeth and not wearing a Night Guard
• Tooth position

Prior to any treatment of the receded gum, the causative factor needs to be dealt with, or else recession will come right back even after the surgical treatment.
What if I do not treat it?

Gum recession, just like most gum diseases, is a slowly deteriorating process for you mouth. Not treating gum recession can lead to any or all of the following (not limited to this..):
• Teeth sensitivity
• Deep root decays- most times needing root canals for treatment
• Loss of Teeth
• Unattractive smile
Although some of the above are reversible, some are not and may lead to eventual tooth loss!

What are my treatment options?

There are two effective options currently. One is placing a filling on the tooth, the other are 2 different forms of surgery- the newer of which is more desirable, I will explain…

In some cases when the recession is minor, and there’s lots of good gum tissue still around the tooth, we may opt to place a white filling material on the exposed and sensitive root. This usually deals with the sensitivity issue, but does not regain the lost gums, hence why not may tend to opt for this.
Instead, many who suffer with recession do get a full surgical intervention in the hopes of alleviating: sensitivity, thin gums, lost gums, better aesthetics, and also tends to have a much better long term success! These are not seen with the fillings method.

So, surgery seems to be the golden standard for a more definitive treatment, but there are 2 options as I mentioned. The traditional option is known as Connective Tissue (CT) Graft, and the newer technique is know as Pinhole Surgical Technique (PST).
CT graft, involves taking a piece of gum from your palate, and transplanting it to the gum area of recession, where it is tucked under your gums and held in with plenty of sutures that are designed to cover the exposed roots of the teeth in question. The recovery of this tends to be difficult, especially since there is a second surgical site (Donor) being the palate, that also needs to heal at the same time of the roots site in question (Recipient). Special care needs to be taken for the first 6wks that the gums do not move back away from the tooth crown, most have a tough time with these recovery restrictions. We also recommend that people take 4-5 days off for recovery.

The newer technique is know as Pinhole Surgical Technique (PST) for gum recession. This is a scalpel-free, suture-free and virtually pain free option to correct gum recession. It does not involve taking material from your palate and creating a second wound. In simple terms its less invasive as there are no large incisions, does not need sutures, and most do not need more than over the counter pain killers. The same 6 weeks of care still apply to this technique, but is less critical and more manageable.
Some of our patients have gone back to work the same day even, although we always recommend to take that day off following your surgery.

What is the recovery like after surgery?

As mentioned, with PST some patients opt to go to work the same day, that is not our recommendation, we prefer you take off at least the day of, and as in life always best to plan for the worse case scenario which means taking a few more days for healing. If you have the luxury to take time off, then I would say 3 days off is ideal, if that luxury isn’t there, take at least the 1 day off for sure.

In the comprehensive instructions, which should be explained to you in detail during your consultation, you will generally find most of it involves avoiding the surgical site for about 6 weeks. Patients actually find the 6 weeks after the PST quite manageable. Most of the comments we get are from those who have had the traditional surgery (CT graft) at some point prior to the PST, they find that PST is much more comfortable for them as they do not have a second surgical site, no open wounds, no stitches, no strong pain killers needed….All this makes PST the current preferred method. I am sure we will see this trend continue as doctors and patients both become more familiar with the Pinhole Surgical Technique for the treatment of gum recession, versus the traditional CT surgery.

How do I get the treatment?

The recession needs to be diagnosed. Typically your dentist or hygienist can recognize this. The dentist can either do the treatment if they are appropriately trained for it, or refer you out to a trained practitioner. Those who have had the training for Pinhole Surgical are the only ones that can display the Chao Pinhole Surgery Emblem (see below) on their website/clinic, so thats a good starting point.
We find that practitioners who have had extensive experience with the traditional CT technique, are typically better at performing the new technique, so do ask your doctor on what their experience is in general with gingival grafting, hoping they are well experienced with all techniques we described, not just PST. As there are the rare cases that PST is no the best option, and the skill set of the doctor needs to be there to recognize this an offer the alternative! If you feel satisfied and confident with their experience then you are where you need to be!