9914 Kennerly RoadSt. Louis, MO 63128

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Periodontal and Implant Dentistry

Pinhole Gum Rejuvenation Procedure

Home > Post-Ops > Pinhole Gum Rejuvenation Procedure

The Procedure

This type of soft tissue grafting procedure is done to cover exposed root structure on teeth. This can decrease sensitivity, improve esthetics and to create a tough barrier of gum tissue which will help to resist further recession. This procedure results in variable root coverage, meaning that 100% root coverage cannot be guaranteed, which may result in incomplete resolution of tooth sensitivity.
The pinhole procedure will prevent further recession from normal healthy brushing. this results in protecting the bone underneath it. The primary cause of this is thin, inadequate/absent firm attached tissue surrounding the tooth/teeth, resulting in the loose lip/mucosal tissue surrounding the tooth. Even normal proper brushing, this fragile tissue will continue to recede along with the bone that is immediately underneath it. This inadequate loose tissue is also very susceptible for food entrapment, resulting in an infection that can quickly destroy the bone in the area. The is procedure is done using local anesthetic, that can be supplemented with nitrous oxide, oral sedation, or iv conscious sedation.

Presurgical Instructions

Please arrive at the office at least 20 minutes prior to your surgical appointment to make any final arrangements prior to the procedure.
Please don’t apply makeup and lipstick around the mouth. If a cleaning is due, it is ideal to have it done within a week prior to the procedure and brush your teeth immediately prior to the appointment is advised.

Take your medications as advised. If taking blood thinners, some aspirins, or fish oil prescriptions, we will contact your Prescribing Doctor for their recommendation on modification. We will inform you of their recommendations before surgery. If you have any questions about your prescriptions, please contact us.

If advised to, begin taking pain reliever about 24 hours in advance (600-800mg Ibuprofen or 1000mg Tylenol, typically for an adult and 200-400mg Ibuprofen for a child; this was discussed in your pre-surgical appointment). The over-the-counter ibuprofen comes in 200mg tablets, and the over-the-counter Extra Strength Tylenol comes in 500mg tablets, so please take the appropriate number as listed above for them to be effective.

Periodontal Post-Surgical Instructions

A woman is putting toothpaste on her bamboo toothbrush

Care of The Mouth

Don’t do anything that will disturb the surgical sites. Be your own best wound caretaker.
• No touching of the surgical sites with fingers, tongue or any other object like cotton swaps, picks, etc.

• Do not look at the surgical sites. Keep cheek movements to a minimum.

• Do not sleep with your hands under cheeks.

• Be as gentle as possible for 6 weeks.

• Normal brushing and flossing following the procedure should be followed throughout the mouth except in the area where surgery was performed. It is important to maintain a high level of oral hygiene care after periodontal surgery. You may very slowly & gently brush the lingual (inside next to tongue) of the teeth that had surgery on them. This reduces the accumulation of bacteria (plaque), chances of infection, and minimizes unpleasant mouth odor.

A spoon with salt

Oral Hygiene After Surgery

• Do not brush, waterpik, floss, or otherwise disturb the surgical area during the first 6 weeks or longer if instructed.
• Use an extra soft toothbrush for 6 months after surgery.

• Beginning 24 hours after surgery, rinse gently with warm salt-water mixture (1/2 teaspoon of salt into 6-8 oz. of warm water) 3-4 times per day for the first couple of weeks.

• A prescription rinse can be used as well and as directed. Rinse to “drool rinse” Turn head side to side and let rinse come out. No gargling, no swooshing & no spitting.

The hands of a woman holding two dark brown pills


It is normal for there to be varying amounts of discomfort for 1-6 days after surgery. How much pain and how long it lasts depends on the extensiveness of surgery done, how long it took, and your unique response to it. Everyone differs in his or her perception of, and response to pain; the pain medication may not eliminate all pain but should make you reasonably comfortable. It is not routine to require narcotics.
• If advised to, begin taking pain reliever about 24 hours in advance (600-800mg Ibuprofen or 1000mg Tylenol, typically for an adult and 200-400mg Ibuprofen for a child; this was discussed in your pre-surgical appointment). The over-the-counter ibuprofen comes in 200mg tablets, and the over-the-counter Extra Strength Tylenol comes in 500mg tablets, so please take the appropriate number as listed above for them to be effective.

A young woman resting in her bed.


It is normal to have some oozing for 2-3 days. To prevent excessive bleeding follow these steps:
• If advised, Ceasing/modifying your blood thinner/aspirin/fish oil at the recommended time prior to surgery should have occurred. (If you have any questions concerning this, please call the office).

• Don’t spit, rinse, or use a straw for at least 24 hours after the surgery.

• Avoid strenuous activity for 1 week.

• Slow oozing of blood is expected for 2-3 days. It is recommended to place a towel over your pillow and keep your head slightly elevated for the first 3 days.

A woman putting ice on her jaw because she is in pain


• Gently apply an ice pack to the side(s) of your face over the surgical area for 10-15 minutes per hour during the first 24-48 hours after surgery.
• Keep your head elevated at night to reduce the swelling.

• Some Bruising may occur.

• Minimize the heat of your food for the next 24-48 hours to slightly warm.

• After 48 hours, if still swollen, a moist heated washcloth or heating pad applied to the site will then be effective.

• Swelling typically peaks on the third day and then slowly begins to reduce from there forward. This is also why ibuprofen/ anti-inflammatory is advised to continue to be taken for the first 4-5 days after the surgery.

A glass of fresh mango smoothie


• For the first 24 hours, restrict your diet to cool soft foods and liquids (ie. milk shakes, ice cream, instant breakfast drinks, junior baby food, Ensure, yogurt, cottage cheese, pudding, jello, applesauce, etc.) After 24 hours soft warm foods can be introduced.
• For the first 7 days, avoid Spicy foods, citrus, alcohol.  • Then for the 3-4 weeks, continue with warm softer foods (ie. Pastas, malts, soups, well cooked chicken, fish, omelets, mashed/baked potatoes, tuna noodle casseroles, meat loaf well cooked vegetables, etc.) and continue to avoid chewing on the surgical side.
• For 6 weeks avoid crunchy and chewy foods along with peanuts, popcorn, and chips for 6 weeks after surgery.
• No tobacco products (cigarettes, chewing tobacco, snuff, etc.) sticky foods, or sucking candies and mints for at least 6 weeks after.
By 6 weeks, unless otherwise advised, you are usually able to eat without any restrictions.

A glass of fresh mango smoothie


No heavy aerobics, vigorous dancing, heavy lifting, or physical activity for 1 week.


Take your medications for blood pressure, heart, anxiety asthma/lung the day of your procedure. If you are having iv conscious sedation, then take them with enough water to get the medication down (less than 3oz.) Bring your inhalers with you. If you are diabetic and having iv sedation, do not take oral diabetic medication or insulin the morning of your procedure. If there are any issues regarding the interruption of your medication, contact your prescribing physician.
Blood thinner medications: (Our office will be consulting your cardiologist. Unless otherwise told, the following recommendations for temporarily discontinuing your blood thinner/s is listed below.)
Dabigatran (Pradaxa)- hold off 48 hours and wait to begin 48 hours after treatment. Rivaroxaban (Xarelto)- hold off 48 hours prior to the procedure and begin 48hrs after treatment. Apixaban (Eliquis)-hold off 48 hours prior to the procedure and begin 72 hours after treatment.Edoxaban (Savaysa, Lixiana)- hold off 48 hours prior to the procedure and begin 48hrs after treatment. Warfarin (Coumadin, Jantoven)-If instructed, hold off 3 days prior and begin 48 hours after treatment.*Ticagrelor (Brilinta)- hold off 5 days prior to the procedure and begin 48 hours after treatment.*Ticlopidine (Ticlid)- hold off 5 days prior to the procedure and begin 48hrs after treatment.*Clopidogrel (Plavix)- If instructed, hold off 5 days prior to the surgery and begin 48 hours after treatment.*Prasugrel (Effient)- hold off 5 days prior to the procedure and begin 72 hours after treatment.*Cilostazol (Pletal)- hold off 3 days prior to the procedure and begin 4 days after treatment.*Aspirin 325mg or greater- hold off 1 week prior to the procedure and begin 48 hours after treatment.*Dipyridamole (Aggrenox)-hold off 5 days prior to the procedure and begin 48 hours after treatment. (*) anti-platelet meds

***Patients with mechanical artificial heart valves cannot stop their anticoagulant medications (blood thinners) without discussion with their cardiologist and the periodontist!!
Supplements are non-prescribed medications. If you are taking any of the supplements listed below, please stop 1 week prior to your surgical procedure.● Dong Quai (Angelica sinensis)● Ginseng (Panax quinquefolium/Panax ginseng)● Feverfew (Tanacetum parthenium)● Licorice Root (Giycyrrhiza glabra)● Fish oil● Red Clover (Trifolium pretense)● Garlic● Vitamin E● Ginkgo Biloba
Commonly prescribed/recommended medications for this procedure:
__ Ibuprofen (ie. Motrin, Advil): This is usually over the counter. (if can be taken, 600-800mg for adult and 200-400 for a child, every 6-8 hours for at least 4-5 days after the surgery.) This is an over the counter medication. It is used to control mild to moderate pain. The medication also has an anti-inflammatory result at surgical sites. It works best when taken before surgery followed by consistent dosing times afterwards. The major side effect of Motrin an upset stomach. To avoid this issue, take ibuprofen gel caplets with meals, milk, or 2 full glasses of water to lessen this complication. If you are prone to stomach ulcers, take this medication cautiously and discontinue if you have any stomach pain, nausea, or vomiting. Do not take ibuprofen if you have had any allergic type of reactions (itching, swelling, rash, difficulty breathing, etc.). Ibuprofen has been reported to make some people drowsy (1 in 100).
__ Tylenol (Acetaminophen):
(Can be taken 325mg-650mg every 4-6 hours) This is an over the counter pain reliever that can be taken while breast-feeding. It is contraindicated to those that are allergic to acetaminophen, or those who have a known G-6PD deficiency.

___ Closys®: This is a post-surgical rinse that is initiated 24 hours after a surgery. Gently rinse for at least 30 seconds with ½ oz (2 full caps), then spit it out. It should be used 2-3 times a day. This is a non-staining, killing 99.9% germs in the external part of the surgical site. The rinse is used specifically for the surgical site, generally until all of the sutures are removed. Brushing and flossing should occur throughout the rest of the mouth.
__ Peridex (chlorohexidine Gluconate):
This is a mouthwash used to kill the bacteria in the surgical area. Take ½ oz. of mouth rinse, swish for a full 30 seconds, or swab the teeth with a Q-tip in the area, 2 times a day, no eating or drinking for 30 minutes afterwards. If instructed, begin this medication 24 hours after the surgery is completed and continue for at least 3 weeks or longer, even if brushing and flossing has been implemented again. Staining of the teeth can occur, which can be polished off. Avoiding tannin containing food products during its use will reduce staining tendencies (ie, red wine, tea, coffee).

__ Sinecch ™/Arnica Montana: This medication is used to reduce bruising and swelling that may occur after your surgery. Use as directed on the packaging and you should ideally start the medication 1-24 hours prior to the surgery and finished up 4 days after the surgery. If you are breast feeding, or pregnant, please inform your doctor. Don’t use if you are taking other medications that contain pentazocine (such as Talwin), if you are sensitive to any of the ingredients in Sinecch.
Office (314) 842-6151Dr. Scott Schlueter (636) 492-1756Dr. Trinity Boszko (314) 221-6832