Sub-junctional Pinhole Technique

Periodontal intrabony defects associated with Stage III periodontitis remain a major clinical challenge because conventional surgical approaches may require extensive flap reflection, which can compromise soft tissue support and increase patient morbidity. Minimally invasive periodontal therapy has been introduced to preserve soft tissues while maintaining favorable clinical outcomes.

This randomized controlled clinical trial is designed to evaluate the efficacy of a novel Pinhole Regenerative Therapy (PRT) in the treatment of intrabony periodontal defects. The proposed technique is based on minimally invasive non-surgical periodontal therapy (MINST) followed by a minimally invasive pinhole approach for defect degranulation and regenerative graft placement without flap elevation. The technique is intended to maximize preservation of the surrounding soft tissues while promoting periodontal regeneration.

Patients diagnosed with Stage III Grade B periodontitis presenting with 2- or 3-wall intrabony defects will be recruited from the outpatient clinics of the Department of Oral Medicine and Periodontology, Faculty of Dental Medicine, Al-Azhar University. Eligible participants will be randomly allocated to the study groups according to the study protocol.

The primary outcome is radiographic intrabony defect fill assessed using periapical radiographs and cone beam computed tomography (CBCT). Secondary outcomes include probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain. Clinical parameters will be recorded at baseline, 3 months, and 6 months, while radiographic evaluation will be performed at baseline and 6 months.

Inclusion criteria

• Patients aged 39-61 years.
• Systemically healthy patients.
• Diagnosed with Stage III periodontitis.
• Presence of probing pocket depth (PPD) ≥ 6 mm.
• Presence of clinical attachment loss (CAL) ≥ 4 mm.
• Presence of at least one 2- or 3-wall interproximal intrabony defect with:

• Defect depth ≥ 3 mm.
• Angulation width ≥ 45°.
• Each participant contributed one maxillary or mandibular single- or multi-rooted interproximal intrabony defect.

Exclusion criteria

• Patients with any systemic condition contraindicating surgical intervention.
• Pregnant or lactating females.
• Smokers.
• Alcoholic patients.
• History of periodontal therapy within the previous 6 months.
• History of antibiotic administration within the previous 6 months.
• Patients with unacceptable oral hygiene after re-evaluation following Step 1 and Step 2 periodontal therapy.
• Teeth with any degree of mobility.