Minimally invasive surgical techniques in periodontics – A comprehensive narrative review of concepts and clinical applications

Introduction: Minimally invasive surgical techniques (MISTs) have reshaped periodontal therapy by emphasizing tissue preservation, reduced morbidity, and improved esthetics. This review consolidates evidence on the evolution, definitions, indications, and clinical applications of MIST in periodontal regeneration, root coverage, gingival augmentation, and implantology, highlighting recent innovations. Methods: A narrative review was conducted of English-language literature from 1998 to 2024, retrieved from PubMed, Scopus, and Google Scholar. Thirty-eight original and review articles addressing MIST in periodontology were included. Search terms comprised “minimally invasive periodontal surgery,” “periodontal microsurgery,” “root coverage,” and “implant MIST.” Non-dental studies were excluded. A thematic synthesis examined clinical protocols, outcomes, and limitations. Results: Techniques reviewed included Modified Papilla Preservation Technique, Simplified Papilla Preservation Technique, Modified MIST, Single Flap Approach, Vestibular Incision Subperiosteal Tunnel Access, Pinhole Surgical Technique (PST), and the Subperiosteal Minimally Invasive Aesthetic Ridge Augmentation. These approaches demonstrated enhanced wound stability, reduced postoperative discomfort, and superior esthetic outcomes. Limitations noted were technical sensitivity, operator dependence, and equipment costs. Discussion: MIST offers improved patient-centered outcomes compared to conventional surgery but requires specialized training and resources. While papilla preservation methods are well-supported, the predictability of newer approaches such as PST and SMART remains under investigation. Further randomized controlled trials are necessary to validate long-term outcomes. Case selection, clinician expertise, and technological advancement will continue to influence the adoption and success of MIST in periodontal care.