Innovative Approaches to Enhance Preservation Over Invasion in Minimally Invasive Periodontal Surgery: A Narrative Review.

Minimally invasive surgery (MIS) in periodontology represents a paradigm shift from traditional, trauma-prone surgical procedures to techniques that emphasize tissue preservation, aesthetics, faster recovery, and overall improved patient outcomes. This narrative review delves into the evolution, methodologies, applications, advantages, limitations, and prospects of MIS in periodontal and implant therapy, highlighting key innovations that have refined surgical protocols while enhancing biological and clinical outcomes. The key findings of this narrative review highlight that MIS has significantly advanced periodontal and implant therapy by shifting the focus from extensive tissue resection to preservation, precision, and regeneration. MIS techniques, such as the minimally invasive surgical technique (MIST), modified MIST, vestibular incision subperiosteal tunnel access (VISTA), and tunneling approaches, have demonstrated clear benefits in reducing surgical trauma, enhancing wound stability, and preserving soft tissue architecture, particularly the interdental papillae. These techniques promote faster healing, minimize postoperative complications such as gingival recession, pain, and sensitivity, and offer improved aesthetic outcomes. Furthermore, innovations such as lasers, flapless implant placements, guided sinus augmentation, and soft tissue grafting using allografts have expanded the scope and effectiveness of MIS. Despite some limitations, such as the need for specialized equipment and operator expertise, MIS offers enhanced patient comfort, reduced morbidity, and excellent regenerative outcomes. The integration of robotic-assisted surgery and 3D-guided navigation indicates a promising future for MIS, aligning surgical precision with patient-centered care and long-term clinical success. The evolution of periodontal surgery toward minimally invasive approaches reflects a transformative shift in clinical thinking from aggressive resection to delicate preservation and regeneration. This review comprehensively underscores that MIS is not merely a surgical philosophy but a revolution in periodontal and implant therapy, aligning the goals of biological preservation, aesthetic perfection, and procedural efficiency. As microsurgical and robotic techniques continue to evolve, the scope and success of MIS will expand, making it the cornerstone of contemporary and future periodontal practices.