The Pinhole Surgical Technique (PST) was first described in the International Journal of Periodontics and Restorative Dentistry (IJPRD) in October 2012, in a case series involving 43 patients with 121 recession defects, including follow-up data for 37 patients with 85 Miller Class I-II recession defects over an average period of 20.0 ± 6.7 months. The current study provides a long-term follow-up assessment of 28 patients with 68 Miller Class I-II sites from the original study, with an average follow-up period of 173.8 ± 32.2 months (14.5 ± 2.7 years). The percentage of complete root coverage (CRC) for Class I-II sites was 81.2% in the original study and 77.9% in this follow-up study. The mean root defect coverage was 94.0% ± 14.8% in the original study and 86.6% ± 27.4% in the follow-up study. Within the limitations of this study's design, PST demonstrates long-term predictability and effectiveness in achieving sustained root coverage over an average period of 14.5 years.