Free connective tissue graft techniques are currently considered the most predictable surgical method for root coverage. However, morbidity associated with secondary graft sites has generated interest in other methods. The purpose of this study was to investigate the feasibility of a novel surgical approach to root coverage: the pinhole surgical technique (PST). This retrospective study examined the results of PST used for 43 consecutive patients on 121 recession sites, of which 85 were Class I or II and 36 were Class III. Mean initial recession for all sites was 3.4 ± 1.0 mm. The mean assessment period was 18 ± 6.7 months. No secondary surgical site was necessary, and only bioresorbable membrane or acellular dermal matrix was used as graft material. PST required no releasing incision, sharp dissection, or suturing (when a bioresorbable membrane was used). Only one incision of 2 to 3 mm (for entry) was necessary for the entire procedure. Predictability of PST for Class I and II sites, measured as frequency of complete root coverage, was 81.2%. Effectiveness of PST for Class I and II sites, measured as mean percent defect reduction, was 94.0% ± 14.8%. When data from Class I, II, and III sites were combined, predictability and effectiveness were 69.4% and 88.4% ± 19.8%, respectively. The mean duration per procedure was 22.3 ± 10.1 minutes. The mean level of patient subjective esthetic satisfaction was 95.1% and was realized within a mean 7.34 ± 13.5 days. Postoperative complications were minimal. These results indicate that PST holds promise as a minimally invasive, predictable, effective, and time- and cost-effective method for obtaining optimal patient-based outcomes.