Living Cellular Construct for Increasing the Width of Keratinized Gingiva: Results From a Randomized, Within-Patient, Controlled Trial

Private practice, Houston, TX 77063, USA.
Journal of Periodontology (Impact Factor: 2.71). 03/2011; 82(10):1414-23. DOI: 10.1902/jop.2011.100671
Source: PubMed


The standard of care for increasing keratinized gingiva adjacent to teeth that do not require root coverage is the free gingival graft (FGG). A pilot study indicated that the use of a living cellular construct (LCC) could be effective in this clinical scenario.
A pivotal, multicenter, randomized, within-patient, controlled, open-label trial was conducted (N = 96 patients). After removing the mucosa and keratinized gingiva from the test site, either an LCC or FGG was applied. The primary efficacy endpoint was the ability of the LCC to regenerate ≥2 mm keratinized gingiva at 6 months. Secondary measures were the same color and texture as the adjacent tissue, a 1-mm width of keratinized gingiva at 6 months, patient treatment preference, surgical site sensitivity at 1 week, and patient-reported pain after 3 days. Safety was assessed by reports of adverse events.
At 6 months, the LCC regenerated ≥2 mm of keratinized gingiva in 95.3% of patients (81 of 85 patients; P <0.001 versus a 50% predefined standard). As expected, the FGG generated more keratinized gingiva than the LCC (4.57 ± 1.0 mm versus 3.2 ± 1.1 mm, respectively). The gingiva regenerated with the LCC matched the color and texture of the adjacent gingiva. All patients achieved ≥1 mm keratinized gingiva with the LCC treatment by 6 months, and more patients preferred treatment with the LCC than with the FGG. No difference in sensitivity or pain was noted between the treatments. The treatments were well tolerated, and reported adverse events were typical for this type of periodontal surgery.
The use of an LCC may provide a safe and effective therapy for augmenting the zone of keratinized gingiva.

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    • "These grafts have an advantage over skin grafts in the sense that presence of hair follicles by their growth later in the graft made this procedure less in demand; in addition autogenous gingival grafts carries the genetic nature of the keratinized mucosa. Further technological advancements came in the form of autologous cultured sheets of mucosa but these procedures caused more shrinkage of augmented tissue.[789] Hence, it sounds logical enough to compare the two procedures namely, Periosteal Fenestration and Free Mucosal Graft for increasing the vestibular depth since there is scarcity of studies comparing these two procedures. "
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    ABSTRACT: Purpose: The aim of the present study was to compare the periosteal fenestration (PF) and free mucosal graft (FMG) techniques in mandibular anterior region to increase the vestibular depth. Methodology: A total of 20 systemically healthy cases (10 patients in each group) with shallow vestibular depth and reduced width of attached gingiva in lower anterior region were included in the present study. Clinical parameters recorded included Gingival index (GI), Plaque index (PI), Oral hygiene index simplified (OHI S), Vestibular depth (VD), width of attached gingiva and post operative discomfort. Findings: The results at the end of 3 months showed that the mean GI, PI, OHI S decreased significantly and remained low throughout the study period. The mean gain in percentage of vestibular depth at the end of 3 months for group 1(PF) was 48.4% with relapse of 7.2% from the baseline. For group 2 (FMG), the mean gain in percentage of vestibular depth at the end of 3 months for was 50% with relapse of 6.2% from the baseline. The mean gain in percentage of attached gingiva at 3 months for group 1 and 2 was 65.9% and 74%, respectively. In comparison of group 1 and 2, group 2 showed better results in terms of increasing the vestibular depth and attached gingiva than group 1 although the intergroup comparison was not statistically significant. Conclusion: When aim of the clinician is to treat a patient with shallow vestibule together with reduced width of attached gingiva, the use of periosteal fenestration yields similar results to that of FMG.
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    • "In other soft tissue applications, allogenic foreskin fibroblasts have been utilized to promote keratinized tissue formation at mucogingival defects [50]. A tissue-engineered living cellular construct comprised of viable neonatal keratinocytes and fibroblasts rendered similar clinical outcomes when compared to conventional gingival autografts [51]. This construct has a strong potential to promote tissue neogenesis through the stimulation of angiogenic signals [88]. "
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