An autologous cell hyaluronic acid graft technique for gingival augmentation: a case series.

Background: An autologous cell hyaluronic acid graft was used for gingival augmentation in mucogingival surgery.

Methods: Seven sites from 6 patients were used in this study. Five patients (5 sites) needed gingival augmentation prior to prosthetic rehabilitation, and one patient (2 sites) needed augmentation because of pain during daily toothbrushing. Full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing depth (PD), and clinical attachment level (CAL) were recorded for the sites at baseline and 3 months after surgery. The amount of keratinized tissue (KT) was measured in the mesial, middle, and distal sites of each involved tooth. A small 2 x 1 x 1 mm portion of gingiva (epithelium and connective tissue) was removed from each patient, placed in a nutritional medium, and sent to the laboratory. The gingival tissue was processed: keratinocytes and fibroblasts were separated and only fibroblasts were cultivated. They were cultured on a scaffold of fully esterified benzyl ester hyaluronic acid (HA) and returned to the periodontal office under sterile conditions. During the gingival augmentation procedure, the periosteum of the selected teeth was exposed, and the membrane containing cultivated fibroblasts was adapted to and positioned on the site.

Results: Three months after surgery, an increased amount of gingiva was obtained, and the histological examination revealed a fully keratinized tissue on all the treated sites.

Conclusion: Tissue engineering technology using an autologous cell hyaluronic acid graft was applied in gingival augmentation procedures and provides an increase of gingiva in a very short time without any discomfort for the patient.