Background: Periodontists have found the gingival autograft to be an effective and predictable technique to increase the amount of attached gingiva around teeth, but this technique requires the surgeon to harvest donor tissue from a remote surgical site. The present study seeks to evaluate the safety and effectiveness of a tissue-engineered skin equivalent, a living human fibroblast-derived dermal substitute (HF-DDS), compared to a gingival autograft (GA) consisting of donor tissue harvested from the patient's palate in a procedure designed to increase the amount of keratinized tissue around teeth that do not require root coverage.

Methods: Twenty-five patients with insufficient attached gingiva associated with at least two teeth in contralateral quadrants of the same jaw were treated. One tooth in each patient was randomized to receive either a GA (control) or a HF-DDS graft (test). Clinical parameters measured at baseline and 3, 5, 7, 9, and 12 months included recession, clinical attachment level, keratinized tissue height, and plaque index. Probing depth was measured at 7, 9, and 12 months. Inflammation of each site was scored and texture and color of the grafted tissue were compared to the surrounding tissue. Resistance to muscle pull was evaluated and a questionnaire was used to determine patient preference. Surgical position of the graft and alveolar bone level were recorded at the surgical visit and patients were evaluated weekly for the first 4 weeks at which time recession and level of oral hygiene were measured. Biopsies and persistence studies were performed on a subset of the patients.

Results: Results for both test and control groups were similar for all measured clinical parameters with the exception of amount of keratinized tissue and percent shrinkage of keratinized tissue. The control group exhibited an average of 1.0 to 1.2 mm more keratinized tissue over time than the test group (P <0.001) and the control group had about half as much shrinkage as the test group over time (P <0.001). Test sites demonstrated significantly better color match over time compared to control sites. Similarly, tissue texture for test sites was significantly better than control sites over time.

Conclusions: Based on the results of this investigation, the tissue engineered HF-DDS graft was safe and capable of generating keratinized tissue without the morbidity and potential clinical difficulties associated with donor site surgery. The GA generated more keratinized tissue and shrank less than the HF-DDS graft, but the test graft generated tissue that appeared more natural. J Periodontol 2005;76:867-880.