Cellularized Biomaterials Used as Gingival Connective Tissue Substitutes In Vivo: A Systematic Review

Area of Science:

• Biomaterials Science
• Tissue Engineering
• Periodontology

Background:

• Gingival recession and loss necessitate effective grafting solutions.
• Existing treatments for oral soft tissue augmentation have limitations.
• Tissue engineering offers a promising approach to create gingival substitutes.

Purpose of the Study:

• To systematically review cellularized biomaterials and technologies for engineered gingival substitutes.
• To analyze in vivo studies on graft remodeling and vascularization.
• To identify advancements for compensating gingival loss.

Main Methods:

• Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
• Electronic database search (PubMed, Scopus, Web of Science, Cochrane Library).
• Inclusion of in vivo studies comparing gingival substitutes with controls; risk of bias assessed using SYRCLE checklist.

Main Results:

• Nineteen studies included, mostly using rodent models with subcutaneous implantation.
• Fibroblasts and oral stem cells were common cell sources; naturally derived scaffolds (fibrin, collagen, ECM) were prevalent.
• Engineered grafts demonstrated vascularization and extracellular matrix remodeling, with 3D bioprinting showing potential.

Conclusions:

• Diverse cellularized biomaterials can achieve vascularization and remodeling for gingival tissue engineering.
• Current solutions remain insufficient, highlighting the need for improved bio-inks and techniques.
• Findings can guide the development of advanced 3D bioprinting strategies for clinical applications in treating gingival loss.