From Bench to Chairside: Collagen Scaffolds in Combination with Mesenchymal Stromal Cells for Gingival Augmentation

<b>Background/Objectives:</b> Gingival tissue deficiencies present significant treatment challenges. We investigated three xenogeneic collagen scaffolds-Fibro-Gide, FibroMATRIX, and Mucoderm-with and without human gingival MSCs for soft tissue augmentation. <b>Methods:</b> The study assessed scaffold properties (mechanical properties and micro-CT structure), cytocompatibility, ex vivo vascular growth stimulation (CAM-test), and in vivo effects in rabbit model. <b>Results:</b> All scaffolds were cytocompatible and maintained MSC viability via extract and contact cytotoxicity tests. Fibro-Gide showed the highest porosity at 78.5%, followed by FibroMATRIX at 64.3%, while Mucoderm had the lowest porosity at 33.2%. Mucoderm exhibited the greatest stiffness due to its dense structure, contrasting with the more similar mechanical properties of Fibro-Gide and FibroMATRIX. In an ex vivo HET-Cam model of the angiogenic response, Fibro-Gide exhibited reduced blood vessel length and blood flow rate compared to FibroMATRIX and Mucoderm. In vivo, Mucoderm resorbed completely, FibroMATRIX demonstrated optimal partial degradation, and Fibro-Gide retained most of its collagen structure. <b>Conclusions:</b> The FibroMATRIX with MSCs combination showed particularly promising results for enhancing tissue thickness and vascularization, suggesting this approach could significantly improve gingival regeneration outcomes.