1. Adibrad M, Shahabuei M, Sahabi M.

Significance of the width of keratinized mucosa on the

health status of the supporting tissue around implants supporting overdentures. J Oral
Implantol. 2009;35(5):232-7. A wider mucosal band (> or = 2 mm) was associated with less
mucosal recession and periodontal attachment loss compared with a narrow (< 2 mm) band.
The absence of adequate keratinized mucosa around implants supporting overdentures was
associated with higher plaque accumulation, gingival inflammation, bleeding on probing, and
mucosal recession.
2. Artzi Z, Tal H, Moses O, Kozlovsky A. Mucosal considerations for osseointegrated implants. J
Prosthet Dent. 1993 Nov;70(5):427-32. Lack of masticatory mucosa and the presence of
alveolar mucosa embracing the implant are often associated with plaque, which can induce
inflammation resulting in subsequent peri-implant destruction.
3. Bengazi F, Lang NP, Caroprese M, Urbizo Velez J, Favero V, Botticelli D. Dimensional changes in
soft tissues around dental implants following free gingival grafting: an experimental study in
dogs. Clin Oral Implants Res. 2013 Oct 24. doi: 10.1111/clr.12280. [Epub ahead of print] The
increase in the alveolar mucosal thickness by means of a gingival graft affected the periimplant marginal bone resorption and soft tissue recession around implants. This resulted in
outcomes that were similar to those at implants surrounded by masticatory mucosa,
indicating that gingival grafting in the absence of keratinized mucosa around implants may
reduce the resorption of the marginal crest and soft tissue recession.
4. Berglundh T. Lindhe J: Dimension of the periimplant mucosa. Biological width revisited. J Ctin
Periodontol 1996: 23: 971-973. This implies that a certain minimum width of the periimplant
mucosa may be required, and that bone resorption may take place to allow a stable soft tissue
attachment to form.
5. Bouri A Jr, Bissada N, Al-Zahrani MS, Faddoul F, Nouneh I. Width of keratinized gingiva and the
health status of the supporting tissues around dental implants. Int J Oral Maxillofac Implants.
2008 Mar-Apr;23(2):323-6. Increased width of keratinized mucosa around implants is
associated with lower mean alveolar bone loss and improved indices of soft tissue health

6. Boynuegri D, Nemli SK, Kasko YA. Significance of keratinized mucosa around dental implants: a
prospective comparative study. Clin Oral Implants Res. 2013 Aug;24(8):928-33. The results of
this study showed that an adequate band of keratinized mucosa was related with less plaque
accumulation and mucosal inflammation as well as pro-inflammatuar mediators, suggesting
that it may be critical especially for plaque control and plaque associated mucosal lesions
around dental implants.
7. Chavrier C, Couble ML, Hartmann DJ. Qualitative study of collagenous and noncollagenous
glycoproteins of the human healthy keratinized mucosa surrounding implants. Clin Oral
Implants Res. 1994;5:117124. The distribution of intersticial collagenous and noncollagenous
glycoproteins of keratinized mucosa surrounding successful endosseous implants was similar
to normal gingiva. It clearly demonstrated the capacity of integration of successful
endosseous implants in the surrounding keratinized mucosa.

8. Chung DM, Oh TJ, Shotwell JL, Misch CE, Wang HL. Significance of keratinized mucosa in
maintenance of dental implants with different surfaces. J Periodontol. 2006 Aug;77(8):1410-20.
The absence of adequate KM or AM in endosseous dental implants, especially in posterior
implants, was associated with higher plaque accumulation and gingival inflammation but not
with more ABL, regardless of their surface configurations. Randomized controlled clinical trials
are needed to confirm the results obtained in this retrospective clinical study.
9. Kim BS, Kim YK, Yun PY, Yi YJ, Lee HJ, Kim SG, Son JS. Evaluation of peri-implant tissue response
according to the presence of keratinized mucosa. Oral Surg Oral Med Oral Pathol Oral Radiol
Endod. 2009 Mar;107(3). In cases with insufficient keratinized gingiva in the vicinity of
implants, the insufficiency does not necessarily mediate adverse effects on the hygiene
management and soft tissue health condition. Nonetheless, the risk of the increase of gingival
recession and the crestal bone loss is present. Therefore, it is thought that from the aspect of
long-term maintenance and management, as well as for the area requiring esthetics, the
presence of an appropriate amount of keratinized gingiva is required.
10. Schrott AR, Jimenez M, Hwang JW, Fiorellini J, Weber HP. Five-year evaluation of the influence
of keratinized mucosa on peri-implant soft-tissue health and stability around implants
supporting full-arch mandibular fixed prostheses. Clin Oral Implants Res. 2009 Oct;20(10):11707. In patients exercising good oral hygiene and receiving regular implant maintenance
therapy, implants with a reduced width of <2 mm of peri-implant keratinized mucosa were
more prone to lingual plaque accumulation and bleeding as well as buccal soft-tissue
recession over a period of 5 years.
11. Sullivan H., Atkins J. Free Autogenous Grafts. I. Principals of Successful Grafting. Periodontics
1968; 6(1) 5-13. Free gingival grafts are utilized to increase the zone of attached gingiva and
extend the vestibular fornix.
12. Warrer K, Buser D, Lang NP, Karring T. Plaque-induced peri-implantitis in the presence or
absence of keratinized mucosa. An experimental study in monkeys. Clin Oral Implants Res.
1995 Sep;6(3):131-8. The results of this study suggest that the absence of keratinized
mucosa around dental endosseous implants increases the susceptibility of the periimplant region to plaque-induced tissue destruction.

13. Wennstrm JL, Derks J. Is there a need for keratinized mucosa around implants to maintain
health and tissue stability? Clin Oral Implants Res. 2012 Oct;23 Suppl 6:136-46. The objective
of the present review was to analyze the literature with regard to the need for keratinized
mucosa around implants to maintain health and tissue stability. Collectively, the findings of
this review show that evidence in support of the need for keratinized tissues around implants
to maintain health and tissue stability is limited.