[Establishing adequate periimplant zone of keratinized mucosa to enhance periimplant health]

The presence of an adequate zone of keratinized mucosa (KM) for maintaining gingival health associated with natural teeth is usually described as the presence of 1-2 mm of attached gingiva (AG). Dental implants without KM measuring 2 mm or more, exposed to high levels of bacterial plaque, have shown higher scores of plaque accumulation, peri-implant 'mucosal inflammation', bleeding on probing, peri-implantitis, alveolar bone loss and recession. In a recent study the effects of KM width on peri-implant tissue health was assessed. Significant improvements in clinical and immunological parameters were noted after increasing KM width by the use of free gingival graft (FGG) surgery. A recent systematic review evaluated the efficacy of various techniques and biomaterials adopted in periimplant KM augmentation. Free gingival graft, connective tissue graft, acellular dermal matrix and collagen matrix were used for KM augmentation. Improvements in KM width were reported in all studies. A definitive conclusion could not be achieved owing to the lack of well-designed studies and appropriate methods of studying soft tissue. The establishment of universal surgical guidelines and measurement systems is imperative in the future. The present manuscript will describe the clinical use of FGG for establishing adequate periimplant zone of KM to enhance periimplant health.