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 peri-

implant 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;5:117–124. “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):1170-

7. “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 peri-

implant region to plaque-induced tissue destruction.”

13. Wennström 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.”