Attached Gingiva: How Much is Necessary for Maintaining Periodontal Health after Implants?

3mm at least, the more the better

Though scientific evidence is equivocal at this point,most of us would agree that its better to have at least 3 mm of keratinized tissue around implant restorations.It pays to assess the location of the mucogingival junction prior to implant therapy in order to plan surgical approach from the decision to flap or not (I've seen many who are so enamoured by the flapless technique that they fail to do this basic exam and struggle later) to the decision of doing a single stage or two stage and also the location of the incision. As a general rule if the buccal mucogingival junction is 2 mm or more buccal to the crest of the ridge,and all other factors like ridge width etc are favourable,an incision 1 mm lingual to the crest,implant placement,healing abutment placed and suture with a 1mm gap between the lips of the flap to encourage 2ndary healing/scarring and you'll see adequate attached tissue around your implant.If the MGJ is more towads the crest, an apically displaced flap at the time of placement(single stage) or at 2nd stage(2 stage )will help achieve good results.The problem really arises in situations where the MGJ lies lingual to the crest and there is aumentation to be done along with implant placement,where the primary concern is with getting closure.In these cases,free gingival/connective tissue with apical displacement prior to implantation or at 2nd stage would be the way to go. Given the evidence available it would be presumptuous at most to say that the lack of attached tissue would doom the implants,but as a reponsible practitioner you'd like to heve all your bases covered and so as william said the more the better

Remember why we need the attached tissue. Bob James showed years ago the circular fibers are located in this area. They will hold the tissue tight to the implant neck for the epithelial cells to adhere to the surface of the implant. I have found that 3-5 mm will work, if the patient will have good oral care.

I myself think attached gingiva is key to long term health of implants. But if you look at the orginal branemark studies in sweden, most had no KG. Lang showed in teeth you need 2mm of KG. I think 2mm for implant is the lowest you can go.

LET ME SAY THIS ONCE...IT IS BIOLOGICALLY IMPOSSIBLE FIR GINGIVA TO ATTACH TO AN IMPLANT SURFACE. READ BETWEEN THE LINES OF THE STUDIES AND REVIEW PHYSIOLOGY AND ANATOMY BOOKS AGAIN. There are companies stating they are getting gingiva attachment through a roughing process at the neck. All this doing is the gingiva is laying up on the surface like playdo on a roughed wall. NO TRUE ATTACHMENT!!! Now you so need good keratanized tissue around implants. This equates to one reason...good blood supply which helps in protecting the bone so it can survive. Now bone can survive with mucosa, however studies show it has a faster resorbtion rate with mucosa. Good luck.