While current evidence on the importance of keratinized and/or attached mucosa around teeth and implants for their health and survival is equivocal, it has been proposed that the establishment of a circumferential seal of tightly packed collagen around the implant-oral cavity interface may improve long-term implant success.83 Implant survival rates have been shown to be equivalent for implants placed in keratinized and alveolar mucosa, but increased radiographic bone loss and higher levels of gingival inflammation are associated with a lack of keratinized mucosa.84 While there are no definitive studies to conclude that there is a benefit when implants have an adequate band of fixed and/or keratinized mucosa, in patients with other risk factors, including increased plaque accumulation and previous history of periodontitis, increased keratinized and/or fixed mucosa may be protective to allow for personal and professional plaque removal.84
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