Over past decades, the use of dental implants has become a routine procedure to replace missing teeth. These offer safe and predictable treatment when used to support either removable or fixed reconstructions (Pjetursson et al. 2012, Srinivasan et al. 2016). However, despite the high rates of implant survival, biological complications frequently occur (Pjetursson et al. 2012). The clinical manifestation of biological complications around implants strongly resembles that of periodontal inflammation (Berglundh et al. 2011).

A systematic review including nine studies with 1,497 patients and 6,283 implants assessed the frequency of peri-implant disease (Atieh et al. 2013). Peri-implant mucositis with signs of bleeding and swelling of the surrounding soft tissues was estimated to occur in 63.4% of patients and in 30.7% of implants (Atieh et al. 2013). The corresponding summary estimates for the occurrence of peri-implantitis with loss of supporting bone are 18.8% and 9.6%, respectively (Atieh et al. 2013). This is in accordance with a review on the prevalence of peri-implantitis, which revealed that after an observation period of 5 to 10 years around 10% of implants and 20% of patients were affected (Mombelli et al. 2012).

Besides general risk indicators, such as poor oral hygiene, a history of periodontitis and smoking (Heitz-Mayfield 2008), local risk factors may play a crucial role in the development and the progression of peri-implant diseases. The presence or absence of keratinized mucosa surrounding dental implants was also discussed as a potential local risk factor influencing the success of dental implants (Cairo et al. 2008, Esposito et al. 2007, Martin et al. 2009, Schrott et al. 2009, Thoma et al. 2014). The aim of this narrative review is to give an overview of the present literature and to provide clinically oriented recommendations.