As effective modalities to improve the stability of peri-implant hard and soft tissue, keratinized mucosa augmentation has increasingly been applied in daily practice. Nonetheless, there is still lack of in-depth comprehensive discussion regarding the surgical risk factors, the decision-making strategy and the surgical principle. In this article, three routine procedures of peri-implant keratinized mucosa augmentation were introduced. The surgical principles were deeply discussed and summarized with five key principles. Based on the risk assessment of local factors, the effects of which were analyzed on keratinized mucosa augmentation comprehensively, the authors proposed a decision-making protocol for selection of surgical procedures in the end, intending to provide guidelines for clinical application.
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