The Clinical Significance of Attached Gingiva in the Natural Dentition

Background: The attached gingiva (AG) is the portion of the gingiva firmly bound to the underlying alveolar bone and root cementum, rendering it immobile during functioning. Its dense connective tissue attachment contributes to resistance against mechanical challenges, stabilization of the gingival margin, and dissipation of forces transmitted from the alveolar mucosa. Histologically, AG is characterized by a keratinized epithelium supported by dense collagen fiber bundles, which provide structural integrity to the dento–gingival unit. Clinically, the buccal and lingual width of AG is estimated by subtracting sulcus depth from the total width of keratinized tissue. Although periodontal health may be maintained with minimal AG under optimal plaque control, substantial evidence supports its role in preserving gingival architecture and resisting mechanical trauma. Practical Application: From a clinical perspective, an adequate width of attached gingiva has traditionally been considered necessary to protect the periodontium; however, clinical situations may exist in which its dimension is reduced or absent. Available evidence suggests that a minimal width of approximately 1 mm of attac