For several years, the need for keratinized mucosa (KM) to reduce the risk of peri-implant biological complications has been a controversial topic. Recently, several studies and systematic reviews have confirmed that adequate KM may favorably impact peri-implant health and stability in the long-term. This article will review the recent literature on this topic and suggest clinical guidelines for when to increase peri-implant KM to facilitate surgical handling and enhance long-term maintenance. In conclusion, clinicians should keep in mind that a free gingival graft to increase the width of KM before implant placement may be indicated in situations where the soft tissue is so thin that its manipulation could be particularly difficult, as well as when an implant is already present, but patient reports soreness during oral hygiene procedures. Keywords: Free gingival graft, dental implant, keratinized mucosa, supportive care