A variety of factors can lead to teeth loss. From periodontal disease to trauma, the bone remodeling that always follows this event can complicate the subsequent prosthetical rehabilitation [1]. Both removable and implant-fixed restorations require both an adequate quantity of bone and sorrounding soft tissue. Even in severe atrophies of the jaw, nowadays, many bone augmentation techniques are applicable, all with an acceptable long-term stability [2]. Unfortunately, these techniques, especially in major reconstructions, lead to a deficient quantity of soft tissue, above all keratinized mucosa. Whether or not the presence of keratinized tissue around dental implants is necessary, it has been controversial for many years. The lack of evidence in literature regarding implant survival rate in absence of keratinized tissue cannot lead to any conclusion [3]. Nonetheless, the presence of this kind of tissue is desirable for a number of reasons, as shown by many authors. A retrospective study, based on 339 implants, showed that a lack of keratinized tissue around dental implants, especially in the posterior region, led to higher plaque accumulation and mucositis [4]. Thin or narrow (< 1 mm) peri-implant keratinized mucosa was shown to have a higher association with mucosal recessions [5]. At the same time, another retrospective evaluation of 250 implants after 5 to 10 years of functional loading demonstrated a negative correlation between the presence of keratinized tissue and mucosal recessions [6]. Consequently, it is safe to say that sufficient peri-implant keratinized tissue prevents peri-implant plaque accumulation and buccal soft tissue recessions, accordingly reducing the risk of mucositis and peri-implantitis [7, 8]. A surgical technique based on an apically positioned flap (APF) for vestibuloplasty associated with grafting materials (whether autologous or not) is considered the gold standard for soft tissue augmentation [9]. While a number of autologous grafts have been studied in the past, free gingival grafts from the palatal region are considered the most reliable and effective, in spite of the high morbidity of this type of surgery and extremely poor esthetics [10, 11]. In the past few years, collagen matrices (CM) have been studied as a valid substitute for free gingival grafts, in particular the porcine CM Mucograft (Geistlich Biomaterials GmbH, Baden-Baden, Germany). So far, a number of studies have demonstrated that the Mucograft is reliable and comparable with free gingival graft for what concerns achievements in keratinized tissue augmentation around both teeth or dental implants [12,13,14,15]. Additional advantages are a lower patient morbidity due to the absence of a donor site and the high esthetic value, matching texture and color of the adjacent mucosa [11, 15,16,17]. Concerns about long-term stability of this kind of procedure are more than reasonable, as the majority of papers in literature have short-term follow-ups (< 1 year), while just a few extend over this period. The aim of the present research is to evaluate the efficacy of the Mucograft in a standard APF procedure over 5 years of follow-up.