Sealing the soft tissue-implant interface is one of the key issues in preventing transcutaneous implant-associated infections. A promising surface modification for improving osseointegration and possibly soft tissue integration is to coat the implant surface with hydroxyapatite (HA) nanoparticles. When new implant materials are developed, their ability to facilitate cell attachment and spreading are commonly investigated in vitro to establish their potential for good in vivo performance. However, commonly used techniques, such as microscopy methods, are time consuming, invasive, and subjective. This is the first study using quartz crystal microbalance with dissipation monitoring, where the real-time adhesion of biopsy-derived human gingival fibroblasts onto titanium and nanostructured HA was investigated. Experiments were performed for at least 16 h, and we found that cellular attachment and spreading kinetics can be followed in situ by observing the change in dissipation and frequency with time. Interestingly, a correlation between cell coverage and the magnitude of dissipation shift reached at the end of the experiment was found, but no such trend was observed for the frequency. Furthermore, the level of cell coverage was found to influence the cellular attachment and spreading behavior. No difference in cell response to the two surface types, Ti and nanostructured HA, was found. (c) 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 103A: 3139-3147, 2015.