This study aimed to evaluate the effects of the atomic layer deposited hydroxyapatite (ALD-HA) coating of the titanium (Ti) surface on human gingival keratinocyte (HGK) cell adhesion, spreading, viability, and hemidesmosome (HD) formation. Grade 2 square-shaped Ti substrates were used (n = 62). Half of the substrates were ALD-HA coated, while the other half were used as non-coated controls (NC). The ALD-HA surface was characterized with scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDS) analysis. The initial cell adhesion and HD formation of HGKs were evaluated after a 24-h cultivation period. The cell proliferation was assessed by cultivating cells for 1, 3, and 7 d. The expression levels of the integrin mediating cell adhesion were detected with the Western Blot method. In addition, cell spreading and expression of the proteins mediating cell adhesion were imaged using a confocal microscope. SEM-EDS analysis demonstrated the formation of HA on the ALD-HA surfaces. The relative cell attachment was significantly higher (p < .05) on the ALD-HA compared to the NC surface after 1 and 3 d of cell culture. No significant difference was found in integrin α6 or β4 expression. The microscope evaluation showed significantly increased cell spreading with peripheral HD expression on ALD-HA compared to the NC surfaces (p = .0001). Moreover, laminin γ2 expression was significantly higher on the ALD-HA than on the NC surfaces (p < .001). Compared to the NC Ti surface, the ALD-HA coating has favorable effects on HGK proliferation, growth, and cell spreading. This indicates that the ALD-HA coating has good potential for improving mucosal attachment on implant surfaces.