A controlled clinical trial of implant-retained mandibular overdentures: 10 years' results of clinical aspects and aftercare of IMZ implants and Brånemark implants

Abstract: The aim of this prospective randomized controlled clinical trial was to evaluate the clinical outcomes and prosthetic aftercare of edentulous patients with a mandibular overdenture retained by two IMZ implants or two Brånemark implants during a 10‐year period. Patients were allocated to the IMZ group (n=29) or the Brånemark group (n=32) by a computerized balancing method. In the IMZ group, four implants were lost during the 10‐year follow‐up (survival rate: 93%). In the Brånemark group, nine implants were lost (survival rate: 86%). All patients were re‐operated successfully. Multiple prosthetic revisions were necessary in both groups; especially the precision attachment system in the overdenture (23% of the total number of revisions) and the denture base and teeth (26% of the total number of revisions) were subject to frequent fracture. From this study, it can be concluded that both the IMZ implant and the Brånemark implant systems supporting an overdenture are functioning well after 10 years of follow‐up. There are no indications of a worsening of clinical or radiographical state after 10 years.     

Clinical and radiological results of patients treated with two loading protocols for mandibular overdentures on Brånemark implants

Objective: The aim of this study was to evaluate clinical and radiological outcomes of the unsplinted implants supporting mandibular overdenture when applying conventional or early loading protocols. Material and Methods: Twenty‐six edentulous patients were treated with two unsplinted Brånemark System implants supporting mandibular overdenture. There was a test group, in which the overdenture was connected 1 week after surgery, and a control group, in which the overdenture was connected 3 months after surgery. Peri‐implant paremeters were recorded 1, 6, and 12 months after surgery. Clinical stability measurements were performed at surgery, and after 3, 6, and 12 months. Marginal bone levels were evaluated at implant surgery, after 6, and after 12 months. Results: No implant from either group was lost. Clinical peri‐implant parameters, clinical stability measurements, and marginal bone resorptions showed no statistically significant differences between two groups during 12 months. Conclusion: The results of this study suggest that one‐week of early loading protocol of two Brånemark implants supporting mandibular overdenture does not compromise implant stability, marginal bone loss, and peri‐implant soft‐tissue health.     

A study of 275 retrieved Brånemark oral implants

The aim of this report was to describe the bone tissue response to Br?nemark oral implants retrieved from patients. The material consisted of consecutively received Br?nemark threaded oral implants and related patient data provided by clinicians. The implant samples were processed into undecalcified sections for evaluation under the light microscope. The analysis demonstrated a lower percentage of bone-to-implant contact for the unloaded implants as compared to the loaded implants. When the threads were divided into four different regions, the loaded implants had a lower percentage of bone-contacting length at the thread top as compared to the other three regions.     

Implant-retained mandibular overdentures with Brånemark System MKII implants: a prospective comparative study between delayed and immediate loading

This study was designed to compare the results of immediate and delayed loading of implants with implant-retained mandibular overdentures. Ten patients (test group) received 40 Br?nemark System MKII implants (4 per patient) placed in the interforaminal area of the mandible. Standard abutments were immediately screwed to the implants, rigidly connected with a bar, and immediately loaded with an overdenture. Ten patients (control group) received the same type and number of implants in the same area, but the implants were left to heal submerged. Four to 8 months later, standard abutments were screwed to the implants and the same prosthetic procedure was applied. Each implant was evaluated at the time of prosthetic loading and at 6, 12, and 24 months after the initial prosthetic load with the following parameters: modified Plaque Index (MPI), modified Bleeding Index (MBI), probing depth (PD), and Periotest. Peri-implant bone resorption was evaluated on panoramic radiographs taken 12 and 24 months after initial prosthetic loading. No significant differences were found between the 2 groups regarding MPI, MBI, Periotest, peri-implant bone resorption, and PD at 6 and 24 months (P > .05). The only difference was found regarding PD values on the mesial and lingual sites at 12 months (P < .05). The cumulative success rate of implants was 97.5% in both groups. Results from this study showed that immediate loading of endosseous implants rigidly connected with a U-shaped bar does not seem to have any detrimental effect on osseointegration. Conversely, this method significantly shortens the duration of treatment with relevant satisfaction for the patients.     

Mandibular overdentures supported by two Brånemark, IMZ or ITI implants: a 5-year prospective study

OBJECTIVES: The aim of this prospective comparative study was to evaluate the survival rate and the condition of the peri-implant tissues of the IMZ implant system (two-stage cylindertype), the Br?nemark implant system (two-stage screwtype) and the ITI implant system (one-stage screwtype) supporting a mandibular overdenture during a 5-year follow-up period. MATERIAL AND METHODS: Three groups of 30 edentulous patients were treated with two endosseous implants in the interforaminal region of the mandible. Clinical and radiographic parameters were evaluated immediately after completion of the prosthetic treatment and after 1, 2, 3, 4 and 5 years of functional loading. RESULTS: The five-year survival rate is 98.3% for the IMZ group, 98.3% for the Br? group and 100% for the ITI group. Mean scores on indices for plaque, calculus, gingiva and bleeding were very low at all evaluation periods. Mean marginal bone loss over a period of 5 years, was 1.4 mm for the IMZ group, 0.7 mm for the Br? group and 0.9 mm for the ITI group. CONCLUSION: It is concluded that two implants placed in the interforaminal region, connected with a bar, supply a proper base for the support of a mandibular overdenture in the edentulous patient. After 5 years no clinically relevant and statistically significant radiographic changes had developed between the three implant systems.     

Fixed mandibular restorations on three early-loaded regular platform Brånemark implants

Background: Originally, the Brånemark System was used as a two‐stage surgical procedure. Comparable clinical results have made one‐stage and early‐loading concepts possible alternatives in the edentulous mandible. From the patient's point of view, the financial aspect of implant treatment is important. In an attempt to decrease financial burden, the reduction of surgical interventions and reduction of the number of implants could be considered. Purpose: This prospective multicenter study evaluated (1) the 1‐and 3‐year success rates of implants loaded within 1 month after one‐stage surgery with a fixed 10‐ to 12‐unit bridge on three regular platform Brånemark System implants in the mandible, (2) the outcome of the prosthetic treatment, and (3) the opinion of patients regarding the treatment procedure. Materials and Methods: Of 20 patients, 19 received five implants in the mandible, of which three were functionally loaded with the one‐stage technique (group 1). The loaded implants were inserted in a tripodal position, one implant in the symphysis and two located anterior of the mental foramen in the bicuspid area. Two additional implants were inserted for safety reasons but were not intended to be included in the restoration. These two additional implants served as either an unloaded one‐stage control implant (group 2) or an unloaded control implant installed with the submerged technique (group 3). Immediately after surgery, the implants were loaded with a relined denture. The patients received a 10‐ to 12‐unit prosthetic reconstruction an average 31 days (range, 4‐53 d) after surgery. Implant stability was clinically checked at 3, 12, and 36 months. Radiographs were taken at corresponding follow‐up visits to calculate bone‐to‐implant level and marginal bone resorption. Results: Six of 60 functionally loaded implants (10%) and 3 of 20 prostheses (15%) failed within the first year. The cumulative implant failure rate in group 1, both after 1 and after 3 years, was 9.5%. No implant failure occurred in the control groups 2 and 3. The average marginal bone level measured at 1 and 3 years was 1.6 mm (SD = 0.8 mm) and 2.1 mm (SD = 0.2 mm), respectively, for group 1; 1.5 mm (SD = 1.3 mm) and 2.4 mm (SD = 0.6 mm), respectively, for group 2; 0.8 mm (SD = 1.4 mm) and 0.7 mm (SD = 0.9 mm), respectively, for group 3. Conclusions: The results of treatment using three regular platform Brånemark System implants supporting a fixed mandibular arch reconstruction were less favorable than the outcome that can be expected with a standard four‐ to six‐implant with one‐stage surgery.     

A clinical, radiographic, and microbiologic comparison of Astra Tech and Brånemark single tooth implants

Background: The soft tissues around single tooth implants differ fundamentally from the gingiva around natural teeth. There are very limited data comparing soft tissues around different implant systems. Aim: To assess whether the design characteristics of dental implants, particularly the implant‐abutment junction, may affect the dimensions and health of the peri‐implant soft tissues and radiographic bone levels. Subjects and Method: Fifteen Astra Tech and 15 Brånemark single tooth implants that had been in function for a minimum of 2 years in 30 partially dentate subjects were examined for plaque accumulation, probing depth, and bleeding on probing and compared to contralateral healthy teeth. Standardized radiographs were taken to measure the most coronal bone to implant contact on the mesial and distal surfaces. In addition, samples of subgingival plaque were taken on paper points and examined by darkfield microscopy. Results: Significantly higher mean probing depths (p < .001) and higher mean percentage of spirochetes (p= .003) were found at implants compared to teeth. In this sample, the Brånemark implants had significantly higher probing depths than the Astra Tech implants (median and interquartile range: Astra Tech 2.7 mm [2–3], Brånemark 3.3 mm [3–3.7] p= .026) and the most coronal bone to implant contact was closer to the implant–abutment junction in the Astra Tech implants (Astra Tech 0.6 mm [0.2–0.9], Brånemark 1.6 mm [1.4–2.0]. p < .001). Conclusion: Although there were statistically significant differences between the two implant systems, the clinical differences were small and probably reflect differences in the biologic width in relation to the location and design of the implant‐abutment junction.     

Radiographic follow-up analysis of Brånemark dental implants

Radiography plays an important role in clinical routine practice and in research projects evaluating dental implants, among them Br?nemark System. Presence of a peri-implant radiolucency has been used in studies as a criterion for implant failure without knowledge of its diagnostic accuracy. More precise determination, whether implants are osseointegrated or not, can be achieved if prosthetic constructions are detached to test implant stability. Such an approach is time-consuming and cumbersome. Hence, the accuracy in radiographic diagnosis of clinical instability has to be evaluated. Further, radiography is a commonly used diagnostic tool for monitoring marginal bone loss. Little is known about the observer variation. Long-term follow-up studies have shown conventional implant therapy to be a reliable procedure with few complications and minor average bone loss. Lately, studies have shown progressive bone loss in higher frequencies. When testing accuracy in diagnosis of clinical instability in intra-oral radiographs, it was found to be as good as of many other radiographic procedures, e.g. caries diagnosis. Possibility of predicting instability, however, can be low in populations with low prevalence of implants showing loss of osseointegration. Intra-observer variation was found to be the largest source of the total variation when studying inter- and intra-observer variability in radiographic bone level assessments. The number of radiographs in which individual implants were displayed had an influenced on intra-observer variation, while radiographic density and increased bone loss influenced the total inter-observer variation. Reliability can be improved by multiple readings by one observer or, even better, by letting several observers make several, independent readings, this limits the effect of a single observer who may be an outlier. Marginal bone level was assessed in 640 patients with a radiographic follow-up of > or = 5 years. The number of implants with a mean bone level of > or = 3 mm below the fixture-abutment connection increased from 2.8% at prosthesis insertion to 17.2% after 15 years. Implant-based bone loss was as a mean 0.8 mm (SD 0.8) after 5 years, followed by only minor average changes. Mean bone loss on patient level followed a similar pattern. Disregarding of follow-up time, altogether 183 implants showed a bone loss > or = 3 mm from prosthesis insertion to last examination, most of them in totally edentulous patients. Seventy of the 183 implants were found in 19 of the 107 patients. Hence, there seems to be a clustering effect. For the entire group of patients significantly larger bone loss was found the older the patient was at surgery and for lower jaw implants. Placement of the implant within the prosthetic construction, regardless of jaw-type, was found to be a predictor of a bone loss > or = 2 mm with minor bone loss around implants placed in an end position. Other predictors were age and jaw-type. The number of intra-oral radiographs per examination, and more importantly, radiographic examinations can be reduced without jeopardizing good clinical management, a statement valid also for Br?nemark implants with advanced bone loss. To conclude, conventional implant treatment can still be regarded as a reliable and safe procedure.     

A prospective clinical evaluation of different single-tooth restoration designs on osseointegrated implants. A 3-year follow-up of Brånemark implants

Since single-tooth implant restorations were introduced 12 years ago (Jemt 1986), there has been continuous development both in the technical design and the aesthetic outcome of the treatment. In order to ensure high quality in single-tooth implant treatments a clinical follow-up study was carried out on patients treated with modifications to the original regimen. In this study 69 consecutive patients were provided with 80 single-tooth implant restorations. The patients were followed for 3 years. There was continuous development of the prosthetic design during the time of the study, allowing us to analyse possible prognostic differences for the different prosthetic treatments. This study confirms earlier reports which describe the single-tooth implant treatment as a safe method with few surgical complications and minimal marginal bone loss. Only 1 implant was lost during the follow-up period and the average marginal bone loss was 0.48 mm over the 3-year follow-up period. Crowns veneered with acrylic and with gold casted directly to the abutments, screwed onto the implants, led to recurring prosthetic complications and gave an appearance of rapid ageing. The first generation of crowns made following the Cera-One design, sometimes produced a gap between the crown and the abutment associated with significant marginal bone loss during the first year. Few surgical or prosthetic complications were noted with cemented all-ceramic constructions, although the number of these crowns in this study was limited.     

Immediate functional loading of Brånemark system implants in edentulous mandibles: clinical report of the results of developmental and simplified protocols

PURPOSE: This report evaluates the 5-year results of 9 of 10 patients in a clinical investigation of immediate functional loading of Br?nemark System implants in edentulous mandibles, and of 24 patients treated with a simplified protocol for the same indication. The purpose of the paper is to suggest a simple, reliable, and documented method for immediate implant loading of complete-arch mandibular prostheses. MATERIALS AND METHODS: Ten healthy patients in need of full-arch mandibular implant reconstruction (development group) were treated between December 1993 and December 1994 with 130 Br?nemark System standard Implants, placed in fresh extraction and healed sites. Four implants per patient were immediately loaded with acrylic resin fixed prostheses. The prostheses were replaced by metal-framework conversion prostheses approximately 6 weeks later, and definitive metal-reinforced prostheses incorporating all implants were placed after second-stage surgery. An additional 24 patients were treated with a simplified protocol using a total of 144 implants placed between March 1997 and October 2000. In these patients, the acrylic resin prostheses were not disturbed for 3 months, and fewer implants were used with an increasing ratio of implants loaded. Eventually, all Implants were loaded immediately for the last patients treated. RESULTS: The prosthesis survival rate was 100% for the total material. In the developmental group, the implant cumulative survival rate was 80% for the immediately loaded implants after 5 years, while the 2-stage implants reached 96%. Bone level measurements showed no differences between immediate and 2-stage protocols for this group. The implant cumulative survival rate was 97% for the simplified treatment group. DISCUSSION AND CONCLUSION: A predictable and simple concept for loading of immediate implant prostheses in edentulous mandibles was demonstrated. Results from the development of this technique suggest that it may be essential to maintain the initial implant splinting over a healing period of about 3 months and that implant placement between the mental foramina provides optimal support.     

Immediate loading of Brånemark implants: a 24-month follow-up of a comparative prospective pilot study between mandibular overdentures supported by Conical transmucosal and standard MK II implants

Background: The purpose of this prospective study is to compare the long‐term outcome of immediately loaded implantretained mandibular overdentures supported by four screw‐type one‐piece transmucosal implants with that of four screw‐type two‐piece implants inserted in the interforaminal area of the mandible and rigidly connected by a U‐shaped curved Materials and Methods: A prospective pilot study was conducted with 10 patients receiving an implant‐supported overdenture in the mandible. The patients were randomly assigned to two groups. In the control group (five patients), four standard Brånemark implants (MK II; Nobel Biocare AB, Gothenburg, Sweden), 3.75 mm large and at least 10 mm long, were sited anterior to the mental foramina, and four standard abutments (Nobel Biocare AB) for bar construction were immediately screwed to the implants. In the test group (five patients), four conical transmucosal implants (Nobel Biocare AB), 3.75 mm large and at least 9 mm long in the threaded part, were sited anterior to the mental foramina. Immediately after implant placement, a U‐shaped gold or titanium bar was fabricated and implants were immediately loaded (within 24 h) in both groups with an implant‐retained overdenture. The patients were followed up for a minimum of 24 months. Implants were evaluated at the time of immediate loading and at 12 and 24 months after prosthetic loading, with the following parameters: modified plaque index (MPI), modified bleeding index (MBI), and probing depth (PD). Periimplant bone resorption was evaluated on panoramic radiographs taken 12 and 24 months after the beginning of prosthetic loading. Results: No significant differences were found between the two groups with regard to MPI, MBI, PD, and periimplant bone resorption at 12 and 24 months. The cumulative success rate of implants according to the criteria proposed by Albrektsson and colleagues was 100% in both groups after 2 years of functional loading. Conclusions: Results from this study demonstrated that the success rate for immediately loaded mandibular implants is similar to that obtained in cases of delayed loading and that there are no significant differences between results with two‐piece implants and one‐piece transmucosal implants.     

Early functional loading of Brånemark dental implants: 5-year clinical follow-up study

Background: Short‐term clinical studies have indicated the possibility of one‐stage surgery and early loading of machined titanium implants. However, long‐term data comparing the outcome to the conventional two‐stage technique are missing. Purpose: A clinical and radiographic study was performed to compare the outcome of oral rehabilitation of the endentulous mandible by fixed suprastructures connected to implants installed according to either (1) a one‐stage surgical procedure and early loading (experimental group ‐ EG) or (2) the original two‐stage concept (reference group ‐ RG). The EG and RG comprised 16 and 11 subjects, respectively. Materials and Methods: The following specific inclusion criterion were adopted: (1) all patients had to consider themselves to be in good general health, (2) the amount of bone had to enable the installation of five to six, at least 10‐mm long fixtures (Mk II fixtures; Nobel Biocare AB, Göteborg, Sweden) between the mental foramina, and (3) the patients had to be available for the follow‐up and maintenance program. A total of 88 implants were placed in the EG compared to 30 in the RG. In the EG, fixed appliances were connected to the implants within 20 days following implant installation while the fixed appliances in the RG were connected about 4 months following fixture installation. At delivery of the suprastructures, all patients were radiographically examined, an examination that was repeated at the 18‐ and 60‐month follow‐ups. Results: The analysis of the radiographs from the EG disclosed that during the observation period, between 18 and 60 months, the mean loss of bone support amounted to 0.2 mm (SD = 0.4). The corresponding value observed in the RG was 0.0 mm (SD = 0.5). During the 60‐month observation period, no fixture was lost in any of the two groups examined. The implants under study as well as those in the reference material were at all observation intervals found to be clinically stable. Conclusions: This clinical study demonstrated that it is, at least based on a 5‐year observation period, possible to successfully load via a permanent fixed rigid cross‐arch suprastructure titanium dental implants soon after installation. However, such a treatment approach has to be strictly limited to the interforamina area of the endentulous mandible. Furthermore, the bone resorption was found to be within the same range around such implants as around implants installed and loaded according to the original two‐stage protocal.     

Strength and marginal fit of full and partial porcelain crowns on Brånemark implants

The aim of the present study was to evaluate strength and marginal fit of different designed single crowns screwed on titanium implants (Brånemark) without the usage of any abutment. Seven test groups with 10 specimens each (standardized maxillary central incisor crowns) were fabricated of Empress (staining/veneering technique), metal‐based Empress (staining/veneering technique), metal‐based In‐Ceram and metal ceramic (with/without cervical porcelain margin). The marginal fit of 5 specimens of each group was evaluated (SEM‐Analysis) and the crowns were incisally loaded at a 30° angle in a Zwick testing machine until fracture. The 5 remaining specimens underwent a marginal evaluation (SEM‐analyses) before and after thermo‐mechanical stressing (tms) and were loaded in the Zwick testing machine as well. All Empress ceramic crowns without metal reinforcement fractured during fixing procedure on the implant (32 N cm). The gap medians of the fixed crowns ranged from 11 μm (metal ceramic crowns) to 34 μm (metal ceramic crowns with porcelain margin). No significant differences in gap width were observed before and after tms. In the strength analyses screw‐binding forces (SBF) of about 135 N were registered in all test groups. Fracture failure forces (FFF) reached up to 280 N. The indication of the crown designs presented in this study is limited in clinical use because of low stability and esthetics.     

A retrospective evaluation of 259 single-tooth replacements by the use of Brånemark implants

PURPOSE: The main purpose of this retrospective study was to investigate the clinical outcome of the treatment with 259 consecutively placed Br?nemark system implant-supported single crowns. MATERIALS AND METHODS: There were 259 implants placed in 183 patients with a mean age of 29.8 years; 230 (89%) were placed in the maxilla and 29 (11%) were placed in the mandible. Of the prosthetic restorations, 165 were all-ceramic (68%), 79 were metal-ceramic (31%), and 4 were gold-acrylic (1%). The observation period ranged from 1 to 9 years. RESULTS: A total of 9 patients (10 implants) was lost to follow-up. There were 3 implant failures registered, one before loading and one during the first year in function; one implant fractured after 6 years in service, giving a cumulative success rate for implants of 98.3%. A total of 8 crowns was remade following prosthetic complications; otherwise, the frequency of adverse events was low. The bone loss was of the same magnitude as in other studies on Br?nemark implants as support for single crowns. In general, the soft tissue conditions around the restorations were healthy and comparable to those of the patients' natural teeth. CONCLUSION: This study confirms the favorable results presented in other studies on Br?nemark implants to support single-tooth restorations.     

Immediate functional loading of Brånemark dental implants. An 18-month clinical follow-up study

A clinical and radiographical study was performed to compare the out-come of oral rehabilitation in the edentulous mandible by fixed supra-constructions connected to implants installed according to either i) a l-stage surgical procedure and immediate loading (Experimental Group -EG), or ii) the original 2-stage concept (Reference Group - RG). The EG comprised 16 subjects with edentulous mandibles. Beyond the non-smoking criteria the following specific inclusion criteria were adopted: i) all patients had to consider themselves to be in good general health, ii( the amount of bone had to enable the installation of 5-6, at least 10 mm long fixtures to be bicortically anchored (Mk II fixtures; Nobel Biocare AB, Goteborg, Sweden) between the mental foramina, and iii) the patients had to be available for the follow-up and maintenance programme. A total of 88 implants were placed in the EG (16 patients) compared to 30 in the RG (11 patients). In the EG, fixed appliances were connected to the implants within 20 days following implant installation while the fixed appliances in the RG were connected about 4 months following fixture installation. At the time for delivery of the supraconstructions all 27 patients were radiographically examined, an examination that was repeated at the 18-month follow-up. The analysis of the radiographs from the EG disclosed that during the 18-month observation period the mean loss of bone support amounted to 0.4 mm. The corresponding value observed in the RG was 0.8 mm. During the 18-month observation period no fixture was lost in any of the 2 groups examined. The implants under study as well as those in the reference material were at all observation intervals found to be clinically stable. The present clinical study demonstrated that it is, at least based on an 18-month observation period, possible to successfully load titanium dental implants immediately following installation via a permanent fixed rigid cross-arch supraconstruction. However, such a treatment approach has so far to be strictly limited to the interforamina area of the edentulous mandible.     

Brånemark System Wide Platform implants for single molar replacement: clinical evaluation of prospective and retrospective materials

Background: The use of oral implants for single tooth replacement has become a predictable treatment modality. As single tooth loss is most common in posterior areas of the jaws, the use of the protocol is of specific interest in those regions. New implant designs aimed at this purpose have also been introduced. Purpose: The aim of the study was to present the outcomes for wide diameter implant treatment when being used in posterior areas of the jaws. Materials and Methods: This paper presents the 3‐year results of a prospective multicenter study (three clinics; n = 38 implants) and the 1‐year results from a retrospective multicenter study (two clinics; n = 20 implants) on wide diameter implants for single molar replacement. Based on the hypothesis that dense bone in posterior mandibles would benefit from careful surgery and longer remodeling time, the influences of surgical technique and healing time on implant success and bone resorption were particularly addressed. Results: The outcome demonstrated a good predictability for Brånemark System® Wide Platform implants, at least short term, when used as single molar support (prospective group cumulative success rate [CSR] = 92% after 3 years; retrospective group CSR = 95% after 1 year). The increased mechanical strength of the wide platform implant/abutment complex also turned out to be important for mechanical stability. Conclusions: The study indicated that it was important to carefully perform surgery in posterior mandibles in order to preserve and optimally use the existing dense bone. It was suggested that from bone healing and remodeling aspects, posterior mandibles may be more demanding to handle than corresponding areas of maxillae.     

Turned Brånemark System implants in wide and narrow edentulous maxillae: a retrospective clinical study

Background: The available jawbone volume is regarded as one of the most important factors when assessing the prognosis of oral implants in the rehabilitation of the edentulous maxilla. Purpose: The aim of the current investigation was to retrospectively evaluate and compare the outcome of implants placed in edentulous maxillae with either wide or narrow jaw shapes. The marginal bone loss and implant cumulative survival rates (CSRs) were calculated and analyzed with special reference to smoking habits. Materials and Methods: The study included 75 individuals with edentulous maxillae, of which 33 patients exhibited wide (group A) and 42 patients exhibited narrow jaw shapes (group B). A total of 506 turned Brånemark System® (Nobel Biocare AB, Göteborg, Sweden) implants were inserted (226 in group A and 279 in group B) and followed clinically up to 7 years. Smoking habits were recorded. Radiographs were obtained at connection of prostheses, and at the 1‐ and 5‐year follow‐up visit. The marginal bone loss was calculated for the groups and analyzed using t‐test. Results: Twenty‐eight implants were lost during the study period, revealing implant CSRs at 7 years of 94.6% (11/226) and 93.6% (17/279) for wide and narrow crests, respectively. No difference in marginal bone loss was seen between the two groups, although a trend toward more bone loss was recorded for patients with wide crests. Smoking habits were more common in group A (45%) than in group B (31%). During the first year of function, smokers lost significantly more marginal bone than nonsmokers (p = .0447), albeit this difference did not prevail (p > .05) at the end of the study period. Conclusions: The implant CSRs at 7 years were equally good for the two groups of patients with various jaw shapes. Initially, smokers showed significantly more marginal bone loss than nonsmokers.