The aim of this investigation was to clinically evaluate the periimplant tissues of titanium fixtures, placed in regions augmented using deproteinized bone mineral, after initial functional loading. The original material included 18 individuals (mean age 71+/-9 years) treated using a graft material, Bio-Oss (6 Patients), or Bio-Oss+autogenous bone mixture (12 patients) for alveolar ridge augmentation. 6 titanium fixtures were placed at the time of ridge augmentation. 46 fixtures were placed at a second surgical stage, median 9.5 months after augmentation. Augmentation included crest width (26 fixtures), crest height and width (12 fixtures) and sinus floor lift (14 fixtures) procedures. In addition, 16 fixtures were placed in regions of adequate bone volume. Reconstructions were placed and patients were recalled on a yearly basis. After 4-6.5 years of functional loading, the reconstructions were removed and assessments of fixture stability and periimplant mucosal conditions were made. At this time, 3 patients (13 fixtures) were lost to follow-up (1 deceased, 1 declined to participate, and 1 too ill to attend). In the remaining 15 patients, 7 fixtures were lost due to osseo-disintegration, 2 in one patient in the mandible, and 5 in a second patient in the maxilla. Both individuals were smokers. The remaining 32 fixtures were clinically stable. Periimplant mucosa was healthy with a mean modified sulcular bleeding index of 0.1+/-0.2 and a mean probing depth of 1.5+/-1.1 mm. Radiographic evaluation showed alveolar bone levels at or above the level of the first fixture thread. There were no perifixtural radiolucencies. The survival rate, which coincided with success rate, for fixtures placed in conjunction with ridge augmentation using deproteinized bone mineral was 100% for non-smokers and 43% for smokers after 4-6.5 years of functional loading. No fixture loss occurred in non-augmented areas.