OBJECTIVE The purpose of this study was to report the 5-year clinical performance of implant-supported prostheses with laser-welded titanium frameworks and to compare their performance with that of prostheses provided with conventional cast frameworks. METHODS On a routine basis, a consecutive group of 824 edentulous patients were provided with fixed prostheses supported by implants in the edentulous mandible. In addition to conventional gold-alloy castings, patients were at random provided with 2 kinds of laser-welded titanium frameworks. In all, 155 patients were included in the 2 titanium framework groups. A control group of 53 randomly selected patients with conventional gold-alloy castings was used for comparison. Clinical and radiographic 5-year data was collected for the 3 groups. RESULTS All followed patients still had fixed prostheses in the mandible after 5 years. The overall cumulative success rates were 95.9% and 99.7% for titanium-framework prostheses and implants, respectively. The corresponding success rates for the control group were 100% and 99.6%, respectively. Bone loss was 0.5 mm on average during the 5-year follow-up period. The most common complications for titanium frameworks were resin or tooth fractures, gingival inflammation, and fractures of the metal frames (10%). One of the cast frameworks fractured and was resoldered. Loose and fractured implant screw components were few (< 1%). CONCLUSIONS Even though the cast frameworks had a higher success rate, the overall titanium framework treatment result was well in accordance with the result of the control group. The test groups performed better after clinicians had gained some experience with the technique, and laser-welded titanium frameworks seem to be a viable alternative to conventional castings in the edentulous mandible.