OBJECTIVE Is bone loss associated with implants placed in vascularized iliac crest bone grafts for mandibular reconstruction dependent on the prosthetic restoration modalities used? METHODS Eleven vascularized iliac crest bone grafts for mandibular reconstruction were examined after ablative tumor surgery. Forty implants loaded for at least 1 year were observed for up to 6 years. Horizontal and peri-implant bone loss was assessed for 2 groups: 6 patients with implant-supported bridges and 5 patients with implant-retained overdentures. RESULTS Horizontal bone loss reached a steady state around 2 mm after an observation time of 2 years. Bony pockets had a depth of less than 1 mm. The described pattern was nearly independent of the prosthetic restoration modality used. The implant survival rate was 97.6%. CONCLUSIONS Vascularized iliac crest bone grafts are safe implant-bearing areas. Implant-retained overdentures can be used with as good a longterm efficacy as the more complicated implant-supported bridges.