A clinical and radiographical study was performed to evaluate whether initial submergence of titanium fixtures is an obligate treatment measure for the establishment of proper bone anchorage when implants a.m. Brånemark are used. The sample was comprised of 11 subjects with edentulous mandibles. A split-mouth design was employed; in the right mandibular quadrant a traditional 2-step procedure for fixture installation and abutment connection was utilized, while in the left quadrant a 1-step procedure was carried out, i.e., fixtures were placed and abutments were connected in one and the same session. Three to 4 months after fixture installation, fixed bridgeworks were fabricated and rigidly connected to the implants. Clinical examinations (including probing pocket depth, bleeding on probing and implant stability test) were performed after 12 and 18 months. Radiographs were taken following insertion of the bridges and at the 12- and 18-month re-examinations. The probing pocket depth, the bleeding on probing, the implant stability and the radiographic determinations were similar for the 2 groups of treatment alternatives. This indicates that titanium fixtures a.m. Brånemark can be properly anchored (osseointegrated) in mandibular bone and successfully used for bridge retention also when a 1-step procedure is used for implant installation.