Aim: To compare the survival and peri-implant bone loss of implants with a fluoride-modified surface in smokers and nonsmokers. Materials and methods: Patient files of all patients referred for implant treatment from November 2004 to 2007 were scrutinized. All implants were placed by the same experienced surgeon (B. C.). The only inclusion criterion was a follow-up time of at least 2 years. Implant survival and bone loss were assessed by an external calibrated examiner (S. V.) comparing digital peri-apical radiographs taken during recall visits with the post-operative ones. Implant success was determined according to the international success criteria (Albrektsson et al. 1986). Survival of implants installed in smokers and nonsmokers was compared using the log-rank test. Both nonparametric tests and fixed model analysis were adopted to evaluate bone loss in smokers and nonsmokers. Results: One-thousand one-hundred and six implants in 300 patients (186 females; 114 males) with a mean follow-up of 31 months (SD 7.15; range 24–58) were included. Nineteen implants in 17 patients failed, resulting in an overall survival rate of 98.3% at the implant level and 94.6% at the patient level. After a follow-up period of 2 years, the cumulative survival rates was 96.7% and 99.1% with the patient and implant as the statistical unit, respectively. Implant survival was significantly higher for nonsmokers compared with smokers (implant level P=0.025; patient level P=0.017). The overall mean bone loss was 0.34 mm (n=1076; SD 0.65; range 0–7.1). Smokers lost significantly more bone compared with nonsmokers in the maxilla (0.74 mm; SD 1.07 vs. 0.33 mm; SD 0.65; P<0.001), but not in the mandible (0.25 mm; SD 0.65 vs. 0.22 mm; SD 0.5; P=0.298). Conclusion: The present study is the first to compare peri-implant bone loss in smokers and nonsmokers from the time of implant insertion (baseline) to at least 2 years of follow-up. Implants with a fluoride-modified surface demonstrated a high survival rate and limited bone loss. However, smokers are at a higher risk of experiencing implant failure and more prone to show peri-implant bone loss in the maxilla. Whether this bone loss is predicting future biological complications remains to be evaluated.