Background: Costs for single-implant treatment are mostly described for the initial treatment. Information on the additional cost related to aftercare is scarce. Objective: To make an estimation of complication costs of single implants in periodontally healthy patients after 16-22years and to compare costs for various prosthetic designs. Materials and methods: Patients with a single implant were recalled for a clinical examination and file investigation. Prosthetic designs included single-tooth (ST) and CeraOne (CO) abutments supporting a porcelain-fused-to-metal (PFM), all-ceramic (CER), or gold-acrylic (ACR) crown. Costs related to failures or technical, biologic, and aesthetic complications were retrieved from patient's records. Total and yearly additional complication costs were calculated as a percentage relative to the initial cost. Chair time needed to solve the complication was recorded and prosthetic designs were compared by Kruskal-Wallis tests. Results: Fifty patients with 59 surviving implants were clinically investigated. Additional complication costs after a mean follow-up of 18.5years amounted to 23% (range 0-110%) of the initial treatment cost. In total, 39% of implants presented with no costs, whereas 22% and 8% encountered additional costs over 50% and 75%, respectively. In 2%, the complication costs exceeded the initial cost. The mean yearly additional cost was 1.2% (range 0-6%) and mean complication time per implant was 67min (range 0-345min). Differences between prosthetic designs (CO, ST-PFM, ST-ACR) were statistically significant for total cost (P=0.011), yearly cost (P=0.023), and time (P=0.023). Pairwise comparison revealed significant lower costs for CO compared with ST-ACR reconstructions. Conclusion: Patients should be informed about additional costs related to complications with single implants. The mean additional cost spent on complications was almost one-quarter of the initial treatment price. A majority of implants presented with lower additional costs, whereas the highest complication costs were related to a smaller group with 22% of the implants needing more than half of the initial cost for complication management. Expenses were significantly different for various prosthetic designs.