The bone anchorage of an implant is a complex problem, not only dependent on the material used, but also on other variables like macro- and microstructure of the implant, surgical technique, time and mode of implant loading, and status of the host bone. Brånemark et al. have shown excellent clinical results in the rehabilitation of completely edentulous patients with prostheses on osseointegrated implants. The 15 year success rate of 90% or more is associated with an essential fact: the direct bone-titanium connection, without the intervention of any fibrous tissue. Contrary to the fibrous tissue interface, the osseointegrated interface establishes a stronger bone-implant bond with increasing time. Although these results do not preclude the possibility that other materials or systems could lead to similar results, only osseointegrated implants have shown at present a long term success.