The aim of this study was to evaluate long-term outcomes in a 10-year follow-up study of patients who previously completed a 3-year multicenter randomized controlled trial of immediate and early loading of dental implants with a hydrophilic and chemically active surface (SLActive) in the posterior maxilla or mandible. The patients received implants to replace at least one missing tooth, with provisional restoration on the day of surgery (immediate loading) or 28 to 34 days later (early loading). Implant survival, change in crestal bone level, and patient satisfaction were evaluated. In total, 56 patients (with 72 implants) were available after 10 years and fulfilled the criteria for the radiographic bone level evaluation. The mean crestal bone level change from implant surgery to 10 years was -2.00 ± 1.19 mm and -1.37 ± 1.06 mm in the immediate and early groups, respectively. The corresponding change between 5 to 6 months' post-surgery (permanent fixed restoration placement) and 10 years was -1.25 ± 0.99 mm and -0.89 ± 1.11 mm in the immediate and early groups. After the initial remodeling phase (5 to 6 months) where the depth of implant placement had an influence on the initial bone remodeling, no significant differences between the two treatment groups were detected. Mean implant survival was 97.6% (98.2% and 97.1% in the immediate and early loading groups, respectively). Implants with the SLActive surface show successful long-term outcomes following immediate or early loading in posterior maxillae and mandibles. Keywords: crestal bone level, dental implant, early loading, immediate loading, SLActive, 10-year follow up